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THE
COMMONHEALTH
SPECIAL
NUMBER
1942
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DEPARTMENT ACTIVITIES
1941
MASSACHUSETTS
DEPARTMENT OF PUBLIC HEALTH
Publication of this Document Approved by the Commission on Administration and Finance
2,500-3-43-11492
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH
Commissioner of Public Health, Paul J. Jakmauh, M.D.
Public Health Council
Paul J. Jakmauh, M.D., Chairman
R. Nelson Hatt, M.D.
Gordon Hutchins
Francis H. Lally, M.D.
Richard M. Smith, M.D.
Richard P. Strong, M.D.
James L. Tighe, B.A.Sc, C.E.
Florence L. Wall, Secretary
Division of Administration
Division of Tuberculosis .
Division of Adult Hygiene .
Division of Biologic Laboratories .
Division of Child Hygiene .
Division of Communicable Diseases
Division of Food and Drugs
Division of Genitoinfectious Diseases
Division of Sanitary Engineering .
Under direction of Commissioner
Director and Deputy Commissioner,
Alton S. Pope, M.D.
Director, Herbert L. Lombard, M.D.
Director, Elliott S. Robinson, M.D.
Director, M. Luise Diez, M.D.
Director, Roy F. Feemster, M.D.
Director, Hermann C. Lythgoe, S.B.
Director, Ernest B. Howard, M.D.
Director, Arthur D. Weston, C.E.
Assistant to the Commissioner, John J. Poutas, M.D.
State District
Northeastern District
North Metropolitan District .
South Metropolitan District .
Southeastern District
Worcester District
North Connecticut Valley District
South Connecticut Valley District
Berkshire District ....
Health Officers
Robert E. Archibald, M.D.
Vlado A. Getting, M.D.
Henry M. DeWolfe, M.D.
Harold W. Stevens, M.D.
Oscar A. Dudley, M.D.
Walter W. Lee, M.D.
Charles E. Gill, M.D.
Morris Taylor, M.D.
Institutions and Superintendents
Lakeville State Sanatorium
North Reading State Sanatorium
Rutland State Sanatorium
Westfield State Sanatorium
Pondville Hospital
Leon A. Alley, M.D.
Carl C. MacCorison, M.D.
Ernest B. Emerson, M.D.
Roy Morgan, M.D.
George L. Parker, M.D.
ACTIVITIES
OF THE
DEPARTMENT OF PUBLIC HEALTH OF MASSACHUSETTS DURING 1941
THE PUBLIC HEALTH COUNCIL
At the end of the fiscal year closing November 30, 1941, the Department of
Public Health was constituted as follows:
Commissioner of Public Health, Paul J. Jakmauh, M.D.
Public Health Council
R. Nelson Hatt, M.D., 1945 Richard M. Smith, M.D., 1943
Gobdon Hutchins, 1944 Richard P. Strong, M.D., 1946
Francis H. Lally, M.D., 1942 James L. Tighe, B.A.Sc, C.E., 1947
Thirteen meetings of the Department were held during the year. Twelve public
hearings were held as provided by statute relative to approval of the taking of
certain lands for the protection of water supplies, approval of plans for sanitary
sewers and sewage treatment works, the proposed use of land for cemetery purposes,
an alleged nuisance caused by the keeping of swine, and appeals from actions of
local milk inspectors in refusing to grant licenses to sell milk.
The Committee on Sanitary Engineering, composed of Mr. Tighe, Chairman,
Mr. Hutchins, and the Commissioner, has met whenever necessary prior to the
regular meetings of the Department and submitted recommendations on matters
of sanitary significance.
In October, in order to re-establish the reputation for research work which the
Lawrence Experiment Station held for many years, a cooperative arrangement
between the Department and Harvard University for the employment of a Consult-
ant for Research Work was approved.
The Council has performed its regular duties as imposed by law, including the
promulgation of regulations allowing short-time, high-temperature pasteurization
of milk and the revision of rules and regulations relative to diseases dangerous to
the public health, the operation of plants for the purification of shellfish, the business
of slaughtering, the treatment of persons exposed to rabies, and the use of blood
or other tissues for purposes of transfusion. A renewal contract for the care of
tuberculous patients from Hampden County at the Westfield or Rutland State
Sanatorium was approved for a period of three years, and the contract with the
Massachusetts General Hospital for the care of persons suffering from arthritis
was renewed for one year. The approval of appointments of medical personnel
in the Department and at State and county sanatoria, of subsidies to various
cancer clinics, of dispensaries and laboratories before licensing, of out-of-State
shellfish dealers who have been approved by their respective state shellfish authori-
ties and the United States Public Health Service, and of contracts for the production
of certified milk, constitutes other matters upon which the Council has acted.
At a meeting of the Department on January 13, 1942, the Commissioner of
Public Health presented to the Council a summary of the activities of the Depart-
ment for the year 1941, and after consideration it was voted that the outline,
together with the foregoing brief summary of the activities of the Public Health
Council, be approved and adopted.
THE COMMISSIONER OF PUBLIC HEALTH
To the Public Health Council:
Gentlemen: This summary shows briefly the public health activities of the Com-
monwealth as carried on under near-normal conditions of peace time. As at the end
of the year it seems certain that we are entering upon a new era, the expansion of
our activities as planned for the ensuing year must be subject to changes which
will adapt them to the circumstances of a more militaristic period, and curtailment
or deferment of certain of them will no doubt be necessary.
I. Administration
During the year I personally attended or was represented at regular meetings
of the following boards :
Approving Authority, consisting of the Secretary of the Board of Registration
in Medicine, the Commissioner of Education, and the Commissioner of Public
Health, to consider standards for medical schools and graduates thereof, some
of the meetings including inspection of the various medical schools in the Common-
wealth; Rating Board, consisting of the Surgeon General of the Commonwealth,
the Commissioner of Public Health, and the Commissioner of Public Safety, to
consider the retirement of members of the State Police; State Planning Board,
consisting of the Commissioners of Conservation, Public Health, and Public Works,
and six appointive members; Reclamation Board, consisting of representatives
of the State Departments of Public Health and Agriculture; Massachusetts School
Lunch Advisory Committee; the Massachusetts Child Council, and similar groups.
In April I attended the Annual Conference of State and Provincial Health
Authorities and the State and Territorial Health Authorities held in Washington,
at which time I was appointed to the following committees of the State and Pro-
vincial Health Authorities of North America for 1942: Committee on Child Hygiene;
Subcommittee on Mental Hygiene; Committee on Environmental Sanitation;
Subcommittee on Records and Subcommittee on Uniform Railway Code; and
Committee on Records and Reports. I also attended the Annual Meeting of the
American Public Health Association, the Annual Meeting of the American Medical
Association, a meeting of the Society for Public Health Administration, and a
meeting called by the Surgeon General of the United States Public Health Service
to consider the hazards of mercmy poisoning in the fur industry.
National Defense. The United States Public Health Service has assigned a
representative to the First Corps Area to act as liaison officer between the health
departments and the armed forces in the correlation of health and defense activities.
We have cooperated with this liaison officer to the fullest extent in the control of
certain communicable diseases, examinations for tuberculosis and genitoinfectious
diseases, food inspection, sanitation and other conditions relative to health which
present new problems with sudden overcrowding of living conditions in industrial
and defense areas. He has cooperated with the Department by visiting communities
adjacent to cantonment areas and under the Facilities Act has made surveys with
a view to determining local needs and rendering assistance in order to continue a
high standard of health. He has worked closely with the Department and has
submitted for our advice applications for additional hospital and nursing facilities
throughout the State.
Sanitary surveys have been made by the Department in the vicinity of Camp
Edwards, Fort Devens and Westover Field.
The Department has been active in the defense program, and the organization
formerly designated for disaster relief has been revised so that in the event of any
emergency, coordination of personnel, service and facilities is immediately available.
In this regard we have been in frequent consultation with the State Public Safety
Committee as well as representatives of the Civilian Defense Program. Chapter
719, signed by the Governor on October 30, 1941, creates a State Emergency Com-
mission to provide for the safety of the Commonwealth in time of military emer-
gency. His Excellency has appointed me as a member of this Commission. The
Department is represented on the staff of the Adjutant General by the Director of
the Division of Sanitary Engineering.
A great number of the major defense problems relate to public health, and the
responsibility for the solution of these problems and the direction of normal activi-
ties to meet emergency situations naturally becomes the duty of the Department
of Public Health. The Department is endeavoring to cooperate with all defense
agencies including the Massachusetts Committee on Public Safety, the Committee
on Civilian Defense, and more than 300 local community organizations. In view
of a possible emergency in the State House or immediately adjacent thereto, when
first aid would be promptly needed, I have arranged for sufficient space and facilities
to be made available as first aid quarters, with sufficient professional personnel and
material facilities of the Department available as need requires.
New Legislation — -New Activities. The 1941 session of the General Court enacted
legislation affecting the work of the Department of Public Health in several in-
stances.
Under Chapter 601, amended by Chapter 697, a clerk or registrar cannot accept
notice of intention of marriage until he has received from both parties to the intended
marriage a certificate signed by a physician practicing in Massachusetts or by a
physician on active service in the armed forces of the United States. If a physician
making an examination under this law discovers evidence of an infectious disease
he must inform both parties of the nature of the disease and of the possibilities of
transmitting it in marriage or pregnancy. Such examination must include a blood
test for syphilis performed by the Department laboratory or a laboratory approved
by the Department. With but one month's experience upon which to base an
opinion, from the great number of inquiries which have arisen there would appear
to be some uncertainty in regard to the practicability of enforcing this law as
written.
Chapter 661 of the Acts of 1941 authorizes the Department to license hospitals
and sanatoria. An advisory committee will be appointed to aid the Department
in formulating rules and regulations relative to this new activity.
Under authority of Chapter 506, the Department may admit to the Lakeville
State Sanatorium, for physiotherapy and muscle training, a limited number of
persons with spastic paralysis. Studies under this legislation will be conducted in
connection with the crippled children's program.
Chapter 612 authorizes the Department, with the approval of the Commission
on Administration and Finance, to prepare and distribute without and within the
Commonwealth, antitoxins, serums, vaccines, etc., applicable to the prevention or
cure of disease, for the use of the armed forces of the United States or in civilian
defense work.
Chapters 306 and 334 provide for the furnishing of medical service at low cost
to subscribers to charitable corporations formed under these acts. Under Chapter
334 certain agreements made by medical service corporations with medical organ-
izations and physicians are subject to the approval of the Department of Public
Health, but to date no applications relative to such approval have ccme to our
attention.
Chapter 37 of the Resolves of 1941 directs the Department to make a study
relative to the eradication and control of ragweed.
Chapter 388 gives the Department further authority to prevent the pollution
and contamination of inland and tidal waters. Chapter 353 increases the manda-
tory powers of the Department relative to preventing pollution of the Charles
River.
Certain legislation was passed relative to investigation and improvement of
the Metropolitan water supply and sewerage needs. I have agreed to serve as the
representative of this Department on the special commission authorized by Chapter
91 to investigate the use of the Quabbin Reservoir by additional municipalities
and the financing of the furnishing of water to communities within and adjacent
to the Metropolitan Water District. The Department is represented by the Director
of the Division of Sanitary Engineering on the special commission to consider
sewage disposal needs of the North and South Metropolitan Sewerage Districts,
under Chapter 720 of the Acts of 1941, and on a special commission to investigate
housing, under Chapter 71 of the Resolves of 1941. Another resolve, Chapter 93,
provides for a special investigation relative to additional sewerage works for the
South Metropolitan Sewerage System in Dorchester and Milton.
Approval of Laboratories. The work of evaluating the performance of laboratories
with a view to approval, begun two years ago under authority of Chapter 344 of
the Acts of 1939, has been continued. Thirty-four laboratories have received ap-
proval and over 60 other laboratories have been approved for certain tests, especially
for testing blood from prospective blood donors and performing routine serologic
tests for syphilis, and will receive certificates of approval after further evaluation
of other tests. The Wassermann Laboratory continues to send specimens to labora-
tories already approved in order to insure the continuance of a satisfactory rating.
Milk. 1941 has shown a record increase in the number of communities which
have passed regulations requiring the pasteurization or certification of milk.
Eighteen communities were added, bringing the total to 80, which represents about
78 per cent of the population of the State. It is estimated that over 90 per cent
of the milk sold in the Commonwealth is pasteurized or certified.
Camps. The Department continues to have jurisdiction over the sources of
water supply and sewage disposal works at all recreational, overnight and trailer
camps licensed by local boards of health. In 1941 the original act relative to this
matter was amended, making it compulsory for this Department to notify the
owner of the camp by registered mail, in addition to the local board of health,
relative to its findings in matters of water supply and sewage disposal. During the
past year over 600 overnight and recreational camps were examined by the Depart-
ment staff.
Arthritis. There is an increasing demand on the part of the public for hospitaliza-
tion and treatment facilities for the alleviation of suffering from this disease, and
the inauguration of a general arthritis program similar to programs carried on for
other chronic diseases seems desirable. Consideration has been given to the estab-
lishment of a central research bureau adjacent to or in connection with an outstand-
ing hospital. With existing institutions transforming their available facilities with
a view to the needs of industry and national defense, the question of a special
hospital for cases of arthritis and other chronic diseases should be given further
consideration for the twofold purpose of immediate alleviation of suffering based
on present knowledge, and further research in order to ascertain the most satis-
factory treatment.
The results of the study at the Massachusetts General Hospital to date indicate
that cases of arthritis should be treated as are tuberculosis cases, that pain should
be treated immediately in order to prevent loss of normal joint function, and that
it is desirable to have a small unit in connection with a general hospital or a teaching
hospital for the careful study and intensive treatment of arthritic patients in order
to ascertain a more satisfactory treatment than present limited knowledge of the
disease permits.
New England Health Institute. On April 2, 3 and 4 the Eleventh New England
Health Institute was held in Boston. This Institute was planned and conducted by
the Massachusetts Department of Public Health with the aid of the following
collaborating agencies: the health departments of the other New England States,
the United States Public Health Service, the Children's Bureau of the United States
Department of Labor, the Massachusetts Central Health Council, the Massachu-
setts Public Health Association, and the New England Sewage Works, Water Works,
and Tuberculosis associations. The Institute was a marked success, with 1865
registrants representing twenty-seven of the forty-eight states, Canada, the Philip-
pines and China; 121 individuals of prominence in national, state and local health
organizations contributed their time as speakers or chairmen of various sections.
Local Health Administration. The coordination and extension of state public
health activities into a more unified district organization, based on experience in
the Worcester District, was expanded to the North Connecticut Valley District
early in 1941. The functions and activities of these two areas appear to be accept-
able to the local boards of health and it is anticipated that early in 1942 the Westfield
District may be so organized since in its physical set-up it already contains in a
large measure sufficient facilities to make possible expansion with minimal expense.
It is also proposed that early in 1942 the Pittsfield area be organized, with minor
changes and additions to existing facilities to meet the needs of the district. The
third contemplated district is that of southeastern Massachusetts. Here there is
great need for additional office space and equipment in order to conform to the
service given in the Worcester and North Connecticut Valley areas and meet the
demands of the southeastern section of the State.
Public Health Nursing. The position of Chief Supervisor of Public Health Nursing
6
was filled on September 15, 1941. As the year closes we are planning more effective
coordination of the nursing activities of all Divisions by placing the nursing person-
nel administratively in the Division of Administration under the Chief Supervisor
of Public Health Nursing as soon as suitable office space is prepared.
Social Service. The establishment in the Division of Administration of the
position of Supervisor of Social Service is in keeping with the present day trend in
public health administration. With the development of district health offices, a
more generalized program in medical social service seems possible which would
tend to more efficient service. The Supervisor of Social Service would be responsible
to the directors of the various divisions of the Department in the formation and
extension of their programs in the various districts. This change, however, must
be accomplished gradually because of the long established routine of the social
workers in the various Divisions.
Services for Crippled Children. On September 1, 1941 the Department completed
five years of service to crippled children. During the five-year period 2,089 crippled
children were admitted to service, of whom approximately 900 are still under
active care, indicating the need of long-continued orthopedic treatment in a large
proportion of cases. Regular monthly clinics are held at the ten clinics located in
the following communities: Brockton, Fall River, Gardner, Haverhill, Hyannis,
Lowell, Northampton, Pittsfield, Salem and Worcester. During the five-year
period the average attendance was 16 children at each clinic session. In the past
year the total clinic attendance has exceeded 2,000, including new patients sent
by their physicians, and patients returning for further observation, adjustment of
apparatus, and similar reasons. During 1941 approximately 230 children were
admitted to hospitals for surgical treatment. Almost 4,000 physical therapy treat-
ments were given and approximately 5,700 home visits were made to patients
during the year.
The reporting of congenital deformities and other crippling conditions in infants
resulted in 188 such reports, which is approximately the same as 1940, the first
year in which reporting was required by law.
It is hoped that programs for the care of children suffering from acute rheumatic
fever and from cerebral palsy can be inaugurated early next year.
II. Communicable Disease
There has been an increase in German measles and mumps, with a slight increase
in the incidence of measles, scarlet fever, and whooping cough. Although our 1941
total reported cases of communicable disease may be the highest since 1936, diph-
theria, typhoid fever and paratyphoid fever reached new low levels. The following
data are submitted in reference to the principal communicable diseases :
Anterior Poliomyelitis. For three years we have enjoyed a very low incidence of
this disease. This year there has been a slight increase which did not reach epidemic
proportions.
Diphtheria. I can report a record low for this disease and were it not for an
increase in one city which had an unusually large number of cases, the incidence
in the State would have been under 100. Diphtheria immunization in its newer
aspects has created considerable interest, particularly in relation to national defense.
Encephalitis, Infectious. No new cases or new types have been reported.
Meningitis, All Forms. There has been a decided increase in meningococcic
meningitis. From the locations of the reports it would appear that the increase
occurred in certain areas affected by concentration of the population. Previous to
May 15, 1941, only meningococcic meningitis and Pfeiffer's bacillus meningitis
were reportable, but on that date all forms were made reportable. Reports have
been received of a number of cases of pneumococcal meningitis and a small number
of cases due to staphylococcus, streptococcus, and Salmonella organisms.
Pneumonia. The incidence this year represents the lowest number of cases ever
recorded in the State. Even with the usual expected increase because of the seasonal
nature of the disease, a record low was reached in the State. The use of serum is
apparently decreasing due to the introduction of chemotherapy. The apparent
change in the clinical behavior and the appearance of pneumonia cases indicates
that we must continue our studies on the use of therapeutic serum to guide us in
the future development of our pneumonia program. With serum available for nine
types of pneumonia the distribution and use of the material must be encouraged.
Scarlet Fever. The increase noted during the year marks a continuation of the
gradual increase in this disease which, however, has not reached epidemic propor-
tions in any area since 1932. Although the control program carried on in the State
at present is limited, this increase is evidence that we must enlarge upon a prophy-
lactic preventive program.
Smallpox. We are approaching the close a of ten year period in which no cases
of this disease have occurred in Massachusetts.
Typhoid and Paratyphoid Fever. The number of sporadic cases of these two
diseases has continued to decline. Twenty-one typhoid carriers were added to the
typhoid carrier list; at the present time this list numbers 164, as compared to 159
last year.
Undulant Fever. Although this disease reached an unusually high level, indicating
the need of complete pasteurization of milk and closer inspection of the process
of pasteurization, intensified case-finding efforts, particularly in the central and
western parts of the State, may account for a part of the high incidence.
Whooping Cough. Although this disease showed an increased incidence for the
year as a whole, the increase occurred during the early part of the year, and the
end of the year showed a tendency toward a lower level.
Other Diseases. No cases of psittacosis, Rocky Mountain spotted fever, or
tularemia were reported during the year.
Division of Tuberculosis
The year 1941 showed an upward trend in tuberculosis morbidity and mortality.
There were nearly 300 more cases reported than in the previous year. Since the
ratio of adult male to female deaths from tuberculosis has been rising steadily,
the question of whether this increase may not be due, in part at least, to increased
employment and overtime by industrial workers should be given consideration.
During the school year 1940-41 new school tuberculosis clinics were held in 31
communities, in which 14,487 children were given the tuberculin test, 5,237 of
whom were X-rayed. The incidence of tuberculosis found in this group was 3.2 per
1,000 X-rayed. Re-examination clinics were held in 31 communities, in which 1,252
children were X-rayed. The incidence of tuberculosis found in this group was 1.0
per 1,000 X-rayed.
In addition to the school clinics, our clinic staff X-rayed approximately 34,000
National Guardsmen and soldiers inducted into the Army during the year. With
the exception of the purchase of the films, the entire work of X-raying, processing
and interpreting was done by our clinic personnel, using regular portable X-ray
machines.
Division of Genitoinfectious Diseases
The Department's program in regard to the control of gonorrhea and syphilis
has indicated the lowest reported incidence of these two diseases. Toward the end
of the year this program was largely directed toward the relation of syphilis and
gonorrhea to national defense. While there was a decrease in the amount of arseni-
cals distributed during the year, the increased interest in the use of mapharsen
indicates that this product will eventually displace the other arsenical drugs.
Part of the decrease in the distribution of bismuth subsalicylate is also probably
due to the increased use of mapharsen. During the past year the Department began
the distribution of sulfathiazole to clinics for the treatment of gonorrhea.
The follow-up of 123 pregnant women reported to have syphilis, approximately
half of whom have been delivered, indicates no congenital syphilis among their
infants.
In a program for the control of prostitution and allied problems, the Department
has cooperated with the Social Protection Division of the Massachusetts Committee
on Public Safety, the United States Public Health Service, the Division of Social
8
Protection of the Federal Security Agency, the Boston Licensing Board, the Massa-
chusetts Society for Social Hygiene, various police chiefs, and the Army and Navy.
We have found no indication of the need of drastic measures to control prostitution
nor to date has it been considered necessary to invoke the authority granted under
Federal legislation on this matter.
All selectees have been examined for syphilis serologically by draft board physi-
cians and the results of the analyses of these tests over the country indicate that
Massachusetts had the second lowest positive syphilis rate in the country. All
selectees, soldiers and sailors reported in Massachusetts with positive syphilis have
been interviewed by the Department or clinic nurses.
Laboratories
Antitoxin and Vaccine Laboratory. The routine production and distribution of
biologic products has been maintained at the usual rate although in the later months
of the year special attention was directed toward products needed for national
defense. The preparation of serum albumin for use as a substitute for blood in
transfusion is being studied.
Wassermanw Laboratory. The total number of all tests performed has showed
an increase of 20 per cent, and of tests for syphilis of over 25 per cent, such increases
being largely attributable to the serologic tests for syphilis done for the National
Guard and the selective service boards. The duties imposed on the Department
by Chapter 601 of the Acts of 1941, which requires a blood test on all persons apply-
ing for marriage licenses in Massachusetts, will result in the submission of a great
many more specimens to this laboratory by physicians and institutions.
Bacteriological Laboratory. During the year this laboratory made over 75,000
examinations on specimens submitted, principally for diphtheria, gonorrhea,
malaria, pneumonia, tuberculosis, typhoid fever and undulant fever. While this
was less than the number examined in 1940, the decrease is probably due to the
smaller number of specimens submitted for examination for diphtheria and for the
enteric diseases.
III. Hygiene
Division of Child Hygiene
Upon request, prenatal clinics were visited and assisted by the child welfare physi-
cians, dentists, nursing supervisors and nutritionists of this Division; obstetrical
packages for use in home deliveries were demonstrated by the nursing supervisors;
instruction in maternal and child care was given at mothers, classes; the study of
the deaths of premature infants was continued and plans made for expanding the
study; 23 nursery supervisors took the refresher course offered for the care of pre-
mature infants; well child conferences were held at which over 3,000 children
were examined. A school hygiene survey was made and recommendations based
on the findings sent to the local school authorities.-
In cooperation with the State Department of Public Welfare an institute for
public health nurses was held, assistance was given to local communities, and new
local nursing services and public health activities were stimulated.
Many requests have been received for our nutritionists to serve on various com-
mittees and participate in educational nutritional programs. Lectures on dental
health were given to teachers and school officials, and students at medical, dental
and nursing schools. Much interest has been shown in the Department's work along
the lines of parent education.
"The Massachusetts Vision Test" as approved by members of the State Depart-
ments of Education and Public Health is available to schools upon request. The
Department has cooperated with school superintendents in regard to the develop-
ment of methods and techniques for testing hearing.
The special project planned last year involving a study of pregnant diabetic
women is being continued.
The health education activities of the Department were expanded by exhibits
and lectures to health councils and community health organizations. Under the
sponsorship of the State Departments of Education and Public Health, the Massa-
9
chusetts School Superintendents' Association and the Massachusetts School Princi-
pals' Association, the Joint Committee on Health Education is engaged in a special
study of the health needs of high school pupils.
Division of Adult Hygiene
The year 1941 marked the completion of the fifteenth year of the cancer program
of the Department. During this period the average delay between first recognized
symptom of the disease and the first "visit to a physician has decreased from 6.5
months to 4.6 months. In the early years of the program it was found that only
15 per cent of the cancel patients visited their physician within a month after noting
their symptoms, whereas now we find that this number has risen to 21 per cent.
Another result of our program has been the increased interest and change in atti-
tude toward cancer on the part of both the laity and the medical profession, as
evidenced by increased attendance at cancer clinics, the extension of educational
programs, and the organization oi cancer control committees in additional com-
munities. The Division has carried on extensive research activities and epidemio-
logical surveys. The number of specimens submitted for pathological examination
reached over 4,000, which is a record high. Much interest has been shown in our
program by representatives of other states and countries, indicating that Massa-
chusetts is acting as a leader in constructive procedures in the control of cancer.
IV. Environmental Control
Division of Sanitary Engineering
The number of applications received by the Department for advice on sanitation
and related matters was slightly higher than in 1940. The compliance with many
of these requests necessitated field examinations by representatives of the Water
and Sewage Laboratories and the Lawrence Experiment Station as well as the
engineering staff of this Division.
Rainfall. The rainfall recorded over the State for the year was about 18 per cent
less than normal, with a deficiency in every month except June and July. This rain-
fall deficiency has resulted in serious shortages in drinking water supplies, water
supplies for industrial purposes, and extremely low stages of streams. At the same
time the records of water consumption in the Metropolitan Water District have
showed a progressive increase, particularly in the communities where important
defense industries are located. Because of the drought the following streams have
shown the effect of the pollutional load discharged into them and the Department
has advised communities and industries concerning the matter: the Aberjona,
Assabet, Blackstone, Charles, Hoosick, Housatonic, Merrimack, Millers, Quinebaug,
Seven Mile, Squannacock, and Ten Mile rivers.
Sewage Disposal. New sewage treatment works were put into operation during
the year in East Longmeadow, Ludlow, Chicopee (Westover Field), Fort Devens
and Camp Edwards. The Department has recommended particularly changes in
the Nut Island sewage treatment plant as a part of the program for improving
Boston Harbor, the construction of works at Hull for the removal of present objec-
tionable conditions, the installation of suitable devices for improving sewerage
conditions at Gloucester, and additional sewage treatment works to serve the
town of Ayer, particularly a new United States Defense Housing Project in connec-
tion with Fort Devens. In addition, the Works Projects Administration has been
advised relative to 145 sewerage projects. The following communities have been
advised relative to certain sewerage needs: Danvers, Hingham, Swampscott,
Quincy, Holden, Fitchburg, North Brookfield, Gloucester, Warren, Northbridge
and Natick.
Shellfish. During the year the areas from which the taking of shellfish for food is
prohibited in Barnstable Harbor, Boston Harbor and Gloucester Harbor were
redefined, Scituate Harbor was closed, Manchester and Oak Bluffs harbors were
closed temporarily during the summer season, and an additional area at Coles
River, Swansea, was opened. Certain areas in Boston and Gloucester harbors
and the Ispwich River were approved for the taking of shellfish for purification
purposes.
10
Cross Connections. The inspection of cross connections between public water
supplies and industrial or other secondary water supplies has been continued.
During the past year 852 plants were inspected, at which 637 cross connections were
found. However, at 484 of these plants the public water supply was found to be
adequately protected by approved double check valves, and at 38 the water supply
was partially protected. The owners of the other 115 plants were given instructions
as to adequate protection of the water supply.
Water and Sewage Laboratories
kin addition to the routine chemical, microscopical and mineral examinations
made in these laboratories in connection with the oversight of water supplies,
sewage disposal works and the pollution of streams, the following studies were
conducted : Experiments to determine the saturation index and the required dosage
of chemicals for corrosive correction treatment of certain municipal water supplies ;
experiments on the lime treatment of a scum found floating on the surface of the
Imhoff tank at the Natick sewage disposal plant ; analyses of samples of scum dis-
charged from industrial plants at Woburn and of similar material found floating
on the Aberjona River, Winchester ; experiments on the possible effects of the use
of chlorinated settled sewage at Weston College for irrigation on grasses and plants ;
examination of two samples of industrial wastes, one of which was suspected of
containing benzene and the other of containing gelatin ; testing of a gas-mask canister
for its chlorine absorption capacity; testing of a vacuum breaker device sold for
installation on flush closets to determine its corrosiveness both in fresh and salt
waters; investigation of so-called "black water" appearing in the public water
supply of Groton; the use of various solvents and techniques for the determination
of fats in sewage ; a comparison between the colorimetric and electrcmetric methods
for hardness determination in water; and examinations on samples of water from
Boston Harbor to determine the presence of organisms that might be used as an
index of pollution.
Lawrence Experiment Station
The regular bacterial examinations of water and shellfish, chemical analyses of
industrial wastes, and sand analyses were continued at this laboratory. Differentia-
tion studies on coliform bacteria from Merrimack River water stored for thirty
days and subsequently filtered through sand were continued ; four high rate trickling
filters have been operated- three identical septic tanks with varying detention
periods have been operated in order to study over a period of time the destruction
of sludge and the clarification of sewage ; in connection with the shortage of alum,
successful studies were made both in the laboratory and in the field in regard to the
substitution of iron salts for alum in the treatment of trade wastes ; further study
was made of starch wastes which were found responsible for the high bacterial
content of the Charles River ; the examination of samples of grease balls from the
North Shore indicated that mineral oil discharged into sewers was at least partially
responsible for such formations.
Division of Food and Drugs
The year has shown an increase in the number of pasteurization plants
throughout the State, particularly in the smaller communities. The inspectors of
this Division have checked constantly on the methods and results of the pasteuriza-
tion and have attained a great improvement in many of the plants. High tempera-
ture,short time pasteurization of milk is again allowed in]Massachusetts,this action
of the Department being taken under authority of Section 48A of Chapter 94 of
the General Laws after consideration of studies conducted in IS ew York and Connec-
ticut. To date only three pieces of apparatus for pasteurization by this method have
been installed in Massachusetts and frequent investigations will be made in order
to improve the somewhat unsatisfactory conditions found on first inspection.
The members of the Food and Drug Division have worked closely with the Fed-
eral inspectors in allied lines. It is regretted that the changes which the Department
suggested in the Massachusetts food and drug law in order to conform more closely
with the Federal law were not passed by this year's Legislature. Massachusetts
manufacturers doing interstate business must comply with the Federal law. Because
11
of this they meet unfair competition from other Massachusetts manufacturers
who are not engaged in interstate business and who can therefore operate under a
less strict and rigid law.
In addition to the routine inspectional and investigational work regarding
bakeries, soft drink and ice cream plants, cold storage warehouses, slaughtering,
etc., the production and sale of sausages and olive oil have required constant
supervision by our inspectors and chemists. In the case of sausages, decomposed
meat and an illegal amount of soy bean meal have been detected in many instances,
in most of which convictions were obtained in court and penalties imposed. Due to
the difficulty of obtaining pure olive oil from Europe, the adulteration and mis-
branding of this product are increasing.
V. Regulations
Rules and regulations have been promulgated by the Department of Public
Health relative to :
Diseases dangerous to the public health
Approved Aug. 9, 1938
Revised Oct. 11, 1938
Revised Feb. 14, 1939
Revised May 13, 1941
Conveyance of bodies dead of any disease dangerous to the public health
Approved Aug. 9, 1938
Revised Feb. 14, 1939
Funerals of persons dead of any disease dangerous to the public health
Approved Aug. 9, 1938
Treatment of persons exposed to rabies
Sale of rabbits intended for food purposes
Dispensary license
Approval of bacteriological and serological laboratories
Distribution of biologic products
Approved Aug. 10, 1937
Amended May 13, 1941
Approved May 14, 1929
Approved May 10, 1938
Approved Sept. 12, 1939
Approved Apr. 9, 1935
Amended May 14, 1940
Use of blood or other tissues for purposes of transfusion
Approved Mar. 14, 1939
Amended Oct. 7, 1941
Amended Nov- 4, 1941
Payment for certain laboratory tests on specimens from cases of pneumonia
Approved Nov. 15, 1938
Use of a common drinking cup
Amended Mar. 22, 1916
12
Providing of a common towel
Amended Mar. 22, 1916
el
it's
Jails, houses of correction, prisons and reformatories
Use of the common drinking cup and common towel in factories, workshops,
manufacturing, mechanical and mercantile establishments
Approved July 6, 1905
Lodging houses
Approved July 6, 1905
Cremation
Adopted Dec 5, 1907
Amended Oct. 29, 1918
Cancer clinics
Approved Jan- 15, 1935
Approved prophylatic remedy for use in the eyes of infants at birth
Approved May 12, 1936
Control of gonorrhea and svphilis
Approved Aug. 9, 1938
Revised Aug. 8, 1939
Revised Nov. 6, 1940 ■
Provision of treatment for persons suffering frcm gonorrhea and sj-philis who
are unable to pay for private medical care
Approved Aug. 10, 1937
Tuberculosis hospitals
Approved May 10, 1938
Tuberculosis dispensaries
Approved May 10, 1938
Manufacture and bottling of carbonated nonalcoholic beverages, soda water,
mineral and spring water
Approved Apr. 7, 1936
Approval of contracts for the production and distribution of certified milk
Approved Oct. 14, 1936
Establishments for the pasteurization of milk
Approved Feb. 12, 1935
Amended July 8, 1941
Short-time high temperature pasteurization of milk
Approved July 8, 1941
Amended Nov. 4, 1941
Purity and quality of food
Approved Feb. 9, 1937
13
Bakeries and bakery products
Approved Feb. 14, 1933
Frozen desserts and ice cream mix
Approved Sept. 11, 1934
Hams, pork butts and sausage containing pork products intended to be eaten
without cooking
Approved Feb. 12, 1924
Business of cold storage
Approved Oct. 10, 1933
Sale of cold storage eggs
Approved July 11, 1922
Business of slaughtering and meat inspection
Approved Dec. 10, 1935
Amended Dec. 10, 1940
Tag to be attached to each article of bedding and each article of upholstered
furniture
Approved Nov. 12, 1935
Sterilization of feathers, down and secondhand material intended for use in the
manufacture of articles of bedding and upholstered furniture
Approved Nov. 12, 1935
Operation of plants for the purification of shellfish
Approved Apr. 7, 1936
Amended Oct. 10, 1938
Amended Oct. 7, 1941
Cross connections between public water supplies and fire and industrial water
supplies
Approved Feb. 9, 1937
Protection of the drainage areas and sources of water supply in cities and towns
and fire and water districts and water companies
Amended Apr. 8, 1941
14
IX. Financial Statement
Federal Grants from the United States Public Health Service and Children's Bureau
The allotments for public health work for the Federal fiscal year July 1, 1941
to June 30, 1942 are as follows:
Federal Security Agency, United States Public Helath Service
Division of Administration $ 12,192.16
Division of Adult Hygiene 37,355.00
Antitoxin and Vaccine Laboratory 17,640.00
Division of Communicable Diseases 27,560.00
Division of Food and Drugs 14,105.00
City of Boston Health Education Project — Subsidy .... 4,460.00
Division of Occupational Hygiene 21,195.00
Pneumonia Control Project 10,000.00
Division of Sanitary Engineering 66,391.00
Division of Tuberculosis 27,836.33
Training Personnel 2,600.00
Vitamin Assay Work 7,340.00
Division of Administration (Local Health Units) 12,430.00
Barnstable County 2,280.00
Berkshire District 4,505.00
Nashoba Associated Boards of Health 11,784.00
North Connecticut Valley District 9,780.00
South Connecticut Valley District 3,100.00
Southeastern District 2,070.00
Worcester Health District 12,502.50
Total — Public Health Service $307,125.99
Federal Security Agency, Venereal Disease Control
Training Personnel $ 4,335.00
Division of Genitoinfectious Diseases 120,890.70
Wassermann Laboratory 35,340.00
Instruction in Control of Gonorrhea and Syphilis — Subsidy to
Harvard School of Public Health 9,220.00
City of Boston Venereal Disease Control — Subsidy .... 21,800.00
Postgraduate Courses in Venereal Disease 8,050.00
Total — Venereal Disease Control 199,635.70
Department of Labor, Children's Bureau
Crippled Children's Services A Account $ 82,506.15
Crippled Children's Services B Account 48,266.91
Total — Crippled Children's Services 130,773.06
Maternal and Child Health Services A Account $ 128,430.47
Maternal and Child Health Services B Account 12,255.00
Total — Maternal and Child Health Services .... 140,685.47
Grand Total — Federal Funds $778,220.22*
* Includes balances of previous year.
Department of Public Health
Appropriations and Expenditures for Year Ended November SO, 194-1
Appropriation
and Amounts
Brought
Forward
Division of Administration $ 38,062.26
Division of Adult Hygiene 90.800.00
Division of Child Hygiene 83,113.01
Division of Communicable Diseases 92,460.90
Division of Genitoinfectious Diseases 313,303.05
Division of Food and Drugs 76,017.43
Division of Biologic Laboratories:
Antitoxin and Vaccine 116,274.28
Wassermann Laboratory 26,382.50
Administration of Shellfish Law 2,918.51
Division of Water Supply and Sewage Disposal 156,586.46
Division of Tuberculosis 46,460.64
Subsidies to Cities and Towns 494,745.54
Tuberculosis Clinic Units 50,057.42
Chronic Rheumatism 36,827.75
Sanitary Condition of Certain Rivers 352.52
$1,624,362.27
Receipts for Year Ended November SO, 1941
Licenses, etc.
Expenditures
to
Nov. 30, 1941
$ 37,366.67
82,630.22
80,430.49
88,226.32
249,934.16
71,527.51
110,644.66
24,413.41
2.279.22
146,877.02
45,827.89
494,739.77
47,237.24
35,960.94
288.40
$1,518,383.92
$8,975.71
Financial Statement Verified (Second)
Walter S. Morgan, Comptroller.
State Sanatoria and Pondville Hospital
Lakeville State Sanatorium
North Reading State Sanatorium
Rutland State Sanatorium
Westfield State Sanatorium
Pondville Hospital .
15
Appropriations
and Balances
Expenditures
Receipts
$336,455.32
275,930.27
365,653.34
440,366.89
361,695.85
$332,816.59
268,272.91
359,236.56
437,261.79
354,673.74
$121,021.39
69,363.78
74,570.73
121,317.51
67,608.40
Special Appropriations
Appropriations
and Balances Expenditures
Lakeville
Chapter 419, 1941, Item 2022-21
Fire Protection and Sprinklers $5,840.00
Chapter 730, 1941, Item 2022-22
Water Supply 1,725.00 ■
Chapter 419, 1941, Item 2022-23
Physiotherapy Unit at Children's West Ward 9,000.00 $ 5,290.23
North Reading
Chapter 419, 1941, Item 2023-22
Fire Protection and Sprinklers 2,200.00
Chapter 419, 1941, Item 2023-23
Fire Protection Equipment 1,375.00 ■
Chapter 419, 1941, Item 2023-24
Improvements to Water Supply 4,100.00 •
Rutland
Chapter 419, 1941, Item 2024-21
Sewerage and Sewage Disposal 3,200.00
Chapter 419, 1941, Item 2024-22
Fire Protection 2,700 00
Chapter 419, 1941, Item 2025-21
Fire Protection Equipment 2,000.00
P.W.A. Docket 1155 — Mass. State Project H-102
Cancer and Tuberculosis Group 404.13 404.13
Pondville
Chapter 419, 1941, Item 2031-21
Water Supply — ■ Replacing Pipe Fixtures 700.00
Chapter 419, 1941, Item 2031-22
Roads — Rebuilding and Resurfacing 3,000.00 2,475.80
Chapter 419, 1941, Item 2031-23
Sprinkler System 1,200.00 ■
Chapter 419, 1941, Item 2031-24
Fire Fighting Equipment 2,650.00
Chapter 683, 1941, Item 2031-25
Power Plant Improvements 100,000.00
Respectfully submitted,
Paul J. Jakmauh,
Commissioner of Public Health.
Approved and signed
R. Nelson Hatt
Gordon Hutchins
Francis H. Lally
Richard M. Smith
Richard P. Strong
James L. Tighe
Public Health Council
THE DIVISION OF ADULT HYGIENE
Herbert L. Lombard, M.D., Director
A cancer control program must have three objectives: first, prevention of cancer;
second, early recognition and treatment of the disease; and third, studies to learn
more about the disease. To attain these objectives, diagnostic cancer clinics, treat-
ment centers, research, and education are necessities. Education should incite the
individual to action. Diagnostic facilities must be available to him, and treatment
centers if he is found to have the disease. Research may cover studies both of the
caueative factors of the disease and evaluations of the methods used in a cancer
control program. Every activity should be subjected to appraisal to determine the
16
worthwhileness of its continuation. The Massachusetts Cancer Program attempts
to integrate cancer control by following these general procedures.
A continuation of the shorter period of delay between first recognizable symptoms
and visit to physician first noted in 1936; a far greater use of the Tumor Diagnosis
Service; more clinic admissions than ever before; thirty-nine teaching clinics
attended by 898 physicians; a continuation in the decline cf the adjusted cancer
death rate among females; and an extension of the Cooperative Cancer Control
Committees — were the principal measures of achievement of the Division of
Adult Hygiene for 1941.
Table I. — Outstanding Accomplishments
Number of State-aided cancer clinics
Number of specimens diagnosed by Tumor Diagnosis Service
Number of doctors using Tumor Diagnosis Service
Number of hospitals using Tumor Diagnosis Service
Number of cancer patients attending cancer clinics
Percentage of cancer patients receiving treatment within one
month of first symptoms
Percentage of cancer patients receiving treatment within four
months of first symptoms
Median delay, in months, of cancer patients between first
symptoms and visit to physician
Percentage of cancer patients going to physician within one
month of first symptoms
Percentage of cancer patients attending cancer clinics referred
by physicians
Female age adjusted cancer death rate per 100,000 population
Average
1927-35
12
:,813
421
97
759
3.1
20.3
6.5
15.0
61.1
125.2
Average
1936-40
21
3,349
700
115
1,616
3.8*
27.2*
5.2
19.1
85.0
120.6
1941
23
4,669
889
118
1,712
6.9**
32.9**
4.0
23.5
84.3
118.3
* four-year average.
** 1940.
Table II. -
- Massachusetts State-Aided Cancer Clinics
,1941
*
c
o
a
a
■a
-2
a
"3
Pi
a
CD
OS ft
o s
o
'a
O
CD
CD
S2
O 3
Pi a
aS
CD
Clinic
8 *
■V ft
a 5
a
CD
<
o
p CD
(UK,
3^
a °
a g
•~ to
o a
Is
CD 9 M
O « C
05 •§•*
1 >>o3
03 *
03 O
"go
CD^O
fl W rj
a a £
8 S ■
® to
S c
5 &
CD C
<
<!
H
<
Ph
£
<!
03
Cu
Pk
PL,
Beth Israel
161
1,454
1,615
80
49.7
0
0
132
93
75
34
Beverly .
69
281
350
18
26.1
0
0
788
83
43
12
Boston Dispensarj
r
429
2,038
2,467
132
30.7
1
103
1,666
98
30
34
Brockton
137
125
262
64
46.7
3
68
1,031
81
9
31
Fall River
142
544
6S6
54
38.0
4
143
485
77
6
4
Fitchburg
44
196
240
15
34.1
4
26
746
84
23
23
50
76
126
17
34.0
5
71
422
74
40
0
33
63
96
12
36.3
3
41
285
71
42
0
Greenfield
11
40
51
5
45.4
1
15
72
71
0
0
24
80
104
13
54.2
2
29
261
84
0
8
129
90
219
57
44.1
5
91
1,217
89
34
51
156
189
345
41
26.3
0
0
1,017
76
24
15
249
828
1,077
111
44.2
0
0
2,752
86
14
39
New Bedford .
166
357
523
69
41.6
0
0
1,685
66
25
10
Newburynort
North Adams
25
51
76
6
24.0
4
33
217
68
8
0
7
33
40
4
57.2
0
0
181
72
0
0
Pittsfield
10
39
49
2
20.0
0
0
157
91
0
0
Pondville
1,503
7,650
9,153
515
34.2
0
0
—
-
—
—
17
54
71
3
17.7
0
0
179
77
24
24
139
460
599
50
36.0
4
154
1,154
77
14
32
Springfield
90
192
282
19
21.1
0
0
1,583
73
11
42
Westfield
1,229
5,305
6,534
428
34.8
2
87
—
-
—
—
Worcester
297
856
1,153
67
22.5
1
37
2,148
77
15
8
Total
5,117
21,001
26,118
1,782
34.8
39
898
* Some individuals went to more than one clinic.
17
Table III. — ■ Massachusetts Cancer Deaths
Male Age
Female Age
Average Age,
Adjusted Cancer
Adjusted Cancer
in Years, of
Death Rate
Death Rate
Year
Cancer Deaths
per 100,000*
per 100,000*
1927
62.1
101.2
127.0
62.3
104.1
126.6
1929
62.4
102.7
125.9
1930
62.6
105.7
123.3
1931
62.8
103.0
124.1
1932
62.9
105.8
127.0
1933
63.1
111.2
124.9
1934
63.0
117.6
126.1
1935
63.4
108.5
122.3
1936
63.8
115.0
120.6
1937
64.1
112.4
119.9
1938
63.9
116.9
119.9
1939
64.2
114.0
119.1
1940
64.2
115.3
123.6
1941
64.4
119.3
118.3
*Adjusted to total United States Census Population for 1930.
Table IV. — Median Durations of Delay of Cancer Patients
Massachusetts State- Aided Cancer Clinics
Median Delay, in Months,
Median Delay, in Months,
between First Symptoms
between First Symptoms
Year
and Visit to Physician
and Visit to Clinic
1931
6.7
12.2
1932
6.2
9.3
1933
6.1
9.4
1934
6.2
9.0
1935
6.2
9.3 .
1936
5.3
8.3
1937
5.7
8.7
1938
5.0
8.0
1939
5.0
8.1
1940
4.6
6.9
1941
4.0
7.0
Table V. — Patients with Cancer Attending State-Aided Cancer Clinics from 1927
to June SO, 1981, Alive 10 Years After Cancer Diagnosis at Clinic,
By Location of Cancer
Alive
Dead
Total
Population
Percentage Alive
Location or Cancer
Total
Under
Age 50 at
Clinic
Admission
Over
Age 50 at
Clinic
Admission
Buccal cavity
Digestive tract
Respiratory system \
Male genitourinary organs J
Female genital organs
Breast .....
Skin
Other and unspecified organs .
118
20
50
66
360
43
297
257
232
314
374
83
415
277
282
380
734
126
28.4
7.2
17.7
17.4
49.0
34.1
52.0
12.5
22.4
21.6
87.0
39.3
25.0
5.9
14.5
15.0
44.2
32.2
Total -
657
1557
2214
18
Table VI. — Percentage of Patients with Cancer Attending State-Aided Cancer
Clinics Alive at Yearly Intervals Following Cancer Diagnosis at Clinics
Total
Skin*
Others*
Alive 1 year after . ......
65.1
91.2
53.8
Alive 2 years after
51.7
83.2
37.6
Alive 3 years after .
44.8
76.1
30.7
Alive 4 years after
40.3
69.9
27.0
Alive 5 years after
36.5
64.5
24.1
Alive 6 years after
33.2
59.9
21.5
Alive 7 years after
30.4
54.7
20.1
Alive 8 years after
27.7
49.5
18.5
Alive 9 years after
■
26.4
46.8
17.9
Alive 10 years after
24.5
42.9
16.7
Alive 1 1 years after
21.9
37.5
15.2
Alive 12 years after
19.9
33.8
14.1
Alive 13 years after
18.1
30.7
13.9
Alive 14 years after
13.2
23.3
10.1
Lost or unknown
2.6
5.5
1.9
♦Individuals with multiple cancers have been omitted from this tabulation.
Table VII. — Reason for Coming to Clinic, by Diagnosis
Rate per 100*
Precancerous
Cancer
Lesions
All Others
Total
Reason
1940
1941
1940
1941
1940
1941
1940
1941
Physician
86.4
84.3
60.3
60.3
79.9
81.5
80.8
81.4
Past experience or former
patient
10.5
10.3
30.0
32.3
8.6
8.0
10.6
10.0
Newspaper
0.6
0.7
1.9
1.6
2.2
1.1
1.6
1.0
Friend or relative
1.2
2.2
3.3
2.7
3.8
3.3
2.9
2.9
Social worker or nurse
1.8
1.7
4.7
1.6
3.5
2.6
3.0
2.2
All others
0.6
2.1
1.1
1.9
2.5
3.9
1.8
3.2
*Does not total 100 per cent, as some individuals gave more than one reason.
Table VIII. — Attendance at State-Aided Cancer Clinics, 1941
Total individuals attending clinics ........... 4,971
Total individuals having cancer ........... 1,712
Total individuals having precancerous lesions ..... .... 257
Total individuals having postoperative cancer, no evidence of recurrence .... 175
Total attendance at clinics . . . . . . . . . . . . 5,117
Total cancer attendance at clinics ....... .... 1,782
Total precancer attendance at clinics . . . . . . . _ . . . . 228
Total postoperative cancer, no evidence of recurrence, attendance at clinics .... 187
Total diagnoses .............. 5,120
Total cancer diagnoses ............. 1,784
Total precancer diagnoses . . . . . _ . . . . . . . 257
Total postoperative cancer, no evidence of recurrence, diagnoses ...... 182
Percentage of individuals with cancer . . . . . . . . . . 34.4
Percentage of individuals with precancerous lesions . . . . . . . . 5.2
Median age of total clinic patients . . . . . . . . . . . 55 . 7
Median age of cancer patients . . . . . . . . . . . . 63.4
19
THE DIVISION OF BIOLOGIC LABORATORIES
Elliott S.Robinson, M.D., Ph.D., Director
I. Antitoxin and Vaccine Laboratory
1. General
The routine production and distribution of biologic products has been maintained
at much the usual rate, with no changes in the list. The possibility of war has
directed attention towards products needed for national defense, and legislation
has been passed to permit the laboratory to prepare and distribute nonsurplus
products for military and civilian defense needs.
Licenses were granted by The Federal Security Agency for the manufacture
and distribution of immune globulins (placental extract) and of normal serum
albumin (human).
2. Distribution of Products
Diphtheria
Antitoxin, 1,000 unit doses
Schick Outfits, 50 doses each . . .
Toxin-Antitoxin Mixture, 1 cc. doses
Toxoid, 1 cc. doses ....
Toxin (Bulk), cc
Scarlet Fever
S.F. Streptococcus Antitoxin, doses
S.F. Streptococcus Toxin, 5 cc. vials .
S.F. Streptoccocus Toxin, Heated Control,
5 cc. vials ....
S.F. Streptoccocus Toxoid, 1 cc. doses
Pneumonia
Antipneumococcic Serum, horse, cone, vials
Antipneumococcic Serum, horse, (Bulk) cc.
Antipneumococcic Serum, rabbit, vials
Diagnostic Serums (of rabbit origin, unless
otherwise noted) :
Pneumococcus Type 1 — horse, cc.
Pneumococcus Type 2 — horse, cc.
Pneumococcus Type 3 — horse, cc.
Pneumococcus Type 1, cc.
Pneumococcus Type 2, cc.
Pneumococcus Type 3, cc.
Pneumococcus Type 4, cc.
Pneumococcus Type 5, cc.
Pneumococcus Type 7, cc.
Pneumococcus Type 8, cc.
Pneumococcus Type 14, cc.
Pneumococcus, other types
Pneumococcus, Pool A, cc.
Pneumococcus, Pool B, cc.
Pneumococcus, Pool C, cc.
Pneumococcus, Pool D, cc.
Pneumococcus, Pool E, cc.
Pneumococcus, Pool F, cc.
Measles
Placental Extract, vials
Sodium Citrate Solution, vials
Meningitis
Antimeningoccocic Serum, 15 cc. doses
Antimeningococcic Serum, Cone. 15 cc. doses
Influenza (Pfeiffer Bacillus) Antiserum, vials
Influenza (Pfeiffer Bacillus) Antiserum, Bulk, cc.
Miscellaneous Serums
Horse Serum, Normal, cc.
Enteric Fevers
Typhoid Vaccine, cc. ...
Typhoid-Paratyphoid B vaccine, cc.
1937
1938
1939
1940
1941
63,769
56,503
49,538
48,744
44,989
4,905
4,033
3,928
4,136
3,842
61,530
43,531
43,751
48,945
44,682
274.759
283,139
262,170
251,704
248,003
580
1,070
1,885
1,780
1,715
1,893
1,737
1,823
1,405
1,849
636
554
610
391
195
447
386
495
395
186
25,361
16,121
16,827
11,299
3,618
5,800
6,707
6,651
4,037
2,579
200
4,427
700
11,550
1,450
193
1,266
1,199*
235
105
105
15
7
245
80
70
10
_
230
55
55
15
7
300
335
237
171
103
288
271
218
154
92
276
292
231
162
108
35
108
53
i70
264
166
134
91
134
260
168
142
91
162
281
190
143
130
106
138
53
453
791
796**
256
291
175
260
295
178
217
290
175
206
279
163
201
285
161
205
277
162
2,163
1,304
3,299
3,248
2,666
943
713
535
725
860
3,339
1,781
> 1,888
2,201
1,157
s 87
2
24
20
51
3 2,118
2,488
2,796
2,562
1,666
i, cc. 100
1,200
5,300
87,585
54,471
15,935
64,600 135,010 173,980
107,426 116,326
54,926
45,100
73,150
45,576
34,377
*5 vials Type 21; 10 vials each Types 10, 22, 28 and 32; 13 vials Type 6; 14 vials Type 15; 15 vials each
Types 13, 16, 17; 18 vials Type 11; 19 vials Type 24; 20 vials Types 23 and 31; 21 vials each Types 12 and
27; 28 vials Type 20; 30 vials Type 19; 52 vials Type 29; 60 vials Type 25; 68 vials Type 9; 76 vials each
Types 14 and 18; 80 vials Type 2; 222 vials Type 4 and 271 vials Type 3.
**28 vials Type 23; 29 vials each Types 10, 11, 16, 21, 22 and 25; 30 vials each Types 12, 13, 15, 24, 28,
29 and 31; 31 vials each Types 17, 27 and 32; 32 vials each Types 6, 19 and 20; 50 vials Type 18; 59 vials
Type 9 and 86 vials Type 33.
20
Other Products
1937
1938
1939
1940
1941
244,329
221,576
221,746
233,364
220,638
1,826*
1,821**
1,812
1,769
1,484
11,625
12,730
9,185
12,045
9,145
76,340
77,488
79,076
83,324
88,800
646
947
1,004
1,197
798
60
48
18,388.5
sion of Genitoinfectious Diseases)
3,656
2,625
2,450
2,308
2,183
6,156
4,329
3,533
3,542
3,509
70,071
67,047
63,490
48,339
36,861
10,855
13,280
21,835
37,465
39,234
3,062
5,444
6,663
6,431
6,414
66,500
Smallpox Vaccine, capillary tubes
Tuberculin, ampoules — 0.7 cc.
Tuberculin, capillary tubes
Silver Nitrate Solution, ampoules
Serum Sensitivity Outfits
Serum Sensitivity Outfits (rabbit)
Trichina Antigen, ampoules
Normal Serum Albumin, cc.
Arsphenamine, 0.4, 0.6, and 3.0 gm. ampoules
Sulpharsphenamine, 0.3, 0.6, 1.0# and 3.0 gm.
ampoules ......
Neoarsphenamine, 0.3##, 0.45, 0.6, 0.9 gm.
ampoules ......
Mapharsen, 0.04, 0.06, 0.4### and 0.6### gm.
ampoules ......
Bismuth Salicylate in oil, 10 cc. bottles## and
2 oz. bottles ... . .
Sulfathiazole, tablets contained in 500 and
1,000 tablet bottles ....
Products not distributed in 1941
Scarlet Fever Convalescent Serum — 56 vials in 1937 and 3 in 1938
Scarlet Fever Streptococcus Toxin for immunization — 105 1 cc. doses in 1937 and 580 in 1938
Diagnostic Pneumococcus Type 5 Horse Serum — 15 cc. in 1937
Pneumococcus Vaccine, Type 7 — 150 cc. in 1938
Typhus Serum — 1,194 20 cc. vials in 1937
Typhus Serum — 230 cc. in 1937 and 1,000 cc. in 1939
Mumps Convalescent Serum — 110 cc. in 1939
Poliomyelitis Convalescent Serum — 633 vials in 1937 and 75 in 1938
Typhoid-Paratyphoid A and B vaccine — 116,743 cc. in 1937
Diagnostic Typhoid Serum — 12 cc. in 1937
Diagnostic Paratyphoid A serum — 17 J^ cc. in 1937
Diagnostic Paratyphoid B serum — 17}^ cc. in 1937
*Of these ampoules 68 contained 204 cc. in all and 1,758 contained 0.7 cc. each.
**Of these ampoules 15 contained 5 cc. each and 1 ,806 contained 0.7 cc. each.
#Discontinued in 1937.
##Begun in 1937.
###Begun in 1939.
1. Antipneumococcic Serum. Limitation of serum therapy of pneumonia chiefly
to patients who fail to respond to chemotherapy has resulted in a further drop in
the distribution of this serum.
Type 1
Units
TypeS
Units
Type 5
Units
Type 7
Units
Type 8
Units
Type 14
Units*
1937 . 121,060,000
1938 . 85,550,000
1939 . 85,150,000
1940 . 54,420,000
1941 . 28,170,000
75,880,000
36,524,000
35,590,000
2/,025,000
15,525,000
15,139,500
27,384,500
28,197,500
22,320,000
26,040,000
32,280,000
38,213,500
23,840,000
19,095,000
5,640,000
28,367,500
22,640,000
15,000,000
3,860,000
3,520,000
1,520,000
♦Purchased.
Other types were not distributed prior to 1940, and, therefore, are not given in
this table.
2. Antimeningococcic Serum. Chemotherapy and a continued low incidence of
meningococcus meningitis combine to decrease the use of this product.
3. Typhoid Vaccines. An unusually small amount has been distributed, but
with no apparent reason for the decrease.
4. Other products. Distribution figures are within normal limits.
8.
Expenses
Personal Services
Expenses
Total
Yeas
Appro-
priation
Spent
Appro-
priation
Spent
Appro-
priation
Spent
1937 .
1938 .
1939 .
1940 . . ' .
1941 .
$80,000.00
79,350.00
79,300.00
81,700.00
79,500.00
$77,339.61
75,821.49
77,524.02
77,323 . 60
74,748.20
$36,813.62
34,570.21
34,496.14
34,628.50
36,774.28
$34,423.30
33,474.83
33,561.18
33,169.78
35,896.46
$116,813.62
113,920.21
113,796.14
116,328.50
116,274.28
$111,762.91
109,296.32
111,085.20
110,493.38
110,644.66
21
4. Investigations
Assistance was rendered the Department of Physical Chemistry, Harvard
Medical School, in the preparation of human serum albumin for use as a substitute
for blood in transfusions. Laboratory and clinical knowledge concerning this
product progressed to the point where a license for its distribution was granted
to this laboratory by the Federal Security Agency on August 27, 1941.
II. Wassermann Laboratory
William A. Hinton, M.D., Chief of Laboratory
1. Tests and Examinations
Kind of Specimen
1937
1938
1939
1940
1941
Number of Specimens
Tests:
Hinton
. 215,293
254,195
295,114
360,401
425,581
. 186,387
223,210
255,589
322,797
389,351
Wassermann
8,912
6,173
-
—
-
Blood
Davies Micro-Hinton .
Bacillus Abortus:
1,659
3,207
4,072
4,662
4,620
Agglutination* .
25,431
27,184
29,787
30,380
31,431
G.C. Compl. Fixation
9,196
10,396
11,101
9,146
679
Glanders*
39
24
37
22
25
Number of Specimens
Tests:
Wassermann
8,910
9,740
10,430
11,784
10,934
Spinal Fluid
8,911
9,740
10,435
11,784
10,934
Davies-Hinton .
835
3,865
5,097
6,154
8,774
Gold Sol .
546
500
—
—
-
Number of Specimens
460
295
302
306
269
Rabies
Tests:
Diagnosis*
Impressions
460
295
302
306
269
Sections
455
289
296
298
255
Animal Inoculation
275
230
248
240
232
Number of Specimens
7
7
10
8
3
Tests:
Path, and Bact.
Sections
2
4
4
_
_
Examinations*
Animal Inoculation
5
2
7
1
2
Cultures .
1
1
5
4
2
Smears
~~
2
1
2
1
Total Tests
. 243,114
285,122
316,981
385,796
446,575
Total Specimens .
. 224,670
264,237
305,856
372,496
437,067
♦Diagnostic Examinations for Division of Livestock Disease Control.
As shown in the table, the total number of tests performed has increased nearly
16 per cent and in tests for syphilis nearly 20 per cent. This is chiefly attributable
to tests for syphilis done for the National Guard and the Selective Service Boards
(see below). Performance of the complement fixation test for the detection of
gonorrhea was discontinued after February 1941, since it was felt that the test as
done at that time was unreliable for such purposes as affect the public health.
2.
Expenses
Personal Services
Expenses
Total
Year
Appro-
priation
Spent
Appro-
priation
Spent
Appro-
priation
Spent
1937 .
1938 .
1939 .
1940 .
1941 .
$18,700.00
19,000.00
19,300.00
19,650.00
20,050.00
$18,549.68
18,973.81
17,093.21
19,085.07
18,164.48
$6,000.00
6,000.00
6,200.00
6,322.98
6,332 . 50
$6,012.02
5,992.43
6,177.46
5,956.85
6,248.93
$24,700.00
25,000.00
25,500.00
25,972.98
26,382.50
$24,561.70
24,966.24
23,270.67
25,041.92
24,413.41
22
3. Laboratory Approval
In the program for evaluating the performance of laboratories in the serologic
detection of syphilis, approximately four hundred different sera have been sent out
for testing. Thirty-six institutions have now been approved for testing blood from
prospective blood donors, and sixteen institutions for performing routine serologic
tests for syphilis. Besides sending specimens to those laboratories seeking approval,
we are continuing to send specimens to those laboratories already approved, to
ensure that they maintain a satisfactory rating in the performance of these tests.
4. Investigations
Work on the serology of syphilis in rabbits treated with arsphenamine has been
continued. The reliability of the complement fixation test for gonorrhea is being
reinvestigated at the urgent request of a small group of internists in our Boston
hospitals who have expressed a need for this test as an aid in diagnosis in selected
cases.
Representatives of the Wassermann Laboratory participated in an evaluation
of serologic tests for syphilis held in Washington, D. C, by the American Serologic
Congress. They performed the various Hinton technics and their modifications.
The Wassermann Laboratory also participated in the regular National Evaluation
of Serologic Tests for Syphilis, on invitation of the Surgeon General of the U. S.
Public Health Service.
5. New and Proposed Activities
Serologic tests for syphilis on all draftees for the Selective Service System have
amounted to 64,262. Tests for syphilis on members of the Massachusetts National
Guard were performed on 2,553 specimens.
- The performance of serologic tests for syphilis on persons applying for marriage
licenses in Massachusetts is a service that has been in operation since November 1,
1941, in response to the new law (Chapter 601 of the Acts of 1941) requiring a
medical examination and a blood test on all such persons. The application of this
Act will result in many more specimens being submitted to this laboratory.
628 specimens from the American Red Cross Bleeding Clinic have been tested in
connection with the serum albumin work at the Antitoxin and Vaccine Laboratory
23
THE DIVISION OF CHILD HYGIENE
M. Luise Diez, M.D., Director
Activities of the Division of Child Hygiene during the year ended December 31,
1941, were chiefly the following:
1. Maternal, Infant and Preschool Hygiene:
New requests for prenatal letters ....
Letters sent to fathers .....
New requests for postnatal letters, first year series .
Registered for second year postnatal letters
Total number registered for all monthly letter services
8,609
8,609
10,644
15,515
34,768
Follow-up of mothers and babies discharged from Framingham Reformatory
for Women continued, through service of Public Health Nursing Supervisors.
Mothers' classes conducted during the year by staff nurses 17
Mothers' classes conducted by local nurses ... 19
Fathers' classes conducted ...... 3
Prenatal Clinics:
Plan started to secure X-rays of chest for pregnant women attending prenatal
clinics. Visitation of local prenatal clinics was continued.
Courses for prenatal clinic physicians .... 2
Local prenatal clinic service fees paid physician (Westfield) 1
Delivery Nurse Service:
Home delivery nurse service fees paid . . . . 27
Maternal Mortality Study:
This year completed the five-year study of causes of maternal deaths in Massa-
chusetts, as well as the study of Caesarean sections occurring in hospitals, carried
on through cooperation of the Section of Obstetrics and Gynecology of the
Massachusetts Medical Society.
Maternal deaths studies in 1941 . . . . . 220
Premature Infant Program:
The study of deaths of premature infants was continued.
Nursery supervisors taking course on care of premature infant
Well Child Conferences:
Physicians taking course for well child conference physicians
Well child conference sessions held by State Units
Towns covered by this service ....
Number of infant and preschool children examinations
Nursery school children included in examinations
Communities taking over such conferences locally
Local well child conferences where fees are paid to physician
under Social Security funds .....
Summer Round-up:
Towns conducting Summer Round-Up conferences . . 139
Total examinations of children in such conferences . . 9,429
23
6
378
67
3,583
651
5
2. School Hygiene:
School physician for the Town of Millville was continued by a staff physician.
School hygiene surveys made ..... 1
"Contact" issues distributed ...... 5
School Physicians' and Superintendents' Conferences held 8
24
3. Public Health Nursing.
An Institute on "Public Assistance in Massachusetts" was held for nurses and
public welfare workers, in seven areas of the State, cooperating with the State
Department of Public Welfare. Total attendance 731. Tuberculosis Institutes
continued at State and County Sanatoria.
Promotion and stimulation of tuberculosis programs continued in 58 towns,
including 83 visits to further tuberculosis nursing program.
Well child conference follow-up visits made
Home visits made in communities without nursing service
Home visits for maternity service .....
Home visits for tuberculosis follow-up ....
Home visits for arthritis study follow-up
School nursing survey, as part of school hygiene survey
Group conferences held relative to public health nursing .
Study groups held ........
Toxoid clinics attended .......
Home visits for follow-up of Framingham Reformatory
inmates .........
Birth certificates investigated, for Maternal Mortality
Study . . .
Lectures given on public health nursing subjects
353
1,021
97
241
31
1
238
10
94
70
81
Consultant service continued for local nursing associations, county public health
associations, community health committees, boards of health, parent-teacher
associations, town managers, and other social and lajr groups.
Participation in program planning for the three State nursing organizations
continued.
4. Nutrition:
Attendance at Fifth Annual Conference of New England
Nutritionists .....
Community nutritionists employed locally
Nutrition group meetings held
Nutrition sendee at prenatal clinics
Visits to tuberculosis clinics .
Home visits for instruction and follow-up
Red Cross nutrition classes conducted
Radio talks given .....
Newspaper articles written and published
Visits made to further school lunch facilities
Number of towns included, school lunch activities
Consultant and field service for out-of-state workers
95
7
60
16
9
243
16
18
52
360
189
21
Members of the nutrition staff served on national, state and local committees
concerned with promotion of adequate nutrition.
Cooperation continued with State Departments of Education, Public Welfare,
the Extension Service, Red Cross, Girl Scouts, and State Public Safety Committee.
Summer courses continued at State Teachers Colleges for teachers, nurses and
school lunchroom managers.
Dental Hygiene:
Dental surveys made in schools in 11 towns:
Number of children included in examinations
School hygiene dental survey made
Dental survey of camp children .
Number of children included in this survey .
Lectures to student nurses in training in hospitals
Dental examinations at well child conferences
Dental inspections at well child conferences
1,516
1
1
164
17
12
3,377
25
Participation in courses at Harvard School of Public Health, Harvard Dental
School, Boston University Medical School, Tufts Dental School and Forsyth
Dental Infirmary continued.
An eight-session course for dentists, in Children's Dentistry, was conducted
in cooperation with the American Society for Children's Dentistry. This included
lectures and demonstrations. Sixteen dentists took the course.
Cooperation and consultation service continued for national, state and local
dental societies, and assistance was given the State Welfare Department in securing
dental service for State wards.
6. Paeent Education:
Parent education courses were continued for teachers and nurses. Courses were
given at Fitchburg State Teachers College, for advanced credit, a total of 10 lectures
on "Problems of Adolescence."
The second course for lay leaders in Parent Education was carried on. These
leaders carried on locally 27 community projects, supervised by the Parent Edu-
cation Coordinator.
Annotated booklists were prepared and consultation service given.
7. Child Growth and Development Service:
A program of case studies of preschool and school children was developed
cooperating with the school superintendents in selected communities. Methods
and techniques for hearing testing of preschool children were studied and plans
made for perfecting these methods. The Clarke School for the Deaf and Massa-
chusetts Eye and Ear Infirmarry cooperated in this work.
The Massachusetts Vision Test was approved by both State Departments of
Education and Public Health, and introduced to the schools of the State. Reports
were completed of studies and test materials.
8. Social Work:
A study of economic and social factors involved in behavior problems reported
from well child conferences by Department Units was carried on and is to be
continued. A study of social resources, public and private, in small towns was made
to form the basis of a permanent file of social resources.
Monthly group discussions for nurses were held in three centers. Consultation
service was given directly and through group discussion of case problems.
9. Audiometer Testing:
Three audiometers were in constant use during the year.
Number of children having hearing tests by audiometer . 41,580
Number showing hearing loss ..... 1,750
Number requiring retesting ...... 5,990
10. Health Education:
Health talks given in high Schools . • . . 158
Number of high school pupils reached through this service 31,564
Number of communities where high school health study was
conducted ........ 45
Health exhibits at State Fairs ..... 12
Exhibits at special conferences . . . . . 11
Printed material distributed through State Fairs (pieces) . 17,621
Pamphlets distributed through Boston Book Fair . . ■ 12,779
Pamphlets distributed through schools .... 216,640
Lectures given by staff members ..... 1,147
Communities reached through this service . . . 212
Total number of persons reached ..... 83,493
26
Cooperating with the University Extension Division, courses were given to
teachers and school nurses. The Health Education Coordinator participated in a
course at Forsyth Dental Infirmary. Other staff members participated in courses
at Harvard School of Public Health, Harvard Dental School and Massachusetts
General Hospital; also Fitchburg and Hyannis State Teachers Colleges. In-service
training in health education was carried on for Board of Health nurses and dental
hygienist and the visiting nurse association of Springfield. A workshop in health
education was conducted for teachers in 9 towns.
A special School Health Study was begun this year, under the supervision of
the Joint Committee on Health Education, sponsored by the State Departments
of Education and Public Health and the School Superintendents' Association,
School Principals' Association, and representatives of State medical and dental
societies.
The Division participated in health exhibits for Massachusetts Medical Society,
New England Health Institute, Public Welfare Convention, Boston Book Fair,
State Nurses' Association, and county and local health associations.
"Illustrative Teaching Methods" for grades I, II, III, IV, V, and VI, were
printed, in cooperation with the State Department of Education.
Staff education through special courses and field observation trips was afforded
to various staff members.
The usual advisory committees were called upon during the year for advice
and counsel.
Massachusetts Statistics for 1941
(Allocated)
Birth rate per 1,000 population ..... 16.2
Death rate per 1,000 population ..... 11.7
Infant mortality rate per 1,000 live births . . . 35.3
Maternal mortality rate per 1,000 live births ... 2.9
Population estimated as of June 30, 1941 . . 4,325,106
27
THE DIVISION OF COMMUNICABLE DISEASES
Roy F. Feemster, M.D., Dr. P.H., Director
General Statement
Although only statistical tables are included in this summary, a number of the
activities of the division are touched upon in the Commissioner's section.
Discovery of Typhoid Carriers
Carriers
Per Cent
Cases
Carriers
Rate
Found in
Rate
Epidem-
iological
of Units in
of
Added to
per 100
Investigation
per 100
Which Carrier
Year
Typhoid
List
Cases
of Cases
Cases
Units#
Was Found
1937
114
20
17.5*
16
14.0
96**
16.7
1938
59
19
32.2*
16
27.1
55**
29.1
1939
78
26
33.3*
21
26.9
66**
31.8
1940
86
19
22.1*
12
13.9
59**
20.3
1941
68
22
32.4*
18
26.4
63**
28.6
#A11 cases resulting from the same source are counted as a single unit in this column.
*No adjustment has been made for those cas'es in which disease was probably contracted outside of state
numbering as follows: 1937 — 10; 1938 — 2; 1939 — 5; 1940 — 3; 1941 — 3.
**1937 — 1 unit comprising 1 case caused by known carrier.
1938 — 1 unit comprising 1 caste caused by known carrier.
1939 — 2 units comprising 2 cases caused by known carriers.
1940 — 6 units comprising 11 cases caused by known carriers.
1941 — 4 units comprising 9 cases caused by known carriers.
Outbreaks
Diagnosis
Confirmed
by Lab.
Etiological
Disease
Month Location
Cases Vehicle
Work
Agent
Remarks
Diphtheria
Mar.
Springfield
7
u*
5
_
In family of 11
(4 rept.)
children (4 clinical
and 3 subclinical;
Dysentery
June
Lynn
12
u
12
Flexner
-
Dysentery
July
Dunstable
106
u
106
Flexner
Summer camp.
Dysentery
July
Middleborough
40
u
12
Sonne
Summer camp.
Dysentery
July-
Nov.
Worcester
State Hospital
84
u
84
Sonrie
Dysentery
July-
Dec.
Fernald
State School
26
u
26
Flexner
Dysentery
Sept.
Ipswich
Several U
5
Flexner
In 2 families on
dairy farms.
Dysentery
Oct.
Ayer
18
u
4
Flexner
—
.Dysentery
Oct.
Melrose
10
u
7
Flexner
Employees in
hospital.
Food Poisoning
Dec.
Fall River
8
Muffins
Yes
Sodium
fluoride
Muffins served in
restaurant.
Gastroenteritis
Jan.
Boston
110
Roast
turkey?
-
u*
Banquet.
Gastroenteritis
Feb.
Weymouth
5
U
-
u
In 1 household of
6 persons.
Gastroenteritis
May
Andover
9
U
-
u
In 1 household of
14 persons.
Gastroenteritis
May
Andover
5
U
-
u
5 of 13 em-
ployees.
Gastroenteritis
June
Fall River
Many Water?
—
u
C ont am ina ted
water supply in
factory.
Gastroenteritis
June
Worcester
322
Hamburg and -
u
—
State Hospital
spaghett
i
Gastroenteritis
July
Salisbury
40
Water?
-
—
Summer resi-
dents.
Gastroenteritis
July
S.S. Washington
Few
Contact
-
u
Refugees.
Gastroenteritis
July
Pembroke
60
Salmon
-
Staph, aureus Girls' summer
salad?
and albus
camp.
Gastroenteritis
Aug.
Boston
9
U
—
—
At Fort Dawes.
Gastroenteritis
Aug.
Haverhill
Several
—
U
Newborn infants
in hospital.1
Gastroenteritis
Aug.
Plymouth
135
Chop suey'
Probably
staph, ent.
Camp at Mano-
met.
*U — Undetermined mode of transmission or etiological agent.
28
Outbreaks — Continued
Diagnosis
Confirmee
bv Lab.
Etiological
Disease
Month
Location
Cases Vehicle
Work
Agent
Remarks
Gastroenteritis
Aug.
Windsor
Few
U
-
U
Members of 5
families residing on
large farm.
Gastroenteritis
Oct.
Natick-Newton
4
Chocolate
eclairs
-
Staph, ent.
-
Gastroenteritis
Oct.
Northampton
6
U
-
U
College students.
Gastroenteritis
Oct.
Pittsfield
Several Eclairs
-
Staph, ent.
In different fam-
ilies.
Banquet
Gastroenteritis
Oct.
Worcester
30
Roast
_
Probably
turkey?
staph, ent.
Gastroenteiitis
Nov.
Boston
10
Cream-filled -
Staph, ent.
Pastry bought at
pastry
restaurant.
Gastroenteritis
Nov.
Williamstown
17
U
—
U
Private school.
Gastroenteritis
Dec.
Weymouth
13
U
-
U
Newborn infant
in hospital.
Infectious
Sept.
W. Brookfield
10
u
No
—
jaundice
Meningitis
June
Camp Edwards
8
-
8
Meningococcus -
Salmonella
Apr.
Metropolitan
9
u
9
Montevideo, 7 Among inmates.
State Hospital
Urbana, 1
Oranienburg
1
Salmonella
May
Maiden
4
u
4
Typhimurium Family group.
Scarlet fever
Mar-
Apr.
Boston-Winthrop
15
-
_
-
At Fort Banks.
Scarlet fever,
July
Burlington
81
Ham
15
Hemol. strep
Church luncheon.
sore throat
type 2.
Scarlet fever,
Aug.
Foxborough
7
U
-
-
7 cases on 4 dif-
sore throat
State Hospital
ferent wards.
Trichinosis
Feb.
Framingham
4
Pork chops
-
-
1 family.
Trichinosis
June
Camp Edwards
14
U
-
-
-
Trichinosis
Dec.
Attleboro
5
U
-
-
1 family.
Typhoid
May
Boston
3
Water
3
Boysdrank stand-
ing surface water
Typhoid carrier
lived nearby.
Undulant fever
Mar.-
Sept.
Leominster
16
Raw milk
16
Br. abortus
All cases drank
raw milk from 1
dairy.
*U — Undetermined mode of transmission or etiological agent.
Table I. — Anterior Poliomyelitis
Case Rate
Death Rate
Fatality Rate
Year
Cases
per 100,000 Deaths
per 100,000
(Per Cent)
1937 .
351
8.0
22
0.5
6.3
1938 .
18
0.4
7
0.1
38.9
1939 .
76
1.7
4
0.1
5.3
1940 .
45
1.0
2
0.04
4.4
1941 .
182
4.2
6
0.1
3.3
Table II. — Diphtheria
1937 .
175
4.0
18
0.4
10.3
1938 .
159
3.6
19
0.4
11.9
1939 .
197
4.4
15
0.3
7.6
1940 .
144
3.3
8
0.2
5.6
1941 .
123
2.8
12
0.3
9.8
Table III.— Measles
1937 .
. 21,136
479.9
28
0.6
0.1
1938 .
. 10,533
238.0
13
0.3
0.1
1939 .
. 26,685
600.1
16
0.3
0.1
1940 .
. 21,698
502.6
11
0.3
0.1
1941 .
. 22,338
516.5
4
0.1
29
Year
1937
1938
1939
1940
1941
Table IV.— .
Meningitis, M
mingococcal
Case Rate
Death Rate
Fatality Rate
Cases
per 100,000
Deaths
per
100,000
(Per Cent)
166
3.8
72
1.6
43.4
59
1.3
18
0.4
30.5
48
1.1
17
0.4
35.4
47
1.1
15
0.3
31.9
98
2.3
25
0.6
25.5
Table V. — Pneumonia, Lobar
1937 .
5,322
120.8
1,846
41.9
34.7
1938 .
4,296
97.1
1,312
29.6
30.5
1939 .
4,460
100.3
1,211
27.2
27.1
1940 .
4,332
100.4
925
21.4
21.4
1941 .
3,617
83.6
860
19.9
23.8
Table VI.
— Scarlet Fever
1937 .
8,480
192.5
38
0.9
0.4
1938 .
. 10,146
229.3
24
0.5
0.2
1939 .
5,705
128.3
15
0.3
0.3
1940 .
5,277
122.2
19
0.4
0.4
1941 .
7,141
165.1
13
0.3
0.2
Table VII. — Tuberculosis, Pulmonary
1937 .
3,534
80.2
1,761 40.0
1938 .
3,220
72.8
1,536 34.7
1939 .
2,959
66.5
1,505 33.8
1940 .
2,816
65.2
1,484 34.4
1941 .
2,987
69.1
1,520 35.1
Table VIII. — Tuberculosis,
Nonpulmonary
1937 .
363
8.2
126 2.9
1938 . . .
375
8.5
141 3.2
1939 .
310
7.0
97 2.2
1940 .
294
6.8
114 2.6
1941 .
295
6.8
112 2.6
Table IX. — ■ Typhoid Fever
1937 .
114
2.6
13
0.3
11.4
1938 .
59
1.3
11
0.2
18.6
1939 .
78
1.7
11
0.2
14.1
1940 .
86
2.0
8
0.2
9.3
1941 .
68
1.6
3
0.1
4.4
Table X. — Whooping Cough
1937 .
. 13,333
302.7
95
2.1
0.7
1938 .
5,818
131.5
35
0.8
0.6
1939 .
7,548
169.7
45
1.0
0.6
1940 .
7,959
184.4
22
0.5
0.3
1941 .
9,790
226.4
40
0.9
0.4
30
Table XL — Number and Kind
of Specimens
1937
1938
1939
1940
1941
Diphtheria
6,104
6,923
7,104
6,614
5,463
Gonorrhea
13,621
12,725
12,942
13,070
12,590
Malaria
48 •
58
51
50
48
Pneumonia
1,950
3,602
3,965
3,608
3,207
Tuberculosis .
5,186
6,392
6,479
7,565
6,937
Typhoid Fever:
Widal
3,713
2,642
3,311
3,037
2,730
Culture
9,268
7,852
12,766
12,814
11,019
Undulant Fever
1,393
1,871
1,933
1,966
2,686
Miscellaneous
1,911
1,147
1,018
1,368
1,699
Total
43,194
43,212
49,569
50,092
46,379
Table XII. — Specimens and Examinations for 194-1
Total
Total
.
Number of
Number of
Positive
Negative
Specimens
Examinations
Diphtheria:
Diagnosis .....
53
4,729
4,782
11,788»
Release ......
139
542
681
681
Gonorrhea .....
1,251
11,339
12,590
25,1802
Malaria ......
—
48
48
48
Meningococci, Spinal fluid for
9
43
52
96s
Pneumonia:
Pneumococci found and typed .
1,094
-
1,094
1,094
Pneumococci not found
—
2,113
2,113
2,213
Tuberculosis :
Sputum ......
576
5,624
6,200
6,200
Urine, spinal fluid, etc. (Culture and
animal inoculations)
80
657
737
737
Typhoid Fever:
Widal
80
2,650*
2,730
5,899s
Culture (blood, feces, urine, etc.)
317
10,702
11,019
17,0466
Undulant Fever .....
177
2,509
2,686
8,058'
Miscellaneous:
Diphtheria virulence tests
20
3
23
23
Dysentery agglutination tests
1
155
156
156
Dysentery, Amoebic
-
54
54
54
Vincent's angina (sent by dentists)
709
312
1,021
1,021
Weil-Felix reaction for Rickettsial
diseases .....
16
99
115
115
Unclassified .....
-
-
278
413s
46,379
'Includes examinations for hemolytic streptococci and the organisms of Vincent's angina.
includes examinations for average number of leucocytes per field.
'Includes examinations for influenza bacilli and other organisms.
■•Includes 194 partial reactions.
includes 439 agglutination tests for paratyphoid A and 2,730 tests for paratyphoid B.
6Includes examinations for paratyphoid and dysentery bacilli.
"Includes examinations for agglutinins for typhoid and paratyphoid B.
includes miscellaneous examinations for identification of organisms.
80,822
Table XIII. — Pneumococcus Type Differentiation
Type
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
umber
Per Cent
93
8.1
31
2.7
150
13.1
56
4.9
34
3.0
62
5.4
65
5.7
92
8.0
26
2.3
22
1.9
37
3.2
8
0.7
29
2.5
25
2.2
26
2.3
17
1.5
27
2.4
27
2.4
64
5.6
Type
Number
Per Cent
20 .... 37
3.2
21
13
1.1
22
12
. 1.0
23
27
2.4
24
22
1.9
25
3
0.3
27
. 4
0.4
28
16
1.4
29
41
3.6
31
9
0.8
32
1
0.1
33
28
2.4
Buckley
16
1.4
Carver
13
1.1
Dougherty
1
0.1
Reilly
10
0.9
Typed pneumococci
1,144
100.0
Nopne
mmoc
occi
2,113
x71 specimens with more than one type.
Total
. 3,2571
31
Table XIV. — Laboratory Examinations for Rabies*
Positive
Negative
Year
Other
Total Animals
Dogs
Animals
Examined
1937
158
6
247
460
1938
49
1
233
255
1939
31
1
264
304
1940
52
4
244
309
1941 '
20
1
240
274
*Wassermann Laboratory.
Cases and Deaths, with Case and Death Rates per 100,000 Population1 for Reportable
Diseases During the Year 1941
Disease
Cases
Case Rate
per 100,000
Population
Deaths
Death Rate Fatality
per 100,000 Rate
Population (Per Cent)
Actinomycosis
Anterior poliomyelitis
Anthrax
Chicken pox .
Diphtheria
Dog bite
Dysentery, Amebic
Dysentery, Bacillary
Encephalitis, Infectious
German measles
Gonorrhea
Malaria
Measles
Meningitis, Meningococcal
Meningitis, Pfeiffer bacillus
Meningitis, Other forms
Mumps
Ophthalmia neonatorum
Suppurative Conjunctivitis
Paratyphoid infections
Pellagra
Pneumonia, Lobar
Scarlet fever .
Septic sore throat .
Syphilis.
Tetanus
Trachoma
Trichinosis
Tuberculosis, Pulmonary
Tuberculosis, Other forms
Tuberculosis, Hilum
Tularemia
Typhoid fever
Typhus
Undulant fever
Whooping cough
Total .
4
.1
2
*
50.0
182
4.2
6
.1
3.3
7
.2
1
*
14.3
11,808
273.0
4
.1
*
123
2.8
12
.3
9.8
11,038
255.2
-
-
-
4
.1
—
—
—
303
7.0
6
.1
2.0
21
.5
13
.3
61.9
2,334
54.0
-
-
-
3,791
87.7
7
.2
.2
10
.2
1
*
10.0
22,338
516.5
4
.1
*
98
2.3
25
.6
25.5
14
**
21
.5
#*
22
***
_
_
_
10,491
242.6
6
.1
.1
481
11.1
-
—
—
492
11.4
-
-
—
77
1.8
1
*
1.3
18
.4
7
.2
38.9
3,617
83.6
860
19.9
23.8
7,141
165.1
13
.3
.2
171
4.0
22
.5
12.9
4.613
106.7
267
6.2
5.8
19
.4
5
.1
26.3
24
.6
—
—
—
50
1.2
—
—
—
2,987
69.1
1,520
35.1
50.9
295
6.8
112
2.6
38.0
184
4.3
_
_
-
1
*
—
—
—
68
1.6
3
.7
4.4
2
*
—
—
—
86
2.0
2
*
2.3
'. 9,790
226.4
40
.9
.4
92,704
2,143.4
2,960
68.4
^Population, 4,325,108.
*Less than .05.
♦♦Incompletely reported.
***Made reportable May, 1941.
32
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4,613
19
24
50
2,987
295
1
68
2
86
9,790
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a
Actinomycosis ........
Anterior poliomyelitis ......
Anthrax ........
Chicken pox ........
Diphtheria
Dog bite .........
Dysentery, Amebic .......
Dysentery, Bacillary ......
Encephalitis, Infectious ......
German measles .......
Gonorrhea ........
Meningitis, Meningococcus .....
Pfeiffer bacillus meningitis
Tuberculosis, Pulmonary
Tuberculosis, Other forms .....
35
Index to Line Numbers in the Table of Cases and Deaths from Diseases Dangerous
to the Public Health, 1941
Abington
123
East Bridgewater
145
Longmeadow
Acton
179
East Brookfield
279
Lowell .
Acushnet
141
East Longmeadow .
157
Ludlow
Adams .
67
Eastham
306
Lunenburg
Agawam
93
Easthampton .
79
Lynn
Alford .
343
Easton .
126
Lynnfield
Amesbury
76
Edgartown
255
Amherst
112
Egremont
312
Maiden .
Andover
69
Erving .
261
Manchester
Arlington
26
Essex
256
Mansfield
Ashburnham
204
Everett .
20
Marblehead .
Ashby
277
Marion
Ashfield
291
Fairhaven
73
Marlborough
Ashland
190
Fall River
5
Marshfield
Athol .
70
Falmouth
104
Mashpee
Attleboro
40
Fitchburg
22
Mattapoisett
Auburn
10S
Florida .
317
Maynard
Avon
201
Fort Banks
355
Medfield
Ayer
149
Fort Devens .
Fort Rodman
356
357
Medford
Medway
Barnstable
85
Foxborough .
118
Melrose
Barre
155
Framingham .
37
Mendon
Becket
300
Franklin
103
Merrimac
Bedford
143
Freetown
244
Methuen
Belchertown
153
Middleborough
Bellingham
173
Gallups Island
358
Middlefield .
Belmont .
31
Gardner
43
Middleton
Berkley .
271
Gay Head
350
Milford .
Berlin
275
Georgetown
229
Millbury
Bernardston
284
Gill
288
Millis .
Beverly .
33
Gloucester
36
Millville.
Billerica
87
Goshen
338
Milton .
Blackstone
135
Gosnold
348
Monroe .
Blandford
310
Grafton
100
Monson
Bolton .
297
Granby .
272
Montague
Boston
2
Granville
302
Monterey
Bourne .
159
Great Barrington
122
Montgomery .
Boxborough
323
Greenfield
52
Mount Washington
Boxford .
295
Groton .
186
Boylston
251
Groveland
216
Nahant .
Braintree
50
Nantucket
Brewster
292
Hadley .
187
Natick .
Bridgewater
83
Halifax
290
Navy Yard
Brimfield
280
Hamilton
218
Needham
Brockton
15
Hampden
274
New Ashford
Brookfield
253
Hancock
328
New Bedford .
Brookline
IS
Hanover
175
New Braintree
Buckland
246
Hanson .
184
New Marlborough
Burlington
200
Hardwick
Harvard
214
223
New Salem
Newbury
Cambridge
6
Harwich
188
Newburyport .
Camp Edward
3
354
Hatfield
208
Newton
Canton
114
Haverhill
21
Norfolk .
Carlisle
298
Hawley
337
North Adams
Carver .
250
Heath
326
North Andover
Charlemont
296
Hingham
88
North Attleborough
Charlton
185
Hinsdale
267
North Brookfield
Chatham
210
Holbrook
161
North Reading
Chelmsford
86
Holden .
144
Northampton
Chelsea .
25
Holland
336
Northborough
Cheshire
234
Holliston
169
Northbridge .
Chester
265
Holyoke .
17
Northfield
Chesterfield
318
Hopedale
166
Norton .
Chicopee
23
Hopkinton
180
Norwell
Chilmark
340
Hubbardston
281
Norwood
Clarksburg
262
Hudson .
92
Clinton
68
Hull^ .
209
Oak Bluffs
Cohasset
167
Huntington
258
Oakham .
Colrain
248
Orange .
Concord .
91
Ipswich .
116
Orleans
Conway
287
Otis
Cummington
304
Kingston
177
Oxford .
Dalton .
140
Lakeville
228
Palmer .
Danvers
60
Lancaster
171
Paxton .
Dartmouth
82
Lanesborough
260
Peabody
Dedham
54
Lawrence
11
Pelham
Deerfield
182
Lee
139
Pembroke
Dennis .
219
Leicester
128
Pepperell
Dighton
172
Lenox
174
Peru
Douglas
181
Leominster
39
Petersham
Dover
254
Leverett
301
Phillipston
Dracut .
102
Lexington
63
Pittsfield
Dudley
133
Leyden
333
Plainfield
Dunstable
313
Lincoln
227
Plainville
Duxbury
192
Littleton
235
Plymouth
36
' Plympton
Princeton
Provincetown
Quincy .
Randolph
Raynham
Reading
Rehoboth
Revere .
Richmond
Rochester
Rockland
Rockport
Rowe
Rowley
Royalston
Russell .
Rutland
Salem
Salisbury
Sandisfield
Sandwich
Saugus .
Savoy
Scituate
Seekonk
Sharon .
Sheffield .
Shelburne
Sherborn
Shirley .
Shrewsbury
Shutesbury
Somerset
Somerville
South Hadley
Southampton
Southborough
Southbridge
308
299
148
12
95
213
72
178
30
303
263
89
152
339
245
294
268
212
24
196
319
257
59
331
138
127
147
233
239
278
183
96
345
121
8
106
286
206
48
Southwick
243
Warren
156
Spencer ....
109
Warwick
314
Springfield
4
Washington
332
Sterling ....
232
Watertown
29
Stockbridge
226
Wayland
151
Stoneham
74
Webster
64
Stoughton . .,
84
Wellesley
53
Stow ....
266
Wellfleet
289
Sturbridge
203
Wendell
322
Sudbury
225
Wenham
269
Sunderland
273
West Boylston
230
Sutton
176
West Bridgewater
163
Swampscott .
75
West Brookfield
252
Swansea.
130
West Newbury
West Springfield
247
47
Taunton
28
West Stockbridge
276
Templeton
134
West Tisbury
334
Tewksbury
119
Westborough
113
Tewksbury State Infirmary
Tisbury
353
220
Westfield
Westford
46
146
Tolland ....
349
Westhampton
321
Topsfield
270
Westminster
211
Townsend
215
Weston
150
Truro ....
305
Westover Field
363
Tyngsborough
237
Westport
142
Tyringham
341
Westwood
Weymouth
154
35
Upton ....
Whately
283
205
W"hitman
94
U. S. Marine Hospital,
Wilbraham
168
Boston
U. S. Marine Hospital,
360
Williamsburg
Williamstown
238
137
Chelsea
U. S. Marine Hospital,
362
Wilmington
Winchendon
131
110
Tisbury
361
Winchester
57
Uxbridge
117
Windsor .
Winthrop
330
49
Wakefield
31
Woburn
44
Wales ....
324
Worcester
3
Walpole
101
Worthing ton
311
Waltham
27
Wrentham
129
Ware ....
98
Wareham
115
Yarmouth
198
38
Cases and Deaths from Diseases
An-
Ger-
terior
Chicken
Diph-
Dog
man
Gonor-
Popu-
Polio-
Pox
theria
Bite
Mea-
rhea
lation
mye-
sles
Cities and Towns
Esti-
mated
as of
July 1,
litis
in Order of Population
6
55
1941
8
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8
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o
Q
o
Q
O
Q
1
Cities op over 500,000
4,325,108
182
6
11S08
4
123
12
11038
-
2334
-
3791
7
2
Cities op over 150,000
769,520
16
1
2841
16
2
2873
362
1199
3
193,493
6
-
636
-
2
-
593
-
191
-
74
-
Cities of 100,000-150,000 .
689,039
39
1
1910
1
62
8
1484
-
216
-
536
1
4
Springfield
149,510
3
-
623
-
7
2
278
-
62
-
175
-
5
Fall River
115,445
3
-
229
-
48
3
157
-
19
-
51
-
6
Cambridge
110,534
8
-
818
-
1
1
551
-
89
-
87
-
7
New Bedford
110,060
18
1
70
-
1
-
101
-
32
-
101
1
8
Somerville
101,960
6
-
82
1
3
-
191
-
11
-
77
-
9
Lowell .
101,530
1
-
88
-
2
2
206
-
3
-
45
-
Cities and Towns of 50,000-100,000 .
615,706
27
/
1606
1
3
;
1617
-
177
-
330
1
10
Lynn
97,600
7
-
396
-
-
-
331
-
28
-
74
-
11
Lawrence
84,235
1
1
76
-
-
-
132
-
6
-
66
-
12
Quincy
76,285
5
-
436
-
-
-
211
-
16
-
29
-
13
Newton
70,446
2
-
222
-
-
-
186
-
46
-
38
-
14
Medford
63,500
2
-
97
-
1
l
148
-
10
-
26
-
15
Brockton
62,162
8
-
146
-
-
-
107
-
25
-
23
1
16
Maiden
58,005
2
-
97
1
1
-
249
-
26
-
35
-
17
Hclyoke
53,403
-
-
41
-
-
-
100
-
5
-
26
-
18
Brookline
50,070
-
-
95
-
1
-
153
-
15
-
13
_
Cities and Towns of 25,000-50,000
574,207
21
_
1055
-
16
l
1407
_
lis
_
301
1
19
Pittsfield
49,684
4
-
34
-
-
-
60
-
3
-
36
-
20
Everett
46,582
-
-
20
-
1
-
81
-
4
-
34
-
21
Haverhill
46,509
4
-
70
-
-
-
205
-
13
-
35
-
22
Fitchburg
41,965
1
-
15
-
1
-
18
-
1
-
22
-
23
Chicopee
41,382
-
-
62
-
-
-
69
-
2
-
18
-
24
Salem .
40,947
1
-
108
-
-
-
127
-
10
-
18
-
25
Chelsea
40,692
1
-
25
-
4
-
131
-
9
-
21
-
26
Arlington
40,500
-
-
205
-
1
-
138
-
13
-
10
-
27
Waltham
40,115
-
-
44
-
4
-
63
-
1
-
24
-
28
Taunton
37,398
4
-
1
-
2
l
3
-
-
-
11
-
29
Watertown
35,490
1
-
117
-
2
-
144
-
6
-
18
-
30
Revere
34,247
-
-
2
-
1
-
34
-
-
-
32
1
31
Belmont
27,500
-
-
137
-
-
-
139
-
18
-
4
-
32
Melrose
25,603
3
-
96
-
-
-
72
-
21
-
5
-
33
Beverly
25,593
2
-
119
-
-
-
123
-
12
-
13
-
Cities and Towns of 10,000-25,000
729,853
29
_
1945
1
11
_
1959
-
546
-
302
-
34
Northampton .....
24,845
-
-
71
-
-
-
48
-
96
-
7
-
35
Weymouth
24,240
-
-
17
-
-
-
86
-
1
-
10
-
36
Gloucester
24,028
-
-
10
-
1
-
76
-
-
-
8
-
37
Framingham .
23,339
1
-
83
-
1
-
108
-
44
-
20
-
38
North Adams
22,285
-
-
23
-
-
-
50
-
2
-
2
-
39
Leominster
22,277
1
-
42
-
-
-
59
-
4
-
4
-
40
Attleboro
22,108
2
-
44
-
-
-
89
-
11
-
11
-
41
Methuen
21,980
5
-
121
-
-
-
46
-
3
-
6
-
42
Peabody
21,756
-
-
22
-
1
-
39
-
3
-
20
-
43
Gardner
20,306
-
-
30
1
-
-
42
-
1
-
9
-
44
Woburn
19,786
-
-
31
-
-
-
6
-
1
-
9
-
45
Milton .
18,991
-
-
87
-
-
-
43
-
6
-
3
-
46
West field
18,670
-
-
10
-
-
-
47
-
1
-
8
-
47
West Springfield
17,191
1
-
75
-
1
-
20
-
5
-
6
-
48
Southbridge .
17,145
-
-
27
-
-
-
10
-
1
-
2
-
49
Winthrop
16,758
-
-
36
-
-
-
82
-
4
-
9
-
50
Braintree
16,460
-
-
46
-
-
-
106
-
4
-
9
-
51
Wakefield
16,212
1
-
1
-
-
-
63
-
4
-
10
-
52
Greenfield
15,693
-
-
278
-
-
-
50
-
1
-
10
-
53
Wellesley
15,585
1
-
86
-
-
-
86
-
59
-
7
-
54
Dedham
15,554
1
-
6
-
-
-
11
-
2
-
2
-
55
Milford
15,468
-
-
2
-
-
-
45
-
-
-
7
-
56
Norwood
15,424
-
-
1
-
-
-
37
-
2
-
3
-
57
Winchester
15,376
-
-
32
-
-
-
58
-
11
-
6
-
58
Marlborough .
15,100
-
-
4
-
-
-
1
-
1
-
2
-
59
Saugus
14,840
1
-
43
-
3
-
84
-
17
-
10
-
60
Danvers
14,330
2
-
2
-
-
-
13
-
3
-
4
-
61
Natick .
13,883
2
-
27
-
1
-
82
-
101
-
3
-
62
Newburyport
13,771
-
-
168
-
2
-
31
-
2
-
8
-
63
Lexington
13,652
~
-
15
—
-
-
47
~
8
8
39
Dangerous to the Public Health,
1941
Oph-
Lobar
Pneu-
monia
Measles
Menin.
Menin-
gitis
Mumps
thal-
mia
Neo-
na-
Scarlet
Fever
Syphi-
lis
Tuber-
culosis,
Pulmo-
nary
Tuber-
culosis,
Other
Forms
Ty-
phoid
Fever
Whoop-
ing
Cough
torum
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1248
2
799
50
482
291
67
22
10
_
1328
9
106
21
855
1
-
1
95
-
52
-
451
-
232
15
73
36
8
3
3
-
359
2
4
61
15
56
_
1
2
255
-
57
-
406
2
74
6
76
58
8
4
4
-
158
3
5
196
32
904
_
1
1
207
-
27
-
85
-
182
9
109
57
12
6
2
-
496
1
6
28
11
24
-
7
1
140
-
21
-
21
-
149
7
83
53
9
6
-
-
153
1
7
80
19
527
-
-
-
14
-
3
-
255
-
87
4
69
40
13
2
1
-
89
-
8
56
14
39
-
-
-
39
I
21
-
30
-
75
9
72
47
7
1
-
-
73
2
9
549
140
3482
J
14
3
1765
_
133
_
1041
2
536
40
365
174
36
16
7
_
1564
6
98
35
75
-
2
-
503
-
16
-
158
2
98
10
70
42
5
1
-
-
215
-
10
26
21
95
-
_
-
8
-
1
-
10
-
79
4
56
20
9
2
-
-
70
2
11
112
14
520
-
4
1
366
-
1
-
139
-
64
6
55
21
5
3
-
-
270
-
12
65
17
687
-
-
-
229
-
2
-
75
-
59
2
20
17
2
4
2
-
283
-
13
60
11
334
-
1
-
34
-
3
-
90
-
47
2
41
15
6
3
2
-
140
1
14
49
9
701
1
7
2
424
-
106
-
344
-
50
1
22
11
4
-
1
-
258
-
15
40
12
083
-
-
-
25
-
2
-
91
-
61
5
37
19
3
1
-
-
178
-
16
02
11
107
-
-
-
48
-
1
-
109
-
34
6
35
19
1
1
1
-
42
2
17
37
10
220
-
-
-
128
-
1
-
25
-
44
4
29
10
1
1
1
-
108
-
18
495
109
1852
_
7
6
1336
_
42
_
485
2
497
23
289
160
SO
15
10
_
1044
2
7
7
8
-
-
-
21
-
2
-
16
1
30
2
18
9
1
1
-
-
30
-
19
41
11
81
-
1
41
2
-
75
-
47
3
21
16
4
1
-
-
47
-
20
56
9
23
-
_
-
160
-
_
-
69
-
66
3
15
11
1
1
2
-
145
-
21
43
12
12
-
2
3
23
-
1
-
13
_
26
-
30
15
1
-
1
-
52
-
22
17
2
65
-
2
1
28
-
-
-
58
1
25
2
31
13
4
1
2
-
16
-
23
53
13
39
-
-
-
140
-
-
-
19
-
30
2
16
11
1
1
-
-
98
1
24
27
10
216
-
_
-
94
-
2
-
17
-
44
4
26
14
4
1
2
-
14
1
25
34
7
515
-
_
-
92
-
2
_
38
-
26
1
17
10
2
1
2
-
164
-
26
79
6
186
-
1
1
89
-
1
-
42
-
30
2
25
6
1
-
-
-
28
-
27
7
7
-
-
1
-
-
-
-
_
10
-
52
1
24
24
4
2
-
-
1
-
28
20
5
128
-
_
-
127
-
-
-
29
-
32
1
20
11
2
4
-
-
94
-
29
3
8
37
-
-
1
6
-
-
-
11
-
41
1
19
10
2
1
-
-
13
-
30
19
-
331
-
-
-
362
-
27
-
10
-
13
-
5
3
1
1
-
-
201
-
31
31
5
169
-
-
-
122
-
3
-
63
-
14
-
9
5
-
-
-
-
44
-
32
58
7
42
-
-
-
31
-
2
-
15
-
21
1
13
2
2
-
1
-
97
-
33
483
109
3627
/
20
3
1391
3
19
_
1124
4
449
86
338
189
41
13
10
_
1602
8
28
2
40
-
-
-
20
-
2
-
10
-
18
5
9
10
2
1
-
-
13
-
34
9
2
32
-
2
-
1
-
1
—
16
-
11
-
11
9
-
-
-
-
21
-
35
7
3
6
-
1
-
12
-
1
-
1
-
19
-
17
12
2
-
-
-
10
-
36
35
4
273
-
3
_
223
-
-
_
143
1
9
1
17
9
1
-
-
-
118
1
37
15
8
-
-
-
-
9
-
-
-
36
_
10
-
9
5
1
-
1
-
1
-
38
9
3
12
-
_
-
10
-
_
_
21
-
17
1
7
6
1
-
-
-
9
1
39
17
4
32
-
-
-
3
-
-
-
32
1
13
1
11
7
1
-
-
-
73
-
40
8
6
24
-
-
-
22
-
1
-
15
-
20
-
15
8
2
2
-
-
55
1
41
24
1
17
1
_
-
165
-
_
-
17
-
17
1
12
11
2
1
-
-
31
1
42
28
2
12
-
-
-
2
—
3
-
3
_
12
3
7
6
1
-
1
-
33
1
43
7
6
34
-
2
-
_
-
-
_
36
_
15
-
7
6
1
2
1
-
16
-
44
3
1
287
-
1
-
41
-
-
-
23
-
16
-
6
2
1
-
-
-
41
-
45
9
3
17
-
-
-
11
1
-
-
25
-
18
1
14
4
1
46
6
1
77
-
-
-
124
-
-
-
67
_
6
-
8
7
3
-
-
-
91
-
47
10
4
3
_
_
-
18
-
1
_
48
_
9
-
8
2
-
-
-
-
1
-
48
15
2
545
-
-
-
29
_
1
_
21
-
7
-
5
3
1
-
2
-
146
1
49
15
3
90
-
3
-
139
-
1
-
11
-
15
2
12
3
1
-
-
-
102
-
50
9
1
247
-
-
-
78
1
-
-
27
-
10
1
9
3
-
-
-
-
57
-
51
2
3
7
-
-
-
159
-
-
-
23
-
11
5
6
2
-
1
-
-
7
-
52
15
2
155
-
_
-
22
1
-
-
21
_
13
2
6
2
-
-
1
-
61
-
53
5
1
171
-
-
-
4
-
-
-
27
-
5
-
4
5
-
-
-
-
17
-
54
15
1
4
-
1
_
17
_
1
-
2
_
10
1
4
3
1
-
-
-
14
-
55
16
4
65
-
1
_
19
-
2
-
19
_
9
1
5
-
-
-
1
-
3
-
56
11
-
45
-
-
-
12
-
-
-
54
_
12
-
4
5
-
-
-
-
49
-
57
3
3
350
-
-
-
34
-
-
_
39
-
10
-
3
2
-
-
-
-
17
-
58
4
1
192
-
-
-
15
-
-
-
15
-
6
-
9
4
-
-
-
-
62
-
59
19
4
2
-
-
-
2
-
-
-
6
-
7
1
6
1
3
1
1
-
21
1
60
11
4
47
-
-
-
40
-
1
-
175
-
8
1
1
3
1
1
-
-
162
-
61
8
2
4
-
-
-
2
-
-
-
8
-
11
-
2
1
-
-
-
-
35
-
62
28
2
136
-
-
~
7
-
-
-
4
-
6
-
32
3
5
-
-
■
17
~
63
40
Cases and Deaths from Diseases
An-
Ger-
terior
Chicken
Diph-
Dog
man
Gonor-
Popu-
Polio-
Pox
theria
Bite
Mea-
rhea
lation
mye-
sles
Cities and Towns
Esti-
litis
in Order of Population
mated
as of
d
July 1,
1941
-c
ja
J3
Ja
j=
a
3
a
§3
3
03
3
a
ea
C3
§
1
3
o
Q
O
C
o
Q
o
P
O
Q
O
Q
64
Webster
13,209
_
15
1
1
58
7
65
Plymouth
13,106
-
-
35
-
-
-
21
-
1
-
11
_
66
Needham
12,643
-
-
35
-
-
-
63
-
7
-
4
_
67
Adams .
12,598
-
20
-
-
-
12
-
1
-
5
_
68
Clinton .
12,394
-
8
-
T-
-
10
-
-
-
1
_
69
Andover
11,265
-
102
-
-
-
27
-
64
-
4
-
70
Athol .
11,242
-
13
-
-
-
-
-
-
-
9
_
71
Marblehead .
11,128
-
75
-
-
-
90
-
8
_
3
_
72
Reading
11,002
-
28
-
-
-
33
-
1
-
7
-
73
Fairhaven
10,937
5
_
74
Stoneham
10,852
-
54
-
-
-
60
-
3
-
5
_
75
Swamps cott .
10,812
-
77
-
-
-
36
-
3
-
-
-
76
Amesbury
10,734
-
31
-
-
-
41
-
1
-
10
-
77
North Attleborough
10,378
4
-
78
Northbridge .
10,307
-
-
-
-
-
-
-
1
-
3
-
79
Easthampton
10,190
-
12
-
-
-
-
-
-
-
1
-
Towns of 5,000-10,000
889,282
16
_
804
1
6
-
502
_
161
_
169
1
80
Palmer
9,097
-
2
-
1
-
-
-
1
-
5
-
81
Middleborough
9,084
-
8
-
-
-
5
-
6
-
1
-
82
Dartmouth
9,039
-
18
-
-
-
23
-
5
-
3
-
83
Bridgewater
8,884
-
19
-
-
-
21
-
37
-
5
-
84
Stoughton
8,684
-
10
-
1
-
18
-
2
-
6
-
85
Barnstable
8,465
-
5
-
-
-
27
-
5
-
15
-
86
Chelmsford
8,208
-
7
-
-
-
12
-
1
-
3
-
87
Billerica
8,189
-
6
-
-
-
19
-
-
-
1
-
88
Hingham
8,170
-
-
81
-
2
-
34
-
-
-
1
-
89
Rockland
8,157
-
-
-
-
-
-
4
-
-
-
1
-
90
Ludlow .
8,095
-
-
45
-
-
-
1
-
2
-
6
-
91
Concord
8,033
-
-
72
-
-
-
9
-
2
-
1
-
92
Hudson
7,990
4
-
93
Agawam
7,934
-
-
5
-
-
-
-
-
2
-
7
-
94
Whitman
7,774
-
-
1
-
-
-
1
-
-
-
4
-
95
Randolph
7,769
4
-
96
Shrewsbury .
7,669
-
-
6
-
-
-
-
-
2
-
-
-
97
North Andover
7,594
-
-
61
-
-
-
25
-
9
-
2
-
98
Ware
7,578
2
99
Montague . .
7,521
-
-
8
1
-
-
10
-
-
-
3
-
100
Grafton
7,509
-
-
1
-
-
-
2
-
-
-
2
-
101
Walpole
7,463
1
-
1
-
-
-
5
-
-
-
-
-
102
Dracut
7,391
-
-
1
-
-
-
12
-
-
-
1
-
103
Franklin
7,335
-
-
21
-
-
-
3
-
1
-
2
-
104
Falmouth
7,130
3
-
12
-
-
-
35
-
7
-
17
-
105
Millbury
6,985
-
-
5
-
-
-
28
-
14
-
-
-
106
South Hadley
6,866
-
-
11
-
-
-
21
-
3
-
1
-
107
Maynard
6,770
-
-
3
-
-
-
3
-
-
-
7
-
108
Auburn
6,689
-
-
77
-
1
-
1
-
3
-
2
-
109
Spencer
6,686
1
-
65
-
-
-
5
-
3
-
4
-
110
Winchendon .
6,621
-
-
55
-
-
-
10
-
1
-
3
.
111
Mansfield
6,550
-
-
25
-
-
-
25
-
1
-
1
-
112
Amherst
6,475
-
-
29
-
-
-
19
-
17
-
2
-
113
Westborough .
6,468
-
-
2
-
-
-
9
-
5
-
-
1
114
Canton .
6,451
-
-
10
-
-
-
39
-
1
-
6
-
115
Wareham
6,447
4
-
3
-
-
-
-
-
-
-
25
-
116
Ipswich
6,440
-
-
1
-
-
-
-
-
14
-
2
-
117
TJxbridge
6,433
1
-
13
-
-
-
12
-
1
-
2
-
118
Foxborough .
6,421
-
-
11
-
1
-
14
-
5
-
1
-
119
Tewksbury
6,344
-
-
17
-
-
-
7
-
1
-
2
-
120
Longmeadow
5,958
-
-
13
-
-
-
20
-
3
-
-
-
121
Somerset
5,931
-
-
7
-
-
-
-
-
-
-
3
-
122
Great Barrington
5,812
-
-
22
-
-
-
6
-
4
-
4
-
123
Abington
5,688
1
-
124
Monson
5,680
-
-
42
-
-
-
-
-
2
-
1
-
125
Orange
5,640
-
-
2
-
-
-
-
-
-
-
6
-
126
Easton .
5,115
1
-
1
-
-
-
17
-
1
-
2
-
Towns of 2,500-5,000
220,849
15
S
461
_
5
_
849
_
121
_
85
2
127
Seekonk
4,930
128
Leicester
4,901
-
-
129
Wrentham
4,809
-
-
7
-
2
-
7
-
-
-
-
-
130
Swansea
4,776
2
-
-
-
-
-
3
-
-
-
1
-
131
Wilmington .
4,723
-
-
1
-
-
-
-
-
-
-
1
-
132
Oxford .
4,706
-
-
19
-
-
-
16
-
5
-
2
-
133
Dudley .
4,659
1
-
1
-
134
Templeton
4,656
~
_
~
~
-
1 1 1
"
1
—
41
Dangerous to the Public Health,
1941 —
Continued.
Oph-
Lobar
Pneu-
monia
Measles
Menin.
Menin-
gitis
Mumps
thal-
mia
Neo-
na-
Scarlet
Fever
Syphi-
lis
Tuber-
culosis,
Pulmo-
nary
Tuber-
culosis,
Other
Forms
Ty-
phoid
Fever
Whoop-
ing
Cough
toriuni
-a
3
Ja
a
%
Ja
8
Js
J3
73
1
m
.&
6
8
C3
«
C3
0)
1
s
§
a
3
"o3
£
"o3
03
"5
3
2
3
V'
c§
8
§
"3
§
o
Q
o
P
u
a
o
a
O
Q
c
Q
o
Q
o
Q
o
Q
o
Q
Q
Q
3
2
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42
Cases and Deaths from Diseases
Cities and Towns
in Order of Population
Popu-
lation
Esti-
mated
as of
Julyl,
1941
An-
terior
Polio-
mye-
litis
Chicken
Pox
Diph-
theria
Dog
Bite
Ger-
man
Mea-
B lacks tone
Med field
Williamstown
Scituate
Lee
Dalton .
Acushnet
Westport
Bedford
Holden
East Bridgewater .
Westford
Sharon .
Provincetown
Ayer
Weston .
Wayland
Rockport
Belchertown .
Westwood
Barre .
Warren .
East Longmeadow
Nantucket
Bourne ■ •
North Brookfield .
Holbrook
Medway
West Bridgewater .
Norton
Pepperell
Hopedale
Cohasset
Wilbraham .
Holliston
North Reading
Lancaster
Dighton
Bellingham .
Lenox
Hanover ,
Sutton .
Kingston
Rehoboth
Acton
Hopkinton
Douglas
Deerneld
Shirley
Hanson
Charlton
Groton
Hadley .
Harwich
Marshfield
Towns of 1,000-2,500
Ashland
Manchester .
Duxbury
Northborough
Middleton
Norfolk
Salisbury
Lynnfield
Yarmouth
Millis .
Burlington .
Avon
Merrimac
Sturbridge
Ashburnham .
Upton .
Southborough
4,554
4,422
4,342
4,256
4,242
4,205
4,151
4,101
3,957
3,930
3,862
3,857
3,784
3,652
3,635
3,623
3,575
3,548
3,548
3,534
3,529
3,503
3,411
3,368
3,367
3,340
3,328
3,314
3,252
3,152
3,137
3,129
3,113
3,081
3,016
3,003
2,970
2,963
2,953
2,901
2,882
2,824
2,796
2,751
2,727
2,713
2,669
2,661
2,630
2,617
2,607
2,563
2,564
2,560
2,517
158,650
2,489
2,452
2,441
2,435
2,426
2,401
2,398
2,373
2,347
2,345
2,343
2,327
2,312
2,283
2,276
2,276
2,238
10
450
7
43
Danger
ous to the Public Health,
1941 —
• Continued
Oph-
Lobar
Pneu-
monia
Measles
Menin.
Menin-
gitis
Mumps
thal-
mia
Neo-
na-
Scarlet
Fever
Syphi-
lis
Tuber-
culosis,
Pulmo-
nary
Tuber-
culosis,
Other
Forms
Ty-
phoid
Fever
Whoop-
ing
Cough
torum
6
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-
-
-
-
43
-
181
-
_
71
-
_
-
2
-
-
-
-
-
-
-
-
1
-
-
1
-
-
-
182
3
1
1
1
7
-
183
2
1
13
4
2
4
5
1
5
1
1
5
184
185
186
-
1
1
2
187
_
_
9
8
1
1
1
-
1
_
_
_
_
188
189
78
80
5m
6
2
847
/
m
/
123
9
64
40
5
5
2
_
878
1
1
-
38
-
-
-
5
-
-
-
28
-
-
-
-
-
-
-
76
.90
~
-
-
-
1
-
17
2
-
-
-
-
-
7
-
1
1
-
-
-
-
3
1
1
L91
192
3
1
-
-
-
-
1
-
-
-
2
-
1
2
-
1
2
-
-
-
-
_
-
193
194
6
-
2
_
_
-
1
-
-
-
4
-
_
-
17
1
-
95
4
-
1
4
-
-
-
39
-
-
-
2
-
6
-
-
-
-
-
-
-
1
1
-
-
96
97
1
1
4
-
1
-
-
-
-
-
2
1
2
-
-
1
-
-
-
-
2
-
98
1
-
1
-
_
-
2
-
-
-
1
-
-
-
1
-
-
-
-
-
1
-
99
-
-
2
-
-
-
-
-
-
-
35
-
3
3
1
3
1
1
-
-
-
-
2
- \
00
01
1
-
-
-
_
-
1
-
-
-
1
-
4
-
2
2
-
-
-
-
1
- i
02
1
3
2
6
- i
03
6
1
1
_
_
-
3
_
_
_
5
-
2
-
1
1
- i
04
-
1
45
19
2
6
- V
05
1
72
"I
-
-
5
~
~
-
-
-
~
"1
"1
-
~
"1
~
—
1
- ti
06
44
Cases and Deaths from Diseases
An-
Ger-
terior
Chicken
Diph-
Dog
man
Gonor-
Popu-
Polio-
Pox
theria
Bite
Mea-
rhea
lation
mye-
sles
Cities and Towns
Esti-
litis
in Order op Population
mated
as of
o
55
July 1,
1941
Js
-Q
-a
a
3
3
S
3
9
O
(4
o
U
o
Q
o
Q
a
«
o
u
207
2,228
_
_
5
_
_
_
1
_
1
_
_
-
208
Hatfield
2,185
-
-
7
-
-
-
4
-
-
-
2
-
209
Hull
2,182
-
-
1
-
-
-
8
-
10
-
5
-
210
2,161
-
-
1
-
-
-
-
-
-
-
2
-
211
2,151
212
2,149
-
-
3
-
-
-
-
-
-
-
-
-
213
2,141
214
2,117
1
-
1
-
-
-
4
-
8
-
1
-
215
2,103
-
-
1
-
-
-
-
-
2
-
-
-
216
2,096
-
-
2
-
-
-
3
-
fi
-
-
-
217
2,078
-
-
4
-
-
-
5
-
1
-
11
-
218
2,037
2
-
219
2,037
-
-
2
-
-
-
5
-
1
-
1
-
220
2,018
1
-
221
1,985
-
-
6
-
-
-
4
-
8
-
-
-
222
Norwell
1,914
-
-
-
-
-
-
4
-
1
-
1
-
223
1,890
-
-
29
-
-
-
4
-
-
-
-
-
224
1,857
-
-
7
-
-
-
4
-
-
-
-
-
225
1,825
1
-
226
1,821
-
-
1
-
-
-
. 4
-
2
-
2
-
227
1,818
228
1,805
1
-
-
-
-
-
2
-
-
-
-
-
229
Georgetown
1,798
-
-
59
-
-
-
20
-
-
-
-
-
230
1,786
3
231
1,745
232
1,739
1
-
3
-
-
-
6
-
-
-
-
-
233
Sheffield
1,715
-
-
5
-
-
-
4
-
-
-
1
-
234
1,709
-
-
2
-
-
-
-
-
-
-
-
-
235
1,676
1
236
Millville
1,675
237
1,667
-
-
55
-
1
-
1
-
6
-
-
-
238
1,659
-
-
-
-
-
-
1
-
-
-
-
-
239
1,647
-
-
16
-
-
-
3
-
3
-
-
-
240
1,620
241
Oak Bluffs
1,615
2
-
242
1,606
243
1,592
1
-
-
-
-
-
6
-
-
-
1
-
244
1,576
1
l
245
1,554
3
246
1,530
247
1,512
-
-
-
-
-
-
1
-
-
-
1
-
248
1,509
-
-
29
-
-
-
-
-
14
-
1
-
249
1,484
-
-
-
-
-
-
7
-
1
-
1
-
260
1,479
1
-
-
-
-
-
2
-
-
-
-
-
251
1,424
252
West Brookfield ......
1,403
-
-
1
-
-
-
7
-
1
-
3
-
253
Brookfield ......
1,398
-
-
11
-
-
-
3
-
1
-
1
-
254
1,395
-
-
3
-
-
-
-
-
1
-
2
-
255
1,381
256
1,374
1
267
1,352
258
1,351
1
-
259
1,340
260
1,339
1
-
261
1,335
10
262
1,319
263
1,284
2
-
264
1,267
266
1,262
1
266
1,255
1
267
1,246
268
1,242
-
-
2
-
-
-
2
-
-
-
1
-
269
1,232
-
-
4
-
-
-
4
-
1
-
2
-
270
Topsfield
1,170
-
-
-
-
-
-
1
-
7
-
-
-
271
1,130
272
Granby
1,108
273
1,077
-
-
6
-
-
-
-
-
-
-
-
-
274
1,064
275
1,056
1
276
1,055
-
-
1
-
-
-
-
-
-
-
1
-
27V
1,031
-
-
16
-
-
-
-
-
-
-
-
-
278
1,030
1
279
East Brookfield
1,027
-
-
1
-
-
-
5
-
1
-
-
_
280
1,027
-
-
-
-
-
-
-
-
1
-
1
_
281
1,023
45
Dangerous to the Public Health,
W^i
Continued
Lobar
Pneu-
monia
Measles
Menin.
Menitt-
gitis
Mumps
Oph-
thal-
mia
Neo-
na-
torum
Scarlet
Fever
Syphi-
lis
Tuber-
culosis,
Pulmo-
nary
Tuber-
culosis,
Other
Forms
Ty-
phoid
Fever
Whoop-
ing
Cough
J3
o
6
■a
Q
o
Is
Q
J3
Q
03
o
Q
o
Q
6
'3
Q
6
i
J3
"cl
Q
i
J3
o
a
3
3
4
3
1
2
1
3
5
1
1
2
1
4
2
3
1
1
2
3
1
3
2
1
1
2
1
1
1
2
2
1
1
2
1
1
1
1
1
1
1
1
2
40
3
36
34
2
14
63
13
2
2
1
2
4
33
4
2
43
2
1
1
1
21
4
1
3
8
1
2
1
2
1
1
21
-
1
1
1
1
1
1
14
4
13
37
35
Jl
1
2
1
4
9
1
6
1
1
6
1
1
1
74
5
13
2
2
1
-
1
-
3
13
9
1
3
7
4
2
2
5
3
2
1
1
4
1
4
7
14
5
1
1
1
2
2
4
1
5
1
1
1
1
8
5
-
3
4
4
1
1
2
1
2
1
5
3
4
2
1
1
2
1
1
1
1
5
2
3
2
5
1
1
2
1
1
1
1
1
1
1
1
1
i
i
i
i
2
2
2
1
1
1
5
2
2
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
I
9
1
1
1
2
1
2
1
1
1
1
1
1
1
1
1
i
i
i
i
i
i
i
i
i
i
1
1
-
2
15
7
6
1
16
26
2
41
36
1
14
27
6
3
2
2
3
2
8
15
8
2
2
4
4
1
12
13
2
207
20s
209
210
211
212
213
214
215
210
217
218
219
220
221
222
223
224
225
220
227
22S
229
230
231
232
233
234
235
236
237
23S
239
240
211
242
243
244
245
246
247
248
24(1
250
251
252
253
254
255
256
257
258
259
200
201
202
203
204
265
266
267
268
269
270
271
272
273
274
275
270
277
278
27!)
280
281
46
Cases and Deaths from Diseases
An-
Ger-
terior
Chicken
Diph-
Dog
man
Gonor-
Popu-
Polio-
Pox
theria
Bite
Mea-
rhea
lation
mye-
sles
£itte6 and Towns
Esti-
litis
in Order of Population
mated
as of
o
July 1,
!5
1941
ja
ja
3
s
a
$
Q
3
Q
S3
0
p
03
55
Q
3
O
Towns under 1,000 ....
34,559
_
_
67
_
_
_
S3
_
18
_
IS
-
282
967
-
-
3
-
-
-
1
-
-
-
-
-
283
Whately
961
1
284
961
-
-
5
-
-
-
1
-
-
-
-
-
285
955
1
286
951
-
-
-
-
-
-
2
-
-
-
1
-
287
949
-
-
2
-
-
-
-
-
-
-
-
-
288
Gill
925
-
-
3
-
-
-
-
-
9
-
-
-
289
Wellfleet
897
-
-
-
-
-
-
3
-
-
-
1
-
290
883
1
291
873
-
-
4
-
-
-
-
-
-
-
-
-
292
833
1
293
804
294
801
295
793
-
-
11
-
-
-
8
-
5
-
-
-
296
787
4
-
297
776
298
768
1
-
299
713
300
690
301
689
-
-
1
-
-
-
-
-
-
-
-
-
302
668
-
303
629
2
-
304
616
-
-
-
-
-
-
1
-
-
-
-
-
305
593
-
-
11
-
-
-
-
-
2
-
-
-
306
307
Pelham
585
581
:
1
-
308
534
1
-
309
310
311
496
472
470
:
312
458
-
-
7
-
-
-
1
-
-
-
1
-
313
454
-
-
1
-
-
-
-
-
1
-
-
-
314
452
-
315
445
1
-
316
442
1
-
317
434
-
318
422
-
-
-
-
-
-
2
-
-
-
-
-
319
421
-
-
1
-
-
-
-
-
-
-
-
-
320
415
_
321
322
Westhampton
Wendell
405
394
-
323
324
383
367
:
2
-
325
364
-
-
1
-
-
-
8
-
-
-
-
_
326
361
_
327
351
_
328
330
_
329
320
-
-
-
-
-
-
1
-
-
-
-
_
330
331
307
300
-
332
272
_
333
260
_
334
260
_
335
336
337
338
259
259
251
236
-
339
226
340
341
342
343
344
345
Alford
Middlefield
224
210
206
201
201
188
1
-
346
181
-
-
3
-
-
-
-
-
-
—
_
347
Peru
145
348
137
-
349
129
350
124
351
352
88
57
353
Tewksbury State Hospital
47
Danger
cms to £Ae Public Health,
1941 —
■ Continued
Lobar
Pneu-
monia
Measles
Menin.
Menin-
gitis
Mumps
Oph-
thal-
mia
Nec-
na-
torium
Scarlet
Fever
Syphi-
lis
Tuber-
culosis,
Pulmo-
nary
Tuber-
culosis,
Other
Forms
Ty-
phoid
Fever
Whoop-
ing
Cough
a
O
2
i
O
J3
1
Q
3
Q
1
P
o
1
i
la
Q
i
,3
Q
"5
Q
i
i
.a
Q
d
a
►3
8
1
1
2
1
1
1
1
25
2
1
1
87
2
8
23
1
1
36
9
3
U
2
3
6
1
1
1
56
S
1
1
1
7
1
2
3
1
-
282
283
284
285
286
287
288
289
290
291
292
293
294
295
296
297
298
299
300
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340
341
342
343
344
345
346
347
348
349
350
351
352
353
48
Cases and Deaths from Diseases
An-
Ger-
terior
Chicken
Diph-
Dog
man
Gonor-
Popu-
Polio-
Pox
theria
Bite
Measles
rhea
lation
mye-
Cities and Towns
Esti-
litis
in Order of Population
mated
as of
o
Julyl,
m
m
1941
.a
ja
8
a
S
o
a
<D
a
s
o
(A
o
a
O
«
O
Q
O
«
o
O
354
1
227
116
355
_
-
1
-
-
-
-
-
n
-
64
-
356
1
-
3
-
_
-
_
_
89
_
39?
_
357
3
_
358
1
-
359
Navy Yard
1
-
-
-
-
-
-
-
1
-
16
-
360
TJ. S. Marine Hospital, Boston
24
-
361
U. S. Marine Hospital, Tisbury
1
_
362
U. S. Naval Hospital, Chelsa .
65
-
363
-
-
-
-
-
~
-
-
8
"
24
-
49
Dangerous to the Public Health, 1941 ■
— Concluded.
Lobar
Pneu-
monia
Measles
Menin.
Menin-
gitis
Mumps
Oph-
thal-
mia
Neo-
na-
torum
Scarlet
Fever
Syphi-
lis
Tuber-
culos s,
Pulmo-
nary
Tuber-
culosis,
Other
Forms
Ty-
phoid
Fever
Whoop-
ing
Cough
i
Q
I
Ja
Is
CD
Q
o
3
o
o
CS
Q
•5
J3
P
CS
.a
"8
Q
o
Is
Q
i
Is
Q
a
Q
o
c
2
51
-
27
6
131
1
3
:
8
2
-
12
15
2
4
:
:
:
7
16
71
=
11
4
46
1
1
18
13
3
:
:
:
:
1
-
-
1
:
354
355
35(5
357
358
359
300
301
302
363
50
In addition to the above, there occurred 4 cases
of actinomycosis with 2 deaths:
Cases Deaths
Boston .... 1 -
Chicopee .... 1 -
Maiden .... 1
Reading .... 1 1
Southbridge ... - 1
7 cases of anthrax with 1 death:
Holyoke .... 1 -
Lynn .... 1 -
Maiden .... 1
Peabody .... 2
Springfield. ... 1 -
West Boylston ... 1 1
4 cases of amebic dysentery:
Boston .... 2
Fitchburg .... 1 -
Worcester .... 1 -
303 cases of bacillary dysentery with 6 deaths:
Adams .... 1 -
Arlington .... 2 -
Ayer .... 16 -
Belmont ... 4 -
Boston .... 10 -
Brockton .... 1 1
Cambridge . . . 2 • -
Danvers .... 19 1
Dracut .... 2 -
Dunstable ... 91 -
Easthampton ... 3 -
Fairhaven ... 1 -
Fall River .... 3
Framingham ... 1 -
Holliston .... 4
Ipswich .... 10 -
Lawrence .... 1 1
Lowell .... 9
Lynn .... 13 -
Medford .... 1
Melrose .... 9
Northampton ... 2 -
Peabody .... 1 -
Revere .... - 1
Russell .... 1 -
Salem .... 1 -
Seekonk .... - 1
South borough ... 1 -
Springfield. ... 1 -
Stoneham .... 1 —
Waltham .... 18
Watertown ... 2 -
Winchester ... 1 -
Worcester .... 70 1
Wrentham. ... 1 -
21 cases of encephalitis infectious, with 13
deaths:
Agawam .... 1
Attleboro
Beverly
Cambridge ... 1
Danvers .... 1 -
Dedham .... 1 -
Fall River ... 2 1
Gardner .... - 1
Greenfield ... - 1
Hadley .... - 1
Haverhill .... - 1
Holyoke .... - 1
Lawrence .... — 1
Lowell
Lynn
Maiden
Middleborough
Milton .... - 1
New Bedford ... 1 1
Scituate .... 1 1
Springfield.
Sterling
Taunton .
Waltham .
Watertown
Westford .
Winthrop
Worcester
10 cases of malaria with 1 death
Boston
Fort Banks
Foxboro
Haverhill .
Winthrop
therapeutic.
14 cases of meningitis, Pfeiffer bacillus with
21 deaths:
Arlington
Attleboro
Boston
Brockton
Chicopee
Dedham
Everett
Fitchburg
Framingham
Gloucester
Lancaster
Maynard
Methuen
Newbury
Northampt
Orange
Palmer
Revere
Salem
Scituate
Springfield
Waltham .
Weymouth
Wilmington
Woburn
Worcester .
17 cases of men
Arlington .
Boston
Braintree .
Brockton .
Cambridge
Fort Devens
Gloucester
Haverhill .
Lawrence .
Lowell
Norwell
Quincy
Weymouth
Worcester .
5 cases of meningitis
Boston
Chicopee
East Bridgewater
Taunton
Winthrop
ingiti
Cases
1
1
1
1
Deaths
s, pneumococcal:
1
1
1
1
1
1
3
2
1
1
1
1
1
1
other forms:
1
1
1
1
1
77 cases of paratyphoid fever and all other
Salmonella infections with 1 death:
Adams
Belmont .
Beverly
Boston
Brookline
Cambridge
Charlton .
Chelmsford
Everett
Fort Banks
Fort Devens
Foxborough
Haverhill
Ipswich
Lawrence
Lexington
Lowell
Lynn
Maiden
Marblehead
Medford .
Northampton
Norwood
Peabody .
Salem
Saugus
Tewksbury State Hospital
Waltham .
Westwood
Winchester
Worcester .
18 cases of pellagra with 7
Adams
Boston
Fall River
Grafton
Newton
North Adams
Peabody .
Quincy
Wakefield .
2
1
3
7
1
3
1
1
1
1
1
1
2
1
1
10
2
2
14
1
3
1
1
2
6
1
1
1
2
1
2
deaths:
10
1
3
51
Cases
Deaths 50 cases of trichinosis:
West Brookfield . . — ■
1
Cases Dea
Winchendon ... 1
1
Attleboro .... 6
171 cases of septic sore throat with 22 deaths:
Amesbury ... 3
Boston .... 10
Camp Edwards . . 17
Chelsea .... 2
Andover .
3
-
Everett .... 1
Arlington .
1
—
Fall River ... 1
Ashland
Bernardston
1
3
-
Framingham ... 4
Gloucester ... 1
Beverly
Boston
Boxford
9
61
1
1
4
Lawrence .... 1
Medford .... 2
Middleborough ... 1
Brockton .
Cambridge
2
4
-
Southbridge ... 2
Wakefield .... 1
Chelsea
Chicopee .
1
1
2
Worcester .... 1
Concord . .
2
184 cases of tuberculosis, hilum:
Easton
1
_
Boston . . . .160
Everett
1
_
Brookline ... 1
Fall River
20
1
Cambridge ... 1
Fort Banks
1
Framingham ... 1
Fitchburg .
1
Haverhill .... 2
Framingham
1
—
Lawrence .... 2
Gill .
1
_
Lexington .... 1
Greenfield
2
1
Lowell .... 2
Hanson . .
2
Maiden .... 2
Hingham .
1
_
New Bedford . . .2
Holyoke
1
—
Quincy .... 3
Ipswich
-
1
Salem .... 1
Lexington .
1
_
Springfield. ... 1
Lowell
1
_
Wakefield .... 2
Lynn
4
_
Watertown ... 1
Maiden
2
1
Westfield .... 2
Marlborough
-
2
1 case of tularemia:
Medford .
8
-
Lawrence .... 1
Merrimac
4
Milford
1
2 cases of typhus fever:
Millbury .
Milton
1
2
Chelmsford ... 1
Northampton ... 1
Monson
-
86 cases of undulant fever with 2 deaths
New Braintree .
—
Acton .... 1
Newton
2
2
Adams .... 2
Norfolk .
-
Amherst .... 1
Oxford
2
—
Arlington .... 1
Peabody .
-
Athol .... 1
Plymouth .
—
Boston .... 2
Revere
2
—
Bridgewater ... 1
Salisbury .
1
Brockton .... 2
Scituate
—
Brookfield ... 1
Somerville
2
Carver . . . . 1
Springfield .
1
Deerfield .... 1
Waltham .
3
-
Falmouth ... 1
West Springfield
-
Franklin .... 1
Weymouth
-
Gloucester ... 2
Williamstown
2
-
Great Barrington . . 2
Winchester
—
Haverhill .... 1
Worcester .
-
Hopkinton ... 1
Wrentham .
—
Hudson .... 1
Yarmouth
1
Leominster ... 16
19 cases of tetanus w
ith 5 <
leaths :
Littleton .... 1
Attleboro .
1
Lowell .... 2
Boston
1
Medford .... 1
Brockton .
Milford .... 1
Cambridge
_
Montague ... 2
Concord
_
Newburyport ... 1
Dudley
Hingham .
Lowell
1
Newton .... 1
Norfolk .... 1
North Adams ... 2
Methuen .
North Brookfield . . 1
Middleborough .
1
Northampton ... 1
New Bedford
1
Northbridge ... 1
Quincy
Saugus
Orange .... 1
Palmer .... 1
Swampscott
Wakefield .
-
Pittsfield .... 2
Plymouth .... 1
Woburn
_
Reading .... 1
Worcester .
-
Royalston ... 1
Sheffield .... 1
24 cases of trachoma
Shelburne .... 2
Arlington .
-
Somerset .... 1
Boston
-
Somerville ... 1
Burlington
-
Stockbridge ... 1
Cambridge
-
Templeton ... 1
Dedham .
—
Uxbridge .... 1
Everett
-
Walpole .... 1
Fall River
—
Warren .... 1
Haverhill .
-
Wayland .... 1
Lynn . .
—
Webster .... 2
Milford
-
Wellesley .... 1
Natick
—
West Brookfield . . 2
New Bedford
-
Westborough ... 1
Peabody .
—
Westford .... 2
Springfield .
-
Whitman .... 1
Worcester .
2
-
Worcester ... 5
52
THE DIVISION OF FOOD AND DRUGS
Hermann C. Lythgoe, Director
The Food and Drug Division during the year 1941 has been engaged in the usual
routine work relative to the enforcement of the laws pertaining to the sale of milk,
foods and drugs; the slaughtering laws; the cold storage laws: the bakery laws;
the frozen dessert laws; the laws pertaining to the pasteurization of milk; the laws
pertaining to the bottling of carbonated nonalcoholic beverages; certain phases
of the narcotic law; the law pertaining to the sale of wood alcohol; the laws per-
taining to the sale of articles of bedding and upholstered furniture; and examination
of liquors, chemicals, etc. for Police Departments.
There has been a reduction in the number of samples of improperly pasteurized
milk and a great increase in the number of samples of pasteurized milk with high
bacteria counts. This has been traced largely to the substitution of dirty milking
machines for cream and milk because of the difficulty in securing help.
There has been a great increase in the sale of decomposed meats, particularly
hamburg steak, sausage, and sausage meat. Violations pertaining to the sale of
adulterated olive oil, while many, show a reduction over recent years. Violations
of the sanitary food law show an increase due to difficulty in securing help. There
has also been an increase in violations of the law pertaining to articles of bedding
and upholstered furniture. The actual number of prosecutions was slightly less
than in 1940.
Table 1. — Prosecutions for Violations of the Food and Drug Laws
For Sale of Milk not of Good Standard Quality
Name Address Court Date Result
Clover Luck Dairy, Inc. . Newton . . . Newton . . . Oct. 9, 1941 Conviction 1
Green Parrott, Inc. . . North Cambridge . Cambridge . . Aug. 22, 1941 Conviction
For Sale of Milk from Which a Portion of the Cream Had Been Removed
Fenway Farms Dairy, Inc. East Longmeadow
Springfield
. May
9,
1941
Conviction
Smith, William Henry
Great Barrington
Great Barrington . June
7,
1941
Conviction
For Sale of Milk Containing Added Water
Clark, Josenh W.
West Brookfield
Brookfield
. Mar.
14
1941
Conviction
Cronin, William
Methuen
Methuen .
. Oct.
10,
1941
Conviction 2
Hagopian, Kapreal
Marlborough
Marlborough .
Jan.
17,
1941
Conviction
Hood & Sons, H. P., Inc.
Newburyport
Newburyport .
Jan.
27,
1941
Conviction -
Jackson, Mrs. Emma N.
Berkley
Taunton
Apr.
17,
1941
Conviction
Medeiros, Joseph
Taunton
Taunton
Apr.
17
1941
Conviction
Mickewicz, Anthony.
North Wilmington
Woburn .
. July
10,
1941
Conviction
Noel, Felix
Granby
Northampton .
. Feb.
13,
1941
Conviction
Patch, Frank G.
Wilmington .
Woburn .
. July
10,
1941
Conviction !
Patch, Frank G.
Wilmington .
Woburn
July
10,
1941
Conviction
Simard, John D.
Pelham
Northampton .
July
18,
1941
Conviction
Tumidajewicz, Jr., Joseph Willimansett
Chicopee .
Apr.
28,
1941
Conviction
Whitaker, Gowen3 .
Chester
Westfield
Apr.
17,
1941
Conviction
Representing Unpast
zurized Milk as 1
Pasteurized
Angelo, Ant one .
New Bedford
. New Bedford .
. Feb.
28,
1941
Discharged
Bean, Charles A.
Sherborn
Natick
May
2,
1941
Conviction
Bellerose, Rosaire
Charlton
Southbridge
. Feb.
14,
1941
Conviction
Choiniere, Arthur 4
Webster
Webster .
. Sept.
30,
1941
Conviction
Cronin, Joseph .
Methuen
Methuen .
. Oct.
10,
1941
Conviction -
Cronin, William
Methuen
Methuen .
.. Oct.
10,
1941
Conviction 2
Dolinski, Michael
Westfield
. Westfield
. Aug.
7,
1941
Conviction
New Bedford Creamery,
Inc.
New Bedford
New Bedford .
. Feb.
28,
1941
Discharged
Oaks Farm, Inc.
Coh asset
Quincy
• . Oct.
1,
1941
Conviction
Reynolds, Charles H.
Ludlow
Springfield
. May
9,
1941
Conviction 2
Robinson, James A. .
Waltham
Waltham
. Feb.
13,
1941
Dismissed
Souza, Manuel .
Dartmouth .
New Bedford .
June
20,
1941
Conviction
1 Guilty, $50 fine — suspended.
2 Appealed.
3 Two cases.
4 A cream sample.
For Violation of Pasteurization Law and Regulations
Name
Harnisch, Ernest
.Harper, David .
Hood & Sons, H. P.
Lanzillo, Frank .
Pocius, Gus
Slosek, John
Slosek, Thomas
Velantzas, Anastos
Velozo, John
Inc.2
Address
Methuen
Lancaster
Charlestown
Wakefield .
Middleborough
Ludlow
Ludlow
Lowell .
Somerset
Court
Lawrence .
Clinton
Charlestown
Maiden
Middleborough
Springfield
Springfield
Lowell
Fall River.
Date
Jan. 13, 1941
Aug. 19, 1941
May 13, 1941
Feb. 26, 1941
Jan. 14, 1941
May 16, 1941
May 16, 1941
Jan. 20, 1941
Feb. 25, 1941
53
Result
Conviction i
Conviction
Conviction
Conviction
Conviction
Conviction
Dismissed
Conviction
Conviction
For Violation of the Milk Grading Regulations
Clover Leaf Dairy, Inc. .
Southbridge
Southbridge
. July
28
1941
Conviction
Hescock, Harry A.
Westfield
. Westfield
. July
31
1941
Conviction
Hood & Sons, H. P., Inc..
Springfield .
Springfield
. Mar.
7,
1941
Conviction
Kobritz, Nathan
Pittsfield
. Pittsfaeld .
. July
11,
1941
Conviction
Nelson, Frank .
Charlton
Southbridge
. July
28,
1941
Conviction
Rhinehart, Miller
Lanesborough
. Pittsfield .
■ July
23,
1941
Conviction
Weeks Creamery, Inc.
Chicopee
Chicopee .
Apr.
11,
1941
Conviction
For Use of Unclean Utensils in Handling Milk
Miller, Edward J. . . Amherst . . . Northampton . . Apr. 30, 1941 Conviction
Munsell, Frank . . . Hampden . . . Springfield . . Sept. 5, 1941 Conviction
For Sale of Adulterated or Misbranded Foods other than Milk and Milk Products
Clams
I Water)
. May 6, 1941 Conviction >
. Apr. 30, 1941 Conviction3
. May 6, 1941 Conviction
. Sept. 30, 1941 Conviction
(Contained Added Water)
Botticelli, Anthony .
Revere
Boston
Dow, George R.
Salisbury
Amesbury
Savage, Carl
Rowley
Boston
Sta-ws, I. W.
Boston
Boston
Hamburg Steak
(Contained Pork in Violation of the Regulations of the Department)
Bernstein, Hyman
Holyoke
Holvoke
Jan. 30, 1941 Conviction
Hamburg Steak
(Violation of the Law Relative to Use of Sodium Sulphite in Meat and Meat Products)
Alter, William . . Roxbury . . . Roxbury . . June 25, 1941 Conviction
Linehitz, Leonard
Marvin Food Co., Inc.
Pasquale, Enrico
Roover, Albert C.
Woburn
Somerville .
W altham
South Boston
Woburn
Somerville
Waltham
South Boston
Feb. 12, 1941
Nov. 19, 1941
Aug. 8, 1941
Nov. 5, 1941
Conviction
Conviction
Conviction
Conviction
Cimini, Paul
Dearo, Donald
Dearo, Donald .
Del Castello, Mary 4
Gandolfo, John .
La Flatta, Antonio
Lalos, Donatos
Manzi, L. A., Inc. 6
Mazzarelli & Sons, S,
Moroni, Fred
Previte, Dominick
Rapallo, Joseph4
Teti, Joseph
Inc.1
Olive Oil
(Contained Edible Oil Other than Olive
Oil)
Pittsfield
Utica, N. Y.
Utica, N. Y.
Southboro .
Boston
North Attleborough
Southbridge
Worcester
Milford
Holyoke
Boston
Medford
Utica, N. 1
Pittsfield .
Springfield
Pittsfield .
Westboro .
Somerville
Attleboro .
Southbridge
Southbridge
Milford .
Holyoke .
Cambridge
Maiden
Springfield
. Sept.
4
1941
Conviction
. July
22
1941
Conviction
. Oct.
20
1941
Conviction
. . . July
23
1941
Discharged
June
11
1941
Conviction
. Dec.
3,
1940
Conviction
. Nov.
5,
1941
Conviction
. Mar.
21
1941
Conviction
June
27
1941
Conviction '
. July
17,
1941
Conviction
Apr.
24,
1941
Conviction '
Apr.
29,
1941
Conviction
. July
22,
1941
Conviction
Colicci, Luciano
Mazzarelli & Sons, S., Inc.
Previte, Dominick
Olive Oil
(Misbranded Oil)
Providence, R. I.. . Southbridge
Worcester
Cambridge
Milford
Boston
Apr. 30, 1941 Conviction
Sept. 10, 1941 Conviction
Apr. 24, 1941 Conviction
1 Appealed.
2 Involving 2 cases.
3 Guilty, $100 fine: suspended and put on probation for 2 years.
4 Involving 1 case of misbranding.
5 Involving 3 counts on adulteration ; 3 counts on misbranding.
54
For Sale of Adulterated or Misbranded Foods other than Milk and Milk Products -
Continued
Name Address Coubt Date Result
Sausage and Sausage Meat
(Violation of the Law Relative to Use of Sodium Sulphite in Meat and Meat Products)
Alpert, Jennie . . . Roxbury . . . Roxbury . . . Feb. 28, 1941 Conviction
Big Bear Meat Department,
Inc Cambridge . . Cambridge
Consumers' Provision Co.,
Inc Worcester . . . Worcester
Contas Brothers, J. S.,
Waltham . . . Waltham . . Aug. 8, 1941 Conviction
Inc,
Fiermont, Charles
Grupposo, Antonio
Pasquale, Enrico
Viscosi, Fillameo
Newton
Natick .
Waltham
Worcester
Newton
Natick
Waltham
Worcester
Sept. 26, 1941 Conviction
Apr. 25, 1941 Conviction
Jan. 24, 1941 Conviction
Jan. 14, 1941 Conviction
Aug. 8, 1941 Conviction
Apr. 25, 1941 Conviction
Sausage and Sausage Meat
(Excessive Cereal or Vegetable Substance)
Colonial Provision Co.,
Inc. 1 Boston
Colonial Provision Co.,
Inc. l ... Boston
Colonial Provision Co.,
Inc. ' Boston
Colonial Provision Co.,
Inc. ' ... Boston
Morrison, Hugh. . . Everett
Omaha Packing Co., Inc. Lowell .
Omaha Packing Co., Inc. Boston
Omaha Packing Co., Inc.2 Lowell .
United Sausage Co., Inc. Lynn
Boston
New Bedford
Fall River.
Taunton .
Boston
Fall River.
Boston
Worcester
Taunton .
Sept. 30, 1941 Conviction
Nov. 12, 1941 Conviction
Nov. 14, 1941 Conviction
Nov. 21, 1941
Mar. 21, 1941
Sept. 11, 1941
Sept. 30, 1941
Oct. 3, 1941
Nov. 7, 1941
Conviction
Conviction
Conviction
Conviction
Conviction
Conviction
For Sale of Decomposed Food
Hamburg Steak
Bernstein, Hyman .
Holyoke
Holyoke .
Jan.
30, 1941
Conviction
Catferty, Anthony J.
Boston
Boston
. Oct.
10, 1941
Conviction
Economy Grocery Stores
Corp
Hudson
Marlborough .
Jan.
17, 1941
Conviction
Grenon, Simon .
Marlborough . . Marlborough .
Jan.
17, 1941
Conviction
Kaplin, Jack
Woburn
Woburn .
. Feb.
12, 1941
Conviction
Linchitz, Leonard
Woburn
Woburn .
. Feb.
12, 1941
Conviction
Pasquale, Enrico
Waltham
Waltham .
■ Aug
8, 1941
Conviction
Shwachman, Philip .
Boston
Boston
. Aug.
1 , 1941
Conviction
Terminal Markets, Inc. .
Roxbury
Roxbury .
Lamb Patties
June
9, 1941
Conviction
Grand Union Co., Inc.,
The ....
Pittsfield
. Pittsfield .
. Feb.
5, 1941
Conviction
Sausage and Sausage Meat
Alpert, Jennie .
Roxbury
Roxbury .
. Feb.
28, 1941
Conviction
Armour & Co. (2 counts)
Roxbury
Roxbury .
. Feb.
20, 1941
Discharged
Armour & Co. .
Boston
Cambridge
. Mar.
11, 1941
Conviction
Atlantic & Pacific Tea Co.,
The Great .
Salem .
Salem
Nov.
28, 1941
Conviction
Bellantoni, Joseph .
Boston
Roxbury .
. Oct.
7, 1941
Conviction
Berkson, John
Charlestown
Charlestown
Nov.
21, 1941
Conviction3
Big Bear Meat Depart-
ment, Inc.
Cambridge
Cambridge
. Sept.
26, 1941
Conviction
Brockelman Brothers, Inc.2
Marlborough
Marlborough .
Jan.
17, 1941
Conviction
Brockelman Brothers, Inc.
Marlborough
Marlborough .
. Oct.
6, 1941
Conviction
Cooper, David .
Salem .
Salem
. Dec.
20, 1940
Conviction
Economy Grocery Stores
Springfield
Springfield
Jan.
7, 1941
Conviction 3
Economy Grocery Stores
Corp
Cambridge
Cambridge
. Feb.
24, 1941
Discharged
Economy Grocery Stores
Corp
Brockton
Brockton .
Nov.
24, 1941
Conviction 3
Elgart, Myer .
Woburn
Woburn .
. Feb.
12, 1941
Conviction
Elias, James
Norwood
Dedham .
Mar.
14, 1941
Discharged
Esaian, Paul
Boston
Boston
Jan.
23, 1941
Conviction
First National Stores, Inc.
Newton
Newton
. Feb.
3, 1941
Conviction 3
Foster, Dave
Charlestown
Charlestown
Nov.
21, 1941
Conviction
Freedman, Joseph
Roxbury
Roxbury .
. Feb.
28, 1941
Conviction
Goldberg, J.
Boston
Boston
June
11, 1941
Conviction
1 Doing business as State Sausage Co.
2 Involving 2 cases.
3 Appealed.
55
For Sale of Decomposed Food — Continued
Sausage and Sausage Meat — Concluded
Name
Howes, Newton J
Jaffe, Harold
Jankowski, Konstanty
Kelsey's Market, Inc.
Klys, Antonia .
Krasnoff, Morris
Levy, Samuel
L'Heureux, Donat
Linchitz, Leonard
Liro, Joseph
Massachusetts Mohican
Co., Inc., The i .
Massachusetts Mohican
Co., Inc., The
McKenna, Joseph P.
McKenna, Thomas E.
Miller, Louis
Mohican Market, Inc.
Morino, Ermando
Neighborhood Stores, Inc.
Neway Market, Inc.
New England Market,
Inc
O'Loughlin, Michael
Omer, Richard .
Quink, Francis .
Ritso, William .
Saletsky, Jack .
Solin's Market, Inc.
Squire Company, John P.
St. Amand, Adrian
Tillman, Herbert
Torelli, Emilio .
Viera, Manuel .
White Star Foods, Inc.
Willworth, Frank G.
Address
Court
3ate
Result
Holyoke
Holyoke
Jan.
30, 1941
Conviction
Pittsfield
. Pittsfield .
. Feb.
5, 1941
Conviction
Norwood
Dedham
Jan.
23, 1941
Conviction
Great Barringgto
n . Great Barrington
. Dec.
27, 1940
Conviction
Palmer
Palmer
Mar.
7, 1941
Conviction
Cambridge
Cambridge
Nov.
26, 1941
Conviction
Pittsfield
. Pittsfield .
. Feb.
19, 1941
Conviction
Salem .
Salem
. Feb.
5, 1941
Discharged
Woburn
. Woburn .
Feb.
12, 1941
Conviction
Southbridge
Southbridge
Nov.
5, 1941
Conviction
Springfield .
Springfield
Jan.
7, 1941
Conviction
Salem .
Salem
. Oct.
16, 1941
Conviction*
Stoneham .
Woburn .
Feb.
4, 1941
Dismissed
Stoneham
Woburn .
Feb.
4, 1941
Dismissed
Charlestown
Charlestown
. Nov.
21, 1941
Conviction
Newton
Newton
Apr.
21, 1941
Conviction
Norwood
Dedham .
Mar.
14, 1941
Discharged
Athol .
. Athol
Dec.
16, 1940
Conviction
Chicopee
Chicopee .
Jan.
10, 1941
Discharged
Cambridge
Cambridge
Jan.
22, 1941
Conviction
South Boston
South Boston .
Jan.
28, 1941
Conviction
Springfield .
Springfield
Dec.
20, 1940
Conviction
Belchertown
Northampton .
Dec.
19, 1940
Conviction
Norwood
Dedham .
Feb.
19, 1941
Conviction
Boston
Boston
Aug.
7, 1941
Conviction
Chicopee
Chicopee .
Jan.
3, 1941
Conviction
Cambridge
Salem
Nov.
18, 1941
Conviction
Holyoke
Holyoke
Feb.
18, 1941
Conviction
Springfield .
Springfield
Jan.
7, 1941
Conviction
Framingham
Framingham .
Feb.
6, 1941
Conviction
Cambridge
Cambridge
Nov.
17, 1941
Conviction
Waltham
Waltham
Aug.
8, 1941
Conviction
Boston
Boston
June
1, 1941
Conviction '
Using Decomposed Eggs in the Manufacture of Food Products
Vigeant, Louis E. . . Southbridge . . Southbridge . . June 20, 1941 Conviction
For Violation of Sanitary Food Law
Bence Pharmacy, Inc. ] .
Cambridge
Cambridge
June
13
1941
Conviction
Berger's, Bob, Inc. u, .
Boston
Boston
. July
14.
1941
Conviction
Cataldo, Angelo 3
Boston
Boston
July
9,
1941
Conviction
Cataldo, Angelo.
Boston
Boston
. July
9,
1941
Dismissed
Gillispee, John E.
Stoneham
Woburn .
. Sept.
27,
1941
Conviction
Greylock Confectionery
Corp. 3 . . . .
Cambridge .
Cambridge
. June
10
1941
Conviction
Harvard Grill Garden, Inc.
Cambridge
Cambridge
. July
7
1941
Conviction
Johnson Co., Howard D.
Andover
Lawrence .
. Aug.
27,
1941
Conviction
Scollo, Pasquale.
North Reading .
Woburn .
. Aug.
29,
1941
Conviction
Scollo, Pasquale.
North Reading .
Woburn
. Sept.
12,
1941
Conviction
Vigeant, Louis E.
Southbridge
Southbridge
June
20
1941
Conviction
Waldorf System, Inc.
Cambridge
Cambridge
. July
7,
1941
Conviction
Walton Lunch Co. .
Boston
Boston
. Sept.
26,
1941
Wursthaus Restaurant,
Inc
Cambridge
Cambridge
. July
7,
1941
Conviction
Brockton Public Market,
Inc
Fishman, Harry.
Fishman, Harry.
Purity Bakeries, Inc. *
Sternman, John
Sternman, John
Waltham Baking Co.,
The3
For Violation of Bakery Laws
New Bedford
Springfield .
Springfield .
Springfield .
Springfield .
Springfield .
Waltham
New Bedford
Springfield
Springfield
Springfield
Springfield
Springfield
Waltham
Oct. 17, 1941
May 20, 1941
Sept. 19, 1941
Jan. 24, 1941
May 20, 1941
Sept. 19, 1941
Conviction
Conviction
Conviction
Conviction
Dismissed
Conviction
June 20, 1941 Conviction
1 Two counts.
2 Appealed.
8 Involving 2 cases.
' Dismissed for want of prosecution.
56
For Violation of Law and Regulations Relative to the Manufacture and Bottling of
Carbonated Nonalcoholic Beverages, Soda Water, Mineral and Spring Water
Name
Address
Court
Date
Result
Chruscial, Jacob
Everett
. Maiden
. Aug. 14, 1941
Conviction
Czerwonka, Walter .
Fall River .
. Fall River
. May 1, 1941
Conviction
Davis Co., George A.
Gloucester .
Gloucester
. May 7, 1941
Conviction
Dobbs Beverage Co.
Leicester
Worcester
July 24, 1941
Conviction
Rozbicki, Stanley
Everett
. Maiden .
. Aug. 14, 1941
Dismissed
Thomas Beverage Co.
Maiden
. Maiden
. Aug. 26, 1941
Conviction
For Sale of an Adulterated Drug not Conforming to the Requirements of the
U. S. Pharmacopoeia
Johnson Wholesale Per-
fume Co., Inc. . . Springfield . . . Springfield . . Jan. 8, 1941 Conviction >
For Violation of Law Pertaining to Bedding and Upholstered Furniture
American Upholstering
Corp., The .
Berkshire Upholstered
Furniture Co. 2
Boston Dry Goods Mfg.
Co
Boyatzi, Kyriaco
Buchman Co., Inc., The L.
Buchman Co., Inc., The L.
Chuker, Pinkus
Chuker, Pinkus
Comfort Pillow & Feather
Co.2
Denholm & McKay Co. .
Ehrlich Inc., Charles J. .
Feinberg, William
General Mattress Co.
Gilchrist Co.
Goodrest Trading Corp. .
Hadley Co., The
Hartford Mattress Co.,
Inc
Hutner, Etta
Jordan Marsh Co.
Jordan Marsh Co.
Lavine, Edward 1. 3
Lincoln Stores, Inc.
Lincoln Stores, Inc.
Lullaby Products Co.
Lullaby Products Co.
Metropolitan Furniture
Co
Moller's Inc.
New England Drv Goods
Co
New England Furniture
Corp
Reliable Upholstering
Corp
Russell Furniture Co.,
Inc., Ellis H. .
Sears Roebuck & Co.
Scharco Mfg. Co., Inc.
Sherer Co., Inc., C. T. .
Sherman, Isadore 2 .
Simon & Sons, Inc., A.
Solbro Batting Co., Inc. .
Stillman Co., John2 .
Velsco, Inc.
Victory Mattress Co., Inc.
White Co., R. H.
Wilson, Fred
Waterbury, Coi
m. . Springfield
. Feb.
5, 1941
Conviction
Springfield .
Worcester
. Oct.
3, 1941
Conviction
Boston
Boston
Jan.
7, 1941
Conviction
Worcester
Worcester
. July
28, 1941
Conviction
Brooklyn, N. Y
Boston
Jan.
7, 1941
Conviction
Brooklyn, N. Y
Worcester
Jan.
9, 1941
Conviction
Boston
Boston
Jan.
7, 1941
Conviction
Boston
Boston
. FeD.
la, 1941
Conviction
Somerville .
Boston
Nov.
6, 1941
Conviction
Worcester
Worcester
Jan.
9, 1941
Dismissed
New Bedford
New Bedford .
. July
31, 1941
Conviction
Chelsea
Boston
. Oct.
6, 1941
Conviction
Fall River .
. Fall River
. July
24, 1941
Conviction1
Boston
Boston
. Dec.
17, 1940
Conviction
Springfield .
Fitchburg
. May
20, 1941
Conviction
Springfield .
Springfield
. Feb.
5, 1941
Discharged
Hartford, Conn.
Springfield
. July
10, 1941
Conviction
Springfield
Springfield
. Feb.
26, 1941
Conviction
Boston
Boston
. Dec.
17, 1940
Conviction
Boston
Boston
Jan.
17, 1941
Dismissed
New Haven, Co
an. Fall River.
Jan.
16, 1941
Conviction
Lowell .
Lowell
. July
21, 1941
Dismissed
Fitchburg
Fitchburg
. July
22, 1941
Dismissed
Carnegie, Pa.
Lowell
. July
21, 1941
Conviction
Carnegie, Pa.
Fitchburg
. July
22, 1941
Conviction
Springfield .
Springfield
. Feb.
5, 1941
Discharged
Cambridge
Cambridge
. Dec.
3, 1940
Conviction
Boston
Boston
Jan.
7, 1941
Conviction
Pittsfield
. Pittsfield .
. Feb.
27, 1941
Conviction
Cambridge
. Fall River.
Apr.
17, 1941
Discharged
Salem .
Salem
Apr.
1, 1941
Conviction '
Pittsfield
. Pittsfield .
. Feb.
27, 1941
Conviction
New York, N. "i
Boston
. July
18, 1941
Conviction
Worcester
Worcester
Jan.
9, 1941
Dismissed
Chelsea
Boston
. Oct.
6, 1941
Conviction
Framingham
Framingham .
June
3, 1941
Conviction
Worcester
Gardner .
. Nov.
27, 1941
Conviction
Springfield
Springfield
. Feb.
5, 1941
Discharged
New York, N. Y
Southbridge
. Oct.
10, 1941
Conviction
Boston
Boston
. Nov.
6, 1941
Conviction
Boston
Boston
Jan.
7, 1941
Conviction
Pittsfield
. Pittsfield .
. Feb.
27, 1941
Conviction
Obstruction of an Inspector of the Department of Public Health
Astuti, Frank . . . Boston . . . Boston . . . Apr. 15, 1941 Conviction
1 Appealed.
2 Involving 2 cases.
3 Doing business as New Haven Quilt Co., New Haven.
57
Table 2. — Summary of Milk Statistics
Number of samples above standard
Number of samples below
Total samples .....
Number having more than 15% solids
Number having between 14% and 15% solids
Number having between 13% and 14% solids
Number having between 12% and 13% solids
Number having between 11% and 12% solids
Number having between 10% and 11% solids
Number having between 9% and 10% solids
Number having between 8% and 9% solids
Number showing removal of cream
Number showing addition of water
6,995
32
270
1,907
4,070
656
43
14
3
50
76
Table 3. — Average Composition of Milk Samples
Total Samples
Samples Not Declared Adulterated
Number
Solids
Number
Solids
of
Total
not
of
Total
not
Samples
Solids
Fat
Fat
Samples
Solids
Fat
Fat
%
%
%
%
%
%
December .
363
12.92
4.06
8.86
359
12.93
4.07
8.86
January
413
12.76
3.96
8.82
397
12.85
3.99
8.86
February
712
12.87
4.01
8.86
703
12.89
4.02
8.87
March
652
12.84
3.95
8.89
629
12.89
3.97
8.92
April .
642
12.82
3.99
8.83
633
12.84
4.00
8.84
May
692
12.73
3.96
8.77
682
12.73
3.97
8.76
June .
611
12.59
3.94
8.65
587
12.66
3.97
8.69
July .
610
12.50
3.86
8.64
600
12.53
3.88
8.65
August
625
12.57
3.95
8.62
617
12.59
3.97
8.62
September
440
12.71
3.98
8.73
438
12.72
3.99
8.73
October
688
12.84
4.02
8.83
683
12.84
4.03
8.81
November .
415
12.82
4.00
8.82
409
12.83
4.00
8.83
Average for year
6,863
12.75
3.97
8.78
6.737
12.77
3.98
8.79
Table 4.-
Summary of Bacteriological Examinations of Milk
Samples Examined
In Boston
In Westfield
Certified Milk
Total Samples
Samples with count below 10,000
Samples with count above 10,000
Highest count
Lowest count
Geometric Mean
17,000
500
2,450
Pasteurized Certified Milk
Total Samples
Samples with count below 500
Samples with count above 500
Highest count
Lowest count
Geometric Mean
550
less than 10
29
Grade A Raw Milk
Total Samples
Samples with count below 100,000
Samples with count above 100,000
Highest count
Lowest count
Geometric Mean
620,000
13,000
9,446
Total Samples
Samples with count below 10,000
Samples with count above 10,000
Highest count
Lowest count
Geometric Mean
Total Samples
Samples with count below 25,000
Samples with count below 40,000
Samples with count above 40,000
Highest count
Lowest count
Geometric Mean
Grade A Pasteurized Milk
1,000,000
less than 100
2,787
Pasteurized Milk
4,000,000
less than 100
14,487
84
83
1
73
71
2
146
122
24
2,725
1,755
1,966
759
450,000
3,000
15,241
200
100
140
422,000
2,300
18,160
2,000,000
200
4,512
10,000,000
100
14,425
26
23
3
111
74
37
1,135
719
847
288
58
Table 4. — ■ Summary of Bacteriological Examinations of Milk — Concluded
Samples Examined
In Boston In Westfield
Special Milk Pasteurized
Total Samples
Samples with count below 5,000
Samples with count above 5,000
Highest count
Lowest count
Geometric Mean
Total Samples
Samples with count below 100,000
Samples with count below 250,000
Samples with count below 400,000
Samples with count above 400,000
Highest count
Lowest count
Geometric Mean
4,700
350
1,235
Raw Milk to be Pasteurized
3,800,000
200
42,658
Raw Milk to be Pasteurized — Grade
Total Samples
Samples with count below 100,000
Samples with count above 100,000
Highest count 487,000
Lowest count ......... 300
Geometric Mean . 48,084
Raw Milk Sold as Such
Total Samples
Samples with count below 100,000
Samples with count below 400,000
Samples with count above 400,000
Highest count
Lowest count
Geometric Mean
4,200,000
800
50,119
2,513
1,635
2,046
2,217
296
84
57
21
289
224
258
31
Special Raw Milk
Total Samples
Samples with count below 50,000
Samples with count above 50,000
Highest count
Lowest count
Geometric Mean
Cream
Total Samples
Samples with count below 100,000
Samples with count above 100,000
Highest count
Lowest count ....
Geometric Mean
4,100,000
100
154,000
276
195
81
800
800
5,200,000
1,000
49,934
87,000
12,000
31,406
5,900,000
1,000
48,944
230,000
3,000
9,311
5,000,000
11,200
300,275
833
584
669
704
129
474
332
429
45
Table 5. — Summary of Analyses of Food Samples
Character of Sample
Butter
Cheese
Clams
Cream
Frozen desserts .
Flavoring extracts
Fruit juices
Maple products
Meat products:
Chops
Hamburg steak
Lamb and meat patties
Poultry
Sausage
Miscellaneous* .
Olive Oil .
Preserved fruits
Soft drinks
Vinegar
Not Declared
Adulterated
Total
Adulterated
or
or Misbranded
Misbranded
72
11
83
33
13
46
37
48
85
304
21
325
226
2
228
12
1
13
11
-
11
17
3
20
4
1
5
140
24
164
19
4
23
2
-
2
192
113
305
30
12
42
85
84
169
11
-
11
6
1
7
58
12
70
Totals
1,609
*Includes individual items totaling less than 5.
59
Miscel-
laneous
Meats
(lbs.)
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2,795,647
2,760,500
2,537,276
2,195,277
2,186,506
2,109,066
1,886,551
1,770,511
1,358,222
1,047,249
1,113,527
1,201,067
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and
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(lbs.)
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June .
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August
September
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November.
December
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5,504,408
4,347,809
2,776,196
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1,131,326
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235,186
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217,921
2,042,469
4,810,064
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62
Table 10. — Requests for Extension of Time Granted on Goods in Cold Storage,
from December 1, 1940, to December 1, 1941
being that goods were in proper condition for further storage.)
Name
Standard Brands, Inc.
Wilson & Co.
Wilson & Co.
Standard Brands, Inc.
Standard Brands, Inc.
Standard Brands, Inc.
Standard Brands, Inc.
Standard Brands, Inc.
Standard Brands, Inc.
Armour & Co.
The Emulsol Corp.
Standard Brands, Inc.
Standard Brands, Inc.
Standard Brands, Inc.
Standard Brands, Inc.
Swift & Co.
Swift & Co.
Swift & Co.
Wilson & Co.
Standard Brands, Inc.
Wilson & Co.
Wilson & Co.
Benson Bros. Corp.
Berman & Co., Inc.
Berman & Co., Inc.
Frosted Foods Sales Corp.
Frosted Foods Sales Corp.
Berman & Co., Inc.
Berman & Co., Inc.
Berman & Co., Inc.
Berman & Co., Inc.
Berman & Co., Inc.
Berman & Co., Inc.
Berman & Co., Inc.
Berman & Co., Inc.
Dewey & Almy Chemical Co.
Frosted Foods Sales Corp.
Frosted Foods Sales Corp.
Frosted Foods Sales Corp.
Frosted Foods Sales Corp.
Frosted Foods Sales Corp.
Frosted Foods Sales Corp.
Frosted Foods Sales Corp.
Frosted Foods Sales Corp.
Frosted Foods Sales Corp.
Frosted Foods Sales Corp.
Quincy Market, C. S. & W. Co.
Mades Co., Inc., M. M.
Beane Co., H. E.
Frosted Foods Sales Corp.
Frosted Foods Sales Corp.
Frosted Foods Sales Corp.
Frosted Foods Sales Corp.
Frosted Foods Sales Corp.
Frosted Foods Sales Corp.
Frosted Foods Sales Corp.
Frosted Foods Sales Corp.
Frosted Foods Sales Corp.
Folsom's Market, Inc.
Folsom's Market, Inc.
Frosted Foods Sales Corp.
Frosted Foods Sales Corp.
Frosted Foods Sales Corp.
Frosted Foods Sales Corp.
Frosted Foods Sales Corp.
Frosted Foods Sales Corp.
United Markets, Inc.
Smith, E. H.
Smith, E. H.
Smith, E. H.
Smith, E. H.
Smith, E. H.
Smith, E. H.
Smith, E. H.
Smith, E. H.
Smith, E. H.
(Rea
son for sue
i extension
Weight
Article
(Pounds)
Sugar Yolks
750
Sugar Yolks
2,430
Sugar Yolks
3,000
Voltex
250
Voltex
. 38,700
Voltex
500
Voltex
2,430
Voltex
11,370
Voltex
750
Egg Whites
750
Egg Whites
1,860
Egg Whites
1,140
Egg Whites
450
Egg Whites
800
Egg Whites
- 750
Egg Whites
35,970
Egg Whites
17,820
Egg Whites
2,730
Egg Whites
5,550
Whole Eggs
3,000
Whole Eggs
6,060
Whole Eggs
3,150
Chicken
7,042
Geese .
677
Geese (2 lots
) !
453
Roasters
1,118
Roasters
3,388
Turkeys (4 lots) .
3,440
Turkeys (2 lots) .
1,225
Turkeys
1,471
Turkeys (2 lots) .
1,129
Turkeys
2,510
Turkeys (2 lots) .
2,521
Turkeys
2,379
Turkeys
632
Turkeys (2 lots) .
2,640
Turkeys
269
Turkeys
405
Turkeys
453
Turkeys (2 lots) .
1,386
Turkeys (3 lots) .
2,911
Turkeys (4 lots) .
3,791
Turkeys
143
Turkeys (4 lots) .
12,898
Turkeys
1,436
Turkeys
1,139
Turkeys (5 lots) .
21,658
Beef Kidneys
6,873
Calves' Livers
5,460
Chopped Steak
7,020
Chopped Steak (2 lots)
56,700
Chopped Steak
13,860
Chopped Steak
14,040
Chopped Steak
19,620
Chopped Steak
38,040
Chopped Steak
54,480
Rump Steak
2,184
Sirloin Steaks
114
Lamb Flanks
3,650
Lamb Flanks
1,000
Lamb Fores .
634
Lamb Fores .
4,452
Lamb Legs .
1,214
Lamb Legs .
898
Pork Loin Roasts .
778
Pork Loin Roasts .
3,082
Spare Ribs .
7,500
Dog Meat
60
Dog Meat
100
Dog Meat
40
Dog Meat .
90
Dog Meat .
60
Dog Meat .
40
Dog Meat .
120
Dog Meat .
440
Dog Meat .
360
Placed in
Extension
Storage
Granted to
Apr. 22
1940
July 1
, 1941
May 1
1940
Aug. 1
, 1941
June 25
1940
Sept. 25
, 1941
May 3
1940
Aug. 1
, 1941
May 23
1940
Aug. 23
, 1941
May 27
1941
Aug. 27
, 1941
May 31
1940
Aug. 31
, 1941
June 11
1940
Aug. 21
, 1941
June 10
1940
Sept. 1C
, 1941
Apr. 19
1940
July 19
, 1941
fApr. 8
1939
Mar. 22
, 1941
Apr. 1
1940
July 1
, 1941
Apr. 26
1940
Aug. 1
, 1941
May 21
1940
Aug. 21
1941
May 29
1940
Aug. 27
1941
tApr.
1940
*Dec. 1
1941
May,
1940
Aug. 1
1941
May,
1940
*Dec. ]
1941
May 1,
1940
Aug. 1
1941
June 3,
1940
Aug. 21
1941
May 20,
1940
Aug. 1
1941
May 30,
1940
Sept. 25
1941
Oct. 10,
1940
Feb. 10
1942
Dec. 2,
1939
June 1
1941
Feb. 23,
1940
Aug. 23
1941
July 1,
1940
Dec. 1
1941
July 4,
1940
Dec. 1
1941
Dec. 1,
1939
June 1
1941
Dec. 4,
1939
June 1
1941
Dec. 8,
1939
June 8
1941
Dec. 12,
1939
June 12
1941
Dec. 28,
1939
June 8
1941
Dec. 29,
1939
June 12
1941
Jan. 23,
1940
June 23
1941
Jan. 26,
1940
June 23
1941
Feb. 1,
1940
*Jan. 1
1942
tNov. 16,
1939
Sept. 1
1941
tNov. 22,
1939
June 1
1941
tNov. 22,
1939
Sept. 1
1941
tDec. 5,
1939
June 1
1941
tDec. 8,
1939
June 1
1941
tDec. 11,
1939
June 1
1941
tDec. 12,
1939
Sept. 1
1941
tDec. 18,
1939
June 1
1941
tDec. 20,
1939
June 1
1941
tDec. 27,
1939
June 1
1941
Dec. 2,
1939
Apr. 2
1941
May 29,
1940
Nov. 29,
1941
Nov. 15,
1940
Mar. 15,
1942
tOct. 24,
1939
June 1
1941
tFeb. 26,
1940
Aug. 1
1941
Feb. 27,
1940
Aug. 1
1941
tMar. 5,
1940
Aug. 1
1941
tMar. 12,
1940
Aug. 1
1941
tMar. 25,
1940
Aug. 1
1941
Apr. 9,
1940
*Dec. 31
1941
tDec. 19,
1939
July 1
1941
•j-Jan. 8,
1940
Sept. 1
1941
Nov. 1,
1940
Mar. 1,
1942
Nov. 4,
1940
Jan. 1,
1942
tNov. 8,
1939
June 1
1941
tDec. 7,
1939
June 1
1941
tFeb. 23,
1939
Sept. 1,
1941
tNov. 17,
1939
June 1,
1941
tDec. 16,
1938
*Dec. 31
1941
tNov. 13,
1939
*Dec. 1
1941
Jan. 27,
1940
Mar. 31
1941
May 19,
1939
Dec. 31,
1941
June 29,
1939
Dec. 31,
1941
July 14,
1939
Dec. 31,
1941
July 26,
1939
Dec. 31,
1941
Aug. 3,
1939
Dec. 31,
1941
Sept. 20,
1939
Dec. 31,
1941
Sept. 22,
1939
Dec. 31,
1941
Oct. 11,
1939
Dec. 31,
1941
Oct. 20,
1939
Dec. 31,
1941
*The extension of time granted on this lot was amended before the expiration of the time to which
extended. The length of time given includes the total amended period, and the weights given are the
initial weights upon which extensions were asked.
tPreviously frozen.
63
Table 10. — Requests for Extension of Time Granted on Goods in Cold Storage,
from December 1, 19Jfi to December 1, 1941 — ■ Concluded
Article
Dog Meat
Dog Meat
Dog Meat
Dog Meat
Dog Meat
Dog Meat
Pheasants
Rabbits
Butterfish
Chubs .
Cod Cheeks
Smoked Cod
Smoked Cod
Tom Cod (3 lots)
Tom Cod
Tom Cod
Tom Cod (2 lots)
Eels .
Flounders
Halibut (3 lots)
Lobster Meat
Mackerel
Mackerel (2 lots)
Mackerel (13 lots)
Mackerel
Mackerel
Mackerel (2 lots)
Mackerel (6 lots)
Mackerel
Mackerel
Mackerel
Mackerel
Mackerel
Mackerel
Mackerel
Mackerel
Mackerel
Mackerel
Polpi .
Polpi .
Salmonettes
Salmonettes
Salmonettes
Salmonettes
Sardines
Sardines (2 lots)
Sardines
Scallops
Shad .
Shad .
Shad (2 lots)
Smelts
Smelts
Smelts
Smelts (2 lots)
Smelts
Smelts
Smelts
Smelts
Smelts
Smelts
Smelts
Smelts (2 lots)
Weight
(Pounds)
520
40
280
320
200
80
4,639
3,422
150
998
230
2,432
1,749
845
310
535
623
17,250
1,037
26,746
185
448
4,500
30,284
1,500
2,300
8,000
15,184
300
900
2,250
1,350
1,200
900
7,707
31,381
1,910
466
7,450
130
250
80
80
768
2,950
4,300
744
1,750
1,715
3,461
3,525
7,050
1,008
10,218
7,155
800
4,545
1,780
1,030
1,650
51,690
Placed in
Storage
Oct. 30, 1939
Nov. 10, 1939
Nov. 17, 1939
Nov. 22, 1939
Nov. 29, 1939
Mar. 29, 1940
Jan. , 1940
Nov. 25, 1940
June 6, 1940
May 25, 1940
Mar. 1, 1940
Dec. , 1939
Jan. , 1940
Nov. 16. 1940
Nov. 19, 1940
Nov. 21, 1940
Nov. 23, 1940
Dec. 21, 1939
Dec. 12, 1939
Sept. 30, 1940
Jan. 26, 1940
July 15, 1940
Sept. 12, 1940
Jun 6, 1940
June 11, 1940
June 14, 1942
June 15, 1940
June 18, 1940
July 6, 1940
July 16, 1940
July 18, 1940
July 19, 1940
Aug. 17, 1940
Aug. 27, 1940
July 8, 1940
July 15, 1940
Sept. 12, 1940
June 28, 1940
Mar. 16, 1940
Feb. 8, 1940
tNov. 27, 1940
May 27, 1940
tFeb. 27, 1941
Nov. 27, 1940
Dec. 8, 1939
Dec. 9, 1939
Oct. 22, 1940
Oct. 8, 1940
Sept. 25, 1940
June 10, 1940
June 13, 1941
Mar. 7, 1940
Mar. 7, 1940
Mar. 11, 1940
Mar. 11, 1940
Mar. 14, 1940
Mar. 14, 1940
Mar. 15, 1940
Mar. 15, 1940
May 29, 1940
Mar. 11, 1940
Mar. 14, 1940
May 27, 1940
Extension
Granted to
Dec. 31, 1941
Dec. 31, 1941
Dec. 31, 1941
Dec. 31, 1941
Dec. 31, 1941
Dec. 31, 1941
Jan. 2, 1942
Feb. 25, 1942
Sept. 5, 1941
Sept. 5, 1941
July 1, 1941
*Oct. 1, 1941
Apr. 1, 1941
Apr. 16, 1942
Apr. 16, 1942
Apr. 16, 1942
Apr. 16, 1942
Jan. 7, 1941
Jan. 31, 1941
Mar. 30, 1942
Mar. 26, 1941
Sept. 1, 1941
Dec. 12, 1941
Feb. 1, 1942
Feb. 1, 1942
Feb. 1, 1942
Feb. 1, 1942
Feb. 1, 1942
Feb. 1, 1942
Dec. 31, 1941
Dec. 31, 1941
Dec. 31, 1941
Dec. 31, 1941
Dec. 31, 1941
*Mar. 31, 1942
*Mar. 31, 1942
Mar. 31, 1942
Sept. 5, 1941
June 16, 1941
May 8, 1941
Nov. 27, 1941
Nov. 30, 1941
Feb. 28, 1942
Dec. 27, 1941
Feb. 28, 1941
Feb. 28, 1941
Dec. 22, 1941
Dec. 8, 1941
Mar. 25, 1942
Sept. 5, 1941
Sept. 5, 1941
June 15, 1941
*Dec. 31, 1941
June 15, 1941
*Dec. 31, 1941
June 15, 1941
*Dec. 31, 1941
June 15, 1941
*Dec. 31, 1941
Nov. 29, 1941
June 11, 1941
May 14, 1941
*Mar. 27, 1942
Name
Smith, E. H.
Smith, E. H.
Smith, E. H.
Smith, E. H.
Smith, E. H.
Smith, E. H.
Conkey & Co., John A.
Chamberlain & Co., Inc.
Standard Fish Co.
Standard Fish Co.
Warren Fitch Co.
Gorton-Pew Fisheries Co.
Gorton-Pew Fisheries Co.
Brockelman Bros., Inc.
Brockelman Bros., Inc.
Brockelman Bros., Inc.
Brockelman Bros., Inc.
Nagle Co., John
Arrington, H. R.
General Seafoods Corp.
Consolidated Lobster Co.
American Fish Co.
Batchelder & Snyder Co.
Gloucester Fresh Fish Co.
Gloucester Fresh Fish Co.
Gloucester Fresh Fish Co.
Gloucester Fresh Fish Co.
Gloucester Fresh Fish Co.
Gloucester Fresh Fish Co.
Gloucester Fresh Fish Co.
Gloucester Fresh Fish Co.
Gloucester Fresh Fish Co.
Gloucester Fresh Fish Co.
Gloucester Fresh Fish Co.
Henry & Close, Inc.
Henry & Close, Inc.
Phillips Co., B. F.
Standard Fish Co.
Genoa Fisheries, Inc.
Russo & Sons Co.
Genoa Fisheries, Inc.
Mantia & Sons Co., John
Mantia & Sons Co., John
Russo & Sons Co.
Mantia Fish Corp.
Mantia Fish Corp.
Russo & Sons Co.
Russo & Sons Co.
Hamilton Co., R. S.
Standard Fish Co.
Standard Fish Co.
General Seafoods Corp.
General Seafoods Corp.
General Seafoods Corp.
General Seafoods Corp.
General Seafoods Corp.
General Seafoods Corp.
General Seafoods Corp.
General Seafoods Corp.
General Seafoods Corp.
Genoa Fisheries, Inc.
Harding Co., F. E.
Russo & Sons Co.
*The extension of time granted on this lot was amended before the expiration of the time to hvhich
extended. The length of time given includes the total amended period, and the weights given are the
initial weights upon which extensions were asked.
fPreviously frozen.
64
Table 11. — Slaughtering Report from December 1, 1940, through November 30, 1941
156,720
Total Number of Carcasses Inspected
Cattle . . . 28,970
Calves . . . 75,909
Total Number of Carcasses Condemned
Cattle ... 110
Calves . . . 1,677
Hogs
Sheep
Hogs
Sheep
49,454
2,387
403
2
2,192
Reasons for Confiscation
Cattle
Calves
Hogs
Sheep
Totals
Immaturity ......
1,503
1,503
Cholera .
—
_
279
_
279
Tuberculosis
8
3
18
_
29
Died other than by slaugh
.er
8
115
5
1
129
Bruised or injured .
28
7
6
_
41
Pneumonia
17
1
13
1
32
Scours
_
22
22
Anemia .
_
3
_
_
3
Emaciation
11
4
6
_
21
Peritonitis
2
_
17
_
19
Septicemia
17
2
4
_
23
Hemorrhagic Septicemia
—
_
22
_
22
Fetus
_
12
_
_
12
Icterus .
1
4
9
_
14
Tumor
1
_
2
_
3
Abscessed
1
_
10
_
11
Parturition
2
_
_
_
2
Mastitis
3
_
_
_
3
Milk Fever
1
_
1
_
2
Gangrene
2
-
_
_
2
Petechia .
1
_
_
_
1
Exhaustion
_
_
1
_
1
Pericarditis
1
_
_
1
Lead Poisoning
1
-
_
_
1
Enteritis
—
1
5
_
6
Strangulation .
2
-
-
_
2
Dropsy .
1
-
-
-
1
Fever
1
-
2
-
3
Ruptured
-
-
1
-
1
Pleurisy
-
-
2
-
2
Empyemia
1
-
-
-
1
Totals
110
1,677
403
2
2,192
65
THE DIVISION OF GENITOINFEGTIOUS DISEASES
N. A. Nelson, M.D., Director
Statistical Summaries
The trend of reporting during the past several years is indicated by the following
figures :
Sources of Reports of Gonorrhea
Year
Physicians
Clinics
Institutions
Military
Total
Cases Number Cases Per Cent Cases Per Cent Cases Per Cent Cases Per Cent
1937
1938
1939
1940
1941
5,856
988
3,140
53.6
2,209
37.7
507
8.7
4,938
883
2,272
46.0
2,266
45.9
400
8.1
4,652
782
2,163
46.5
2,147
46.2
342
7.3
4,014
786
1,815
45.2
1,894
47.2
305
7.6
3,791
685
1,515
40.0
1,391
36.7
179
4.7
706
18.6
Sources of Reports of Syphilis
Year
Physicians
Clinics
Institutions
Military
Total
Cases Number Cases Per Cent Cases Per Cent Cases Per Cent Cases Per Cent
1937
1938
1939
1940
1941
6,207
961
2,103
33.9
2,788
44.9
1,316
21.2
5,674
912
1,814
32.0
2,919
51.4
941
16.6
4,888
839
1,576
32.3
2,528
51.7
784
16.0
5,024
877
1,598
31.8
2,537
50.5
889
17.7
4,613
882
1,635
35.5
2,253
48.8
628
13.6
97
2.1
There were 203 deaths from syphilis (including deaths from general paralysis
and tabes dorsalis) at a rate of 6.2 per 100,000 population as compared with a rate
of 7.9 last year and an average rate of 7.5 for the preceding five years.
Deaths from congenital syphilis numbered 7 in 1941. Only 15 cases of congenital
syphilis under one year of age were reported during the year.
Provision op Treatment
The twenty-five cooperating clinics were paid a total of approximately $227,200
during the fiscal year, an increase of about $11,000 over the previous year. Patients
and contacts made 185,705 visits, or nearly 38,200 fewer visits than during 1940.
The cost per visit to the Commonwealth is approximately $1.23 as compared to
99 cents in 1940. This increase is due to the fact that expenses have remained
constant or have increased and patients have paid less than in previous years.
Patients paid approximately $30,850 as compared to $31,200 last year. The total
cost of maintaining clinic service was, therefore, approximately $259,900, or $1.40
per visit. The cost of transportation provided patients was $1,800 less than in the
year 1940.
Only 25,900 visits were made for the treatment of gonorrhea, as compared to
49,000 last year. This decline is unquestionably due to the effect of the sulfonamides
on the disease, principally its rapid therapeutic effect. One hundred and fifty-nine
thousand visits for the treatment of syphilis were made as compared to 174,000
last year.
Thirty-three hospitals requested reimbursement for the hospital care of patients
with syphilis or gonorrhea, as compared to 38 last year. Hospital care was provided
for 653 patients, as compared to 811 last year, at a total cost of $19,711.64, or
almost $7,000 less than last year.
The twenty-five cooperating clinics admitted 1,363 new cases of gonorrhea and
2,112 new cases of syphilis, a decrease of 495 cases of gonorrhea and 226 cases of
syphilis. The cooperating clinics treated 97 per cent of all gonorrhea treated in
clinics in Massachusetts and 90 per cent of all syphilis so treated.
66
Follow-up by Boards of Health
During 1941, 957 cases were referred to 117 boards of health for follow-up.
No Report fbom Board
of Health
Per Cent
Found
Number of
Communities
Year
Cases
Per Cent of Cases
Communities
1937
3,339
52.3
146
4.8
28
1938
2,020
57.4
131
7.5
34
1939
1,650
61.2
126
4.2
24
1940
1,046
66.7
97
3.0
14
1941
957
59.7
117
10.6
16
Follow-up Service for Private Physicians
One nurse has been engaged throughout the year in the follow-up of cases for
private physicians in the Metropolitan Boston Area. Eighty-five (77 per cent)
of the patients were successfully returned to treatment, 9 per cent were lost and
14 per cent still remain active. Of the contacts, 78 per cent were brought to medical
attention. The nurse made 343 visits to patients and 99 visits to contacts.
Follow-up Service for Syphilis in Pregnancy
In 1941 the nurse followed 208 pregnant women in whom 148 pregnancies were
terminated. Of the 145 babies, 104 have been examined, none of whom showed
any evidence of congenital syphilis.
Other Diagnostic and Treatment Services
Arsenicals and Bismuth:
Free arsenicals and bismuth are supplied to all cooperating clinics and private
physicians in the State who request this service.
Sulfathiazole:
Beginning in January. 1941, the Department has distributed sulfathiazole to
cooperating clinics only, for the treatment of gonorrhea. The Department also
plans to distribute this drug to private physicians for the treatment of gonococcal
infections.
Laboratory:
The Wassermann Laboratory reports 400,265 blood and spinal fluid examinations,
an increase of almost 70,000 over last year. The Bacteriological Laboratory reported
12,590 smears examined for gonorrhea, which is approximately the same as last year.
Education and Information
During the j^ear the staff lectured to 47 professional and public groups, reaching
5,406 persons.
During the year 167,987 pieces of literature were distributed (163,380 in 1940).
The Bulletin of Genitoinjectious Diseases was distributed for nine months of the
year to every physician in the State and to a large mailing list outside this State.
Training of Personnel
The Harvard School of Public Health continued to offer a course of training for
health officers in genitoinfectious disease control, and the Department has con-
tinued to cooperate with the Massachusetts Medical Society in the maintenance
of a course of postgraduate instruction for physicians.
National Defense
The Department has cooperated with the Selective Service System by providing
epidemiologic follow-up of selectees with positive or doubtful blood tests. The
67
following table shows the results of this investigation from December 1, 1940
through December 31, 1941:
Positive Doubtful Total
1. Total selectees referred for follow-up . . 476 111 587
2. Total closed by epidemiologists
Infected ....
Already under treatment
Returned to treatment
No further treatment necessary
No previous treatment .
Not infected
Inducted ....
Lost ....
Refuse to cooperate .
Referred to Board of Health
Referred out-of-state
3. Cases still active with epidemiologists
439
98
537
338
25
363
97
13
110
48
6
54
18
2
20
175
4
179
18
59
77
17
11
28
17
2
19
2
1
3
16
—
16
31
-
31
37
13
50
The most important relation of the Department to the war effort has been the
cooperative program carried on by the Department and the Army and Navy,
which provides for the epidemiologic investigation of sources of infection and
contacts of infected soldiers and sailors. Department nurses are allowed to enter
directly into the camps, the Chelsea Naval Hospital and the U. S. Marine Hospital
to interview infected men. The following table shows the results of this investi-
gation from December 1, 1940 through December 31, 1941:
1. Total men interviewed ............. 980
2. Total contacts involved ............ 1,092
(a) Not referred (insufficient information) . . . . ....■•. . 400
(b) Referred, follow-up closed ......... 481
(1) Followed by nurse ........ 153
Success ....... 130
Failure 23
(2) Followed by police 113
Success ....... 38
Failure 66
No reply ...... 9
(3) Followed out-of-state ....... 208
Success ....... 49
Failure 83
No reply 76
(4) Followed by other agency ...... 7
No reply ....... 7
(c) Referred, follow-up pending . . . . . . . . . 211
This program has provided an example of cooperative effort between a civilian
health agency and the armed forces which should lead to successful control of the
genitoinfections in the Army and Navy in Massachusetts. With the declaration of
war on December 8, 1941, the Department found itself already providing important
services to the Army and Navy in this area.
68
THE DIVISION OF SANITARY ENGINEERING
Arthuk D. Weston, Chief Sanitary Engineer
Foreword
The activities of this division have been presented in tabular form for the
year 1941.
In connection with the use of the tables on water consumption, it should be
remembered that the per capita water consumption shown is determined by the
population of the municipality in which the works are located and not necessarily
on the number of persons served. Under these conditions the per capita water
consumption in some cities and towns where only a small percentage of the popu-
lation is served shows a smaller per capita water consumption than is actually
the case. In addition, it should also be stated that the average daily and per capita
water consumption as shown are not a true indication of the maximum demands
in those municipalities where the bulk of the consumption is during the summer
months.
The table of chemical analyses of water of public water supplies shows the
average results of the total number of samples received from each source during
the year. The total number of analyses to obtain this average is shown in the last
column. In instances where the water has been found to be uniform in quality
only 1, 2 or 3 samples are collected throughout the year; more frequent sampling
is unnecessary.
The tables referring to rainfall represent the rainfall as determined by this
Department at seven long term rainfall stations well distributed throughout the
State. The rainfall for certain sections of the State may vary considerably from
that indicated by this average.
The tables relative to yield of drainage areas and tables relative to sewage
treatment works are presented in order that there may be a continuity of records.
Average Daily Consumption of Water
in Varioits Cities and Towns in 1941
Gallons
Gallons
Popu-
per
Inhabi-
Popu-
per
City or Town
lation
Gallons
City or Town
lation
Gallons
Inhabi-
tant
tant
Metropolitan
Barre
3,532
67,200
19
Water Distric
Bedford .
3,931
181,200
46
Arlington
40,308
2,278,500
57
Belchertown
3,503
33,400
10
Belmont
27,274
1,626,200
60
Bellingham
2,979
83,000
28
Boston
770,816
97,767,600
127
Beverly .
25,537
1,787,900
70
Chelsea
41,259
3,554,800
86
Billerica .
8,190
350,500
43
Everett
46,784
5,762,300
123
Blandford
481
16,800
35
Lexington
13,662
749,700
55
Bourne
3,315
148,000
45
Malden
58,157
4,378,500
75
Braintree
16,378
1,344,000
82
Medford
63,411
3,630,300
57
Bridgewater
8,902
235,800
26
Melrose.
25,548
1,464,500
57
Brockton
62,343
3,011,000
48
Milton .
18,820
1,039,600
55
Brookfield.
1,410
41,000
29
Nahant
1,852
252,400
136
Brookline .
49,786
5,032,200
101
Quinct
75,810
5,076,000
67
Cambridge
110,879
13,750,000
124
Revere
34,40a
1,924,500
56
Canton
6,381
717,000
112
SOMERVILLE
102,45*
9,913,000
97
Chatham
2,153
114,000
53
Stoneham
10,765
657,600
61
Chelmsford
8,173
350,900
43
Swampscott
10,817
822,100
76
Chicopee
41,664
3,483,300
84
Watertown
35,427
3,003,500
85
Clinton
12,453
996,400
80
Winthrop
16,76*
1,401,900
84
Cohasset .
3,111
336,000
108
Abington and
Concord .
8,022
518,000
65
Rockland
13,837
774,000
56
Danvers and
Acton
2,714
132,000
49
Middleton
16,661
1,013,100
61
Acushnet
4,184
130,000
31
Dalton
4,206
1,400,000
333
Adams
12,60*
1,333,000
106
Dartmouth
9,011
261,000
29
Agawam
7,96£
426,000
53
Deerfield .
2,684
42,900
16
Amesbury
10,935
789,300
72
Dedham .
15,535
1,135,000
73
Amherst .
6.41C
628,600
98
Douglas .
2,660
280,600
105
Andover .
11,235
S 1,340,500
119
Dracut
7,507
269,000
36
Ashburnham
2,29(
» 91,700
40
Dunstable.
453
2,835
6
Ashland .
2,475
641,000
259
Duxbury .
2,382
302,000
127
Athol
11,26*
> 581,900
52
East Bridgewate
r 3,864
217,000
56
Attleboro
22,11*
! 1,303,534
59
East Brookfield
1.03C
36,400
35
Avon
2,33.
) 147,000
63
Easthampton
10,316
964,100
93
Ayer
3,575
! 267,100
75
East Longmead(
>w 3,409
114,500
34
Barnstable
8,395
! 769,000
92
Easton
5,135
297,000
58
69
Average Daily Consumption of Water in Various Cities and Towns in 1941
Concluded
Gallons
Gallons
Popu-
per
Popu-
per
City ok Town
lation
Gallons
Inhabi-
tant
City or Town
lation
Gallons
Inhabi-
tant
Edgartown
1,370
165,500
121
North Attlebor-
Fairhaven
10,938
490,000
45
borough
10,390
904,000
87
Fall River
115,428
7,505,500
65
Northborough
2,382
100,600
42
Falmouth
6,946
917,885
132
Northbridge
10,242
772.000
75
FlTCHBURG
41,849
5,474,300
131
Northampton
24,848
3,206,900
129
Foxborough
6,397
631,000
99
North Brookfiek
i 3,328
438,100
131
Framingham
23,327
1,568,000
67
North Reading
2,999
52,500
18
Franklin
7,303
465,000
64
Norton
3,143
219,000
70
Gardner .
20,206
1,086,700
54
Norwood .
15,383
1 ,090,700
71
Georgetown
1,803
49,900
28
Oak Bluffs
1,584
122,000
77
Gloucester
24,046
1,928,100
80
Oxford
4,698
150,000
32
Grafton .
7,457
112,000
15
Palmer
9,149
348,300
38
Great Barringto
i 5,824
445,500
76
Paxton
803
17,400
22
Greenfield
15,672
1,511,600
96
Peabody .
21,711
2,825,000
130
Groton
2,553
445,000
174
Pepperell
3,136
315,300
100
Groveland
0,000
00,000
00
PlTTSFIELD
50,118
6,991,200
139
Hamilton .
2,037
65,600
32
Plainville
1,302
101,416
78
Hanover .
2,908
211,000
73
Plymouth
13,300
1,417,000
107
Hanson and
Provincetown
3,668
363,000
99
Pembroke
4,338
144,700
33
Randolph and
Harwich
2,567
62,000
24
Holbrook
10,968
669,700
61
Haverhill
46,752
4,246,300
91
Reading .
10,899
672,100
62
Hingham and
Rockport
3,556
373,300
105
Hull .
10,214
1,169,100
114
Russell
1,242
40,700
33
Holden
3,926
81,900
21
Salem
41,213
4,461,600
108
Holliston .
3,015
112,000
37
Salisbury
2,402
306,300
128
HOLYOKE .
53,750
7,531,400
140
Saugus
14,825
785,000
53
Hudson
8,042
456,500
57
Scituate .
4,187
522,000
125
Ipswich
6,374
330,100
52
Sharon
3,748
420,600
112
Kingston .
2,791
253,000
91
Shelburne
1,642
97,300
59
Lancaster
3,038
150,900
50
Shirley
2,620
90,900
35
Lanesborough
1,338
31,300
23
Shrewsbury
7,674
405,700
53
Lawrence
84,323
4,363,700
52
Somerset
5,916
288,000
49
Leicester .
4,936
189,600
38
Southbridge
17,033
919,000
54
Leominster
22,292
3,202,000
144
South wick
1,587
38,300
24
Lincoln
1,825
331,500
182
Springfield
149,554
17,200,000
115
Littleton .
1,675
106,100
63
Sterling .
1,744
23,300
13
Longmeadow
5,927
421,000
71
Stoughton
8,663
691,300
80
Lowell .
101,644
5,686,100
56
Sturbridge
2,289
95,600
42
Ludlow
8,181
332,400
41
Sudbury .
1,777
21,000
12
Lunenburg
2,209
81,900
37
Taunton .
37,395
2,823,000
75
Lynn
98,123
8,773,800
89
Tisbury
1,995
246,000
123
Lynnfield .
2,365
74,500
32
Townsend
2,090
155,400
74
Manchester
2,472
371,300
150
Uxbridge .
6,421
352,800
55
Mansfield .
6,530
635,000
97
Wakefield
16,223
839,500
52
Marblehead
10,993
853,900
78
Walpole .
7,443
1,010,000
136
Marion
2,063
200,000
97
Waltham
40,020
2,798,000
70
Marlborough
15,154
851,300
56
Ware
7,557
372,000
49
Marshfield
2,488
377,000
151
Wareham .
6,427
281,000
44
Mattapoisett
1,608
100,000
62
Warren
3,531
102,000
29
Maynard
6,812
328,000
48
Wayland .
3,537
388,600
110
Medfield .
4,428
82,000
19
Webster
13,186
680,240
52
Medway
3,303
260,000
79
Wellesley
15,477
1,444,000
93
Merrimac .
2,342
207,300
89
West Bridgewat
jr 3,247
199,400
61
Methuen .
22,041
1,081,800
49
West Brookfield
1,413
99,500
70
Middleborough
9,065
339,000
37
Westfield
18,794
2,099,100
112
Milford and
Westford .
3,838
131,200
34
Hopedale
18,586
922,000
50
Weston
3,590
242,000
67
Millbury .
7,004
370,000
53
West Newbury
1,523
19,300
13
Millis
2,314
192,000
83
West Springfield
17,138
2,033,900
119
Montague and
Weymouth
24,292
1,432,000
59
Erving .
8,910
912,800
102
Whitman
7,793
328,000
42
Nantucket
3,401
466,290
137
Wilbraham
3,055
64,100
21
Natick
13,851
955,700
69
Williamsburg
1,684
87,700
52
Needham .
12,568
769,000
61
Wilmington
4,675
272,800
58
New Bedford
110,405
10,053,200
91
Winchendon
6,575
263,200
40
Newburyport
13,916
1,521,800
109
Winchester
15,423
1,109,000
72
Newton .
70,619
5,363,200
76
Woburn
19,762
1,757,100
89
North Adams
22,239
2,912,300
131
Worcester
194,339
19,482,000
100
North Andover
7,596
513,200
68
Wrentham
4,777
209,000
44
Yarmouth .
2,324
97,000
42
70
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82
The following table shows the normal rainfall as deduced from the records of
seven long-term stations located at Amherst, Boston, Dalton, Fitchburg, Lowell,
New Bedford and Northbridge; also the rainfall for the year 1941 and the excess or
deficiency for each month as compared with the normal.
Normal
Rainfall
Month (inches)
January .........
February .........
March .........
April ..........
May .........
June ..........
July ..........
August .........
September ........
October .........
November ........
December .........
Totals
Rainfall
in 1941
(inches)
Excess or
Deficiency
in 1941
(inches)
3.59
3.17
—0.42
3.35
2.25
—1.10
3.81
2.34
—1.47
3.59
1.21
—2.38
3.52
2.80
—0.72
3.48
4.11
+0.63
3.80
4.27
+0.47
4.15
3.69
—0.46
3.60
0.96
—2.64
3.51
2.23
—1.28
3.75
2.91
—0.84
3.55
3.73
+0.18
43.70
33.67
—10.03
liable Showing the Average Yield of the Sudbury River for Each Month in the
Year 1941, in Cubic Feet per Second per Square Mile of Drainage Area, and in
Million Gallons per Day per Square Mile of Drainage Area; also Departure
from the Normal.
♦
Normal Yield
Actual Yield in 1941
Excess or
Deficiency
Cubic Feet
Million
Cubic Feet
Million
Cubic Feet
Million
Month
per
Gallons per
per
Gallons per
per
Gallons per
Second
Day
Second
Day
Second
Day
per Square
per Square
per Square
per Square
per Square
per Square
Mile
Mile
Mile
Mile
Mile
Mile
1.768
1.142
1.139
0.736
—0.629
—0.406
February
2.273
1.469
2.103
1.359
—0.170
—0.110
4.103
2.652
2.093
1.353
—2.010
—1 . 299
3.141
2.030
1.586
1.025
—1 . 555
—1.005
May .
1.659
1.072
0.545
0.352
—1.114
—0.720
0.817
0.528
0.254
0.164
—0.563
—0.364
0.360
0.233
—0.077
—0.050
—0.437
—0.283
0.309
0.200
—0.364
—0.235
—0.673
—0.435
September
0.436
0.281
—0.376
—0.243
—0.812
—0.524
0.593
0.383
—0.324
—0.210
—0.916
—0.593
1.179
0.762
0.023
0.015
—1.156
—0.747
December
1.512
0.977
0.287
0.185
—1 . 225
—0.792
Average for whole year
1.508
0.975
0.564
0.364
—0.944
—0.611
83
The rainfall on the Sudbury River watershed and the total yield expressed in
inches in depth (inches of rainfall collected) for each of the past six years 1936
to 1941, inclusive, together with the average for 67 years are given in the following
table:
Table Showing the Average Yield of the Nashua River for Each Month in the
Year 1941, in Cubic Feet per Second per Square Mile of Drainage Area, and
in Million Gallons per Day per Square Mile of Drainage Area; also Departure
from the Normal.
Normal Yield
Actual Yield in 1941
Excess or
Deficiency
Cubic Feet
Million
Cubic Feet
Million
Cubic Feet
Million
Month
per
Gallons per
per
Gallons per
per
Gallons per
Second
Day
Second
Day
Second
Day
per Square
per Square
per Square
per Square
per Square
per Square
Mile
Mile
Mile
Mile
Mile
Mile
January ....
1.913
1.237
1.221
0.789
—0.692
—0.448
February
1.986
1.283
1.846
1.193
—0.140
—0.090
March
3.943
2.548
1.760
1.138
—2.183
—1.410
April .
3.654
2.361
2.105
1.361
—1 . 549
—1 . 000
May .
1.997
1.291
1.078
0.697
—0.919
—0.554
June .
1.288
0.832
0.625
0.404
—0.663
—0.428
July
0.758
0.490
0.475
0.307
—0.283
—0.183
August
0.626
0.405
0.470
0.304
—0.156
—0.101
September
0.729
0.471
— 0..018
—0.012
—0.747
—0.483
October
0.740
0.478
—0.482
—0.312
—1.222
—0.790
November
1.274
0.823
0.473
0.306
—0.801
—0.517
December
1.761
1.138
0.737
0.476
—1 . 024
—0.662
Average for whole year
1.720
1.112
0.850
0.549
—0.870
—0.563
Flow of the Merrimack River at Lawrence in Cubic Feet per Second per Square Mile
Mean for
sixty-two
Month
1936
1937
1938
1939
1940
1941
years,
1880-1941
January ....
1.687
2.620
2.117
1.760
.481
1.571
1.332
February
1.413
2.475
2.416
1.527
.486
1.874
1.373
March
10.408
2.067
2.467
2.403
1.143
1.441
2.755
April
4.477
3.679
2.884
5.691
6.314
2.356
3.676
May
1.867
4.289
1.862
2.735
4.182
.952
2.260
June
.705
2.104
1.310
1.016
2.430
.539
1.269
July
.478
.969
2.039
.489
.940
.536
.772
August
.359
.575
1.898
.508
.520
.294
.645
September
.411
.521
4.156
.367
.709
.267
.695
October .
.889
.827
1.894
.399
.407
.326
.796
November
.969
2.083
1.640
.849
1.488
.529
1.153
December
2.306
2.679
3.309
.688
1.335
.594
1.158
Average for whole year .
2.164
2.074
2.333
1.536
1.703
.940
1.490
Average for driest six
months
.635
1.180
2.077
.550
.900
.415
.870
84
Weekly Flow of the Sudbury, Nashua and Merrimack Rivers
The following table shows the weekly fluctuations during the year 1941 in the
yield of the Sudbury River at Framingham, the South Branch of the Nashua River
at the outlet of the Wachusett Reservoir in Clinton and the Merrimack River at
Lawrence. The flow of these streams, particularly that of the Sudbury River and
the South Branch of the Nashua River, serves to indicate the flow of other streams
in eastern Massachusetts. The area of the Sudbury River watershed is 75.2
square miles, of the South Branch of the Nashua River 107.69 square miles and of
the Merrimack River at Lawrence 4,463 square miles .
Table Showing the Average Weekly Flow of the Sudbury, South Branch of the
Nashua and the Merrimack Rivers for the Year 1941, in Cubic Feet
per Second per Square Mile of Drainage Area
Yield of
\ield of
South
Flow of
South
Flow of
Yield of
Branch
Merri-
Yield of
Branch
Merri-
Week ending
Sudbury
Nashua
mack
Week ending
Sudbury
Nashua
mack
t Sunday
River
River
River
Sunday
River
River
River
Jan. 5
2.413
2.145
2.710
July 6 .
0.056
0.284
0.311
12
0.906
1.072
1.637
13
0.014
0.391
0.518
19
1.002
1.035
1.327
20
—0. 129
0.445
0.698
26
1.098
1.205
1.218
27
—0.769
0.396
0.578
Feb. 2
0.777
0.977
1.160
Aug. 3
0.009
0.863
0.490
9
1.918
2.632
1.460
10
-0.703
0.410
0.367
16
2.962
2.404
2.806
17
-0.887
0.448
0.220
23
1.716
1.371
1.855
24
0.584
0.398
0.286
Mar. 2
1.176
0.955
1.441
31
—0.147
0.608
0.273
9
1.568
1.566
1.348
Sept. 7
-0.036
0.289
0.279
16
1.294
1.340
1.279
14
-0.448
0.306
0.295
23
1.559
1.301
1.285
21
—0.462
—0.170
0.270
30
3.993
2.948
1.814
28
-0.402
—0.366
0.227
Apr. 6
2.779
3.426
2.262
Oct. 5
—0.216
—0.438
0.212
13
1.999
2.647
2.862
12
—0.913
—0.528
0.302
20
1.231
1.702
2.825
19
-0. 199
—0.606
0.424
27
1.061
1.247
1.822
26
—0.520
—0.714
0.329
May 4
0.652
1.152
1.230
Nov. 2
0.725
0.573
0.305
11
1.151
1.626
1.150
9
0.092
0.629
0.817
18
0.726
1.126
1.197
16
-0.108
0.237
0.613
25
0.191
0.872
0.725
23
-0.143
0.342
0.377
June 1
—0.061
0.474
0.618
30
-0.186
0.258
0.402
8
0.407
1.118
0.573
Dec. 7
0.027
0.438
0.338
15
0.183
0.450
0.470
14
0.395
0.904
0.363
22
0.335
0.553
0.680
21
0.234
0.737
0.491
29
-0.007
0.447
0.451
28
0.573
0.907
0.903
85
Table 6. — ■ Efficiency of Sand Filters (Per Cent Removal)
Parts per Million and Per Cent
Total A lrtimi-
Kjeldahl
Free Ammonia
noii
Ammonia
Nitrogen
Chlorides
B
.0. D
_
^
-tJ— i
Citt or Town
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&i
<GG
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Attlbboro
41.6
19.0
54
7.68
1.76
77
16.5
4.1
75
34
34
180
33
82
Brockton
51.2
26.5
48
8.15
1.75
79
18.3
4.2
77
91
82
383
40
90
Clinton
19.5
9.1
53
6.46
1.55
76
12.1
3.6
70
52
49
242
52
79
Concord .
24.9
3.8
85
9.03
0.18
98
16.6
0.3
98
37
27
150
1
99
Easthampton .
34.7
13.0
63
6.37
0.75
88
13.3
1.7
87
39
38
260
3
99
Franklin
22.4
10.1
55
3.09
1.64
47
6.9
3.9
43
24
33
276
2
99
Gardner
(Gardner Area)
38.4
20.3
47
8.35
1.69
80
15.5
4.0
74
47
48
283
13
95
Gardner
(Templeton Area) .
52.1
25.8
50
5.27
1.98
62
8.8
3.7
58
46
45
192
46
76
Hopedale
44.7
13.2
70
4.72
0.70
85
9.8
1.4
86
40
32
153
5
97
Hudson .
57.0
41.5
27
7.55
2.43
68
15.9
5.2
67
57
53
408
107
74
Leicester
21.1
11.0
48
6.05
1.53
75
14.9
3 0
80
20
24
235
23
90
Lenox
20.3
2.6
87
2.37
0.46
81
5.7
1.0
82
21
23
111
3
97
Marion
11.6
0.1
99
1.47
0.18
88
3.5
0.4
89
128
138
63
1
98
Marlborough
39.9
16.2
59
7.50
0.80
89
14.2
1.9
87
42
44
290
2
99
Medfield
22.7
10.1
56
7.53
1.66
78
17.0
4.8
72
29
29
232
28
88
Millis
17.7
0.2
99
2.19
0.17
92
5.1
0.7
86
29
28
46
2
96
North Attleborough
15.2
7.3
52
3.89
0.41
89
9.0
0.9
90
25
22
65
7
89
Northbridge
34.6
5.4
84
4.50
1.01
78
9.3
2.8
70
31
25
108
5
95
PlTTSPIELD
20.5
7.8
62
3.97
1.01
75
8.8
2.3
74
47
53
148
16
89
Southbridge
51.2
24.6
52
6.65
1.90
71
12.0
3.8
68
46
42
183
5
97
Spencer (new beds) .
21.2
11.6
45
6.97
1.17
83
15.7
2.5
84
30
28
195
21
89
Spencer (old beds) .
21.2
6.4
70
6.97
0.38
95
15.7
1.1
93
30
28
195
3
98
Stockbridge
19.2
2.5
87
3.41
0.54
84
8.4
2.3
73
16
26
145
3
98
Westborough
34.4
10.6
69
8.33
1.47
82
15.6
3.3
79
74
182
245
15
94
Winchendon
21.9
1.3
94
3.49
0.21
94
8.3
0.6
93
24
27
103
1
99
86
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88
THE DIVISION OF TUBERCULOSIS
Alton S. Pope, M.D., Director
In 1941 the long-continued decline in tuberculosis morbidity and mortality-
appears to have been temporarily checked. This change in the trend is probably
related to the war, but is as yet no greater than has occasionally been observed
in the past. The number of reported cases of tuberculosis (all forms) was 3,282,
or 172 more than last year; the increase is at least partly due to the extensive use
of the chest X-ray in military recruits, so that the actual reported incidence of the
disease is essentially unchanged. The number of deaths was 1,632 as against
1,598 in 1940.
Tuberculosis morbidity and mortality rates for the last five years will be found
in the summary of the Division of Communicable Diseases.
State Sanatoria
All the sanatoria have experienced increasing difficulty in securing employees
and have been forced at times to employ less capable help or leave positions
unfilled. In one of the institutions it became necessary to close a ward for a con-
siderable period, owing to insufficient nurses to care for all patients. Another change
which has seriously affected our institutions is rising costs, especially food costs.
There was a shortage of beds for women with nonpulmonary tuberculosis at
Lakeville for a part of the year, and waiting lists of cancer cases at Pondville and
Westfield. Rutland and North Reading had a variable number of empty beds,
and the Westfield Tuberculosis Section a few.
County and Municipal Sanatoria
Legislation was passed in 1941 providing for an investigation of the direct charges
to towns for patients in county sanatoria. Another bill was passed which in effect
made tuberculosis, or any other infection acquired by hospital employees in contact
with patients, compensable under the Workmen's Compensation Act.
State Subsidy
The total subsidy paid to cities and towns for the care of patients in county and
municipal sanatoria in 1941 amounted to $467,541.95. This represents a decrease
of $19,513.62 from the 1940 figure. Prior to 1941, subsidy payments had increased
each year since the subsidy law was passed in 1911.
Clinic Services
The school case-finding program results can be seen from the appended table.
A number of surveys of colleges and institutions were also made and are summarized
in this table. Reclassification clinics were held in 60 communities.
The clinic was called upon for the largest task it has ever faced in the X-raying
of approximately 34,000 National Guardsmen and soldiers inducted into the army
under Selective Service during the year. These films, furnished by the army, were
exposed, processed and interpreted entirely by our clinic personnel using the regular
portable X-ray machines. Full details of this work are given in an article to be
published in the Commonhealth. The army has now taken over the task with its
own staff and equipment.
I. Clinics Held in Public and Parochial High Schools During the School Year
1940-1941
New Clinics
Number of towns and cities visited . . . . 31
A.
Children tuberculin tested
Reactors
Per cent of reactors
Number X-rayed .
Pulmonary tuberculosis, active or healed*
Incidence of tuberculosis per 1,000 X-rayed
14,487
4,363
30%
5,237
17
3.2
♦Includes only previously unrecognized cases: does not include suspicious cases which may later be
confirmed.
89
B. Re-examination Clinics
Number of towns and cities visited
Children X-rayed . . . ...
New diagnosis of pulmonary tuberculosis made
Incidence of tuberculosis per 1,000 X-rayed
31
1,252
1
1
II. X-ray Surveys Made During 1941
National Guard
Regular Army-
Selective Service
Holyoke Mills .
Women's Reformatory
Medical and dental schools
Teachers colleges (9)
Other colleges (7)
X-rays Pulmonary Tuberculosis Incidence
Taken (Active and Healed)* per 1,000
9,832 45 4.6
1,896 9 4.7
22,825 135 5.9
425 7 16
328 4 12
302 3 10
1,074 1 1
1,869 1 1
♦Includes only previously unrecognized cases; does not include suspicious case3 which may later be
confirmed.
Arthritis Hospitalization
The contract with the Massachusetts General Hospital for the use of 20 beds
for the treatment of arthritic patients was renewed this year, and the program
for the study of arthritis continued without interruption.
90
LAKEVILLE STATE SANATORIUM
Leon A. Alley, M.D., Superintendent**
Claire W. Twinam, M.D., Acting Superintendent
To Paul J. Jakmauh, M.D., Commissioner of Public Health:
I have the honor to submit the summary of activities of the Lakeville State
Sanatorium for the year ending November 30, 1941.
Table 1. — Admissions and Discharges
Tuberculosis Patients
Adults
Children
Males
Females
Males
Females
Totals
Patients in the sanatorium November 30, 1940
68
49
62
42
221
Patients admitted December 1, 1940, to No-
vember 30, 1941
58
69
38
29
194
Patients discharged December 1, 1940, to No-
vember 30, 1941
73
59
45
18
195
Patients remaining in sanatorium November
30, 1941
55*
60*
53
52
220
Deaths .......
7
6
4
1
18
Daily average number of patients
61.3
52.5
62.2
46.1
222.1
*2 boys and 1 girl reached the age of 21 dur-
ing the year and were shifted to adult columns.
Poliomyelitis Patients
Patients in the sanatorium November 30, 1940 .
Patients admitted December 1, 1940, to No-
vember 30, 1941
Patients discharged December 1, 1940, to No-
vember 30, 1941
Patients remaining in sanatorium November
30, 1941
Deaths ......
Daily average number of patients .
*2 girls reached the age of 21 during the year
and were shifted to adult columns.
4
3
19
20
10
6
26
26
7
9
28
32
7
2*
17
12
2.8
2.0
15.3
20.0
46
68
76
38
40.1
Total of Tuberculosis and Poliomyelitis Patients
Patients in the sanatorium November 30, 1940
72
. 52
81
62
267
Patients admitted December 1, 1940, to No-
vember 30, 1941
68
75
64
55
262
Patients discharged December 1, 1940, to No-
vember 30, 1941
80
68
73
50
271
Patients remaining in sanatorium November
30, 1941
62*
62*
70
64
258
Deaths .......
7
6
4
1
18
Daily average number of patients .
64.1
54.5
77.5
66.1
262.2
*2 boys and 3 girls reached the age of 21
during the year and were shifted to adult
columns.
**On Military Leave of Absence.
91
Table 2. — Diagnosis and Classification on Admission
Tuberculosis Patients
(Classification by Most Serious Lesion Present)
Adults
Children
Males
Females
Males
Females
Total
Tuberculosis :
Of intestines and peritoneum
Of the vertebral column ....
Of the bones and joints (vertebral column
excepted) ......
Of the lymphatic system (bronchial, mesen-
teric and retroperitoneal glands excepted)
Of the genitourinary system
Of the skin and subcutaneous cellular tissue
Of other organs .....
Unclassified .......
Nontuberculous disease ....
2
7
13
6
13
7
6
3
1
9
8
8
17
16
1
5
3
2
8
7
2
6
4
3
8
9
2
5
6
2
3
2
20
25
33
31
37
8
18
9
13
Total
58
69
38
29
194
Poliomyelitis Patients
Stage II
Stage III
Stage IV
7
1
2
1
5
2
5
19
26
9
7
52
Total
10
6
26
26
68
Table 3. — Ages of Patients Admitted
Tuberculosis
Poliomyelitis
Total of Tuberculosis and
Patients
Patients
Poliomyletis Patients
Males
Females
Males
Females
Males
Females
Total
Under 5 years
2
5
_
_
2
5
7
5 to 9 years .
8
3
2
—
10
3
13
10 to 14 years
7
5
12
8
19
13
32
15 to 19 years
19
11
10
15
29
26
55
20 to 29 years
19
29
6
6
25
35
60
30 to 39 years
14
22
6
3
20
25
45
40 to 49 years
12
10
-
-
12
10
22
50 to 59 years
8
7
-
-
8
7
15
60 to 69 years
6
5
-
-
6
5
11
70 and over .
1
1
-
-
1
1
2
Total .
96
98
36
32
132
130
262
Table 4. — Condition on Discharge
Tuberculosis Patients
Adults
Child
*EN
Totals
Males
Females
Males
Females
Percentages
Arrested
Apparently arrested
Quiescent
Improved
Unimproved
Deaths
Not considered
Nontuberculous
19
9
26
4
3
7
2
3
13
5
11
14
3
6
3
4
18
4
4
1
4
1
13
12
2
1
3
62
18
43
19
6
18
6
23
31.8
9.2
22.1
9.7
3.1
9.2
3.1
11.8
Totals .
73
59
45
18
195
100.0
Poliomyelitis Patients
Improved
Unchanged ....
7
8
1
26
2
29
3
70
6
92.1
7.9
Totals
7
9
28
32
76
100.0
92
Table 5. — Deaths of Tuberculosis Patients
Length of Residence in Sanatorium
Adults
Children
Males
Females
Males
Females
Totals
Less than 1 month .....
_
1
_
_
1
1 to 3 months .....
2
4
-
1
7
3 to 6 months .....
2
1
-
-
3
6 to 12 months .....
1
-
1
-
2
1 to 2 years ......
1
-
-
-
1
Over 2 years .....
1
_
3
_
4
Totals
7
6
4
1
18
Table 6. — Causes of Death
Adults
Children
Males
Females
Males
Females
Total
Tuberculosis:
Of intestines and peritoneum
-
3
-
1
4
Of the vertebral column
1
-
-
-
1
Of the bones and joints (vertebral column
excepted) .....
1
1
1
-
3
Of the lymphatic system (bronchial
mesenteric and retroperitoneal glands
excepted) .....
-
1
_
-
1
Of the genitourinary system .
1
—
2
—
Other tuberculous conditions
3
1
-
~
4
Other causes .....
1
-
1
~
2
Total ... ...
7
6
4
1
18
Table 7. — Outpatient Examinations
New patients seen ..........
Old cases ......-••••
Number of visits ..........
Diagnoses made (new patients) :
Negative for tuberculosis ........
Suspicious lesion
Extrapulmonary tuberculosis .......
Pulmonary tuberculosis ....-••■•
Anterior poliomyelitis .........
66
208
273
58
1
3
3
1
Table 8. — Surgical Operations
Tuberculosis Patients*
Amputations
3
Tonsillectomies .
Arthrodeses ...
32
All other operations
Exploratory laparotomies
1
Incisions for drainage .
3
Nephrectomies
3
Cystoscopies
Other kidney operations
5
Transfusions
93
12
7
66
36
31
*Of these operations, 9 were performed at the Baker Memorial Hospital in Boston.
Poliomyelitis Patients
Muscle transplants* .... 23 All other operations
Stabilizations* ..... 26
Stabilizations and muscle transplants 10
Tonsillectomies ..... 2 Transfusions
♦Including other procedures such as plastics and tenotomies done at the same time.
26
87
Major abdominal operations
All other operations
Employees
3 Cystocopies
1
Casts
Boots
47
Shells
Buckets
2
Spicas
Cylinders .
101
Splints
Jackets
154
Reinforcements
Moulds
14
Respectfully submitted,
78
69
82
613
Claire W. Twinam, M.D.,
Acting Superintendent.
94
NORTH READING STATE SANATORIUM
Carl C. MacCorison, M.D., Superintendent
To Paul J. Jakmauh, M.D., Commissioner of Public Health:
I have the honor of submitting the summary of activities of the North Reading
State Sanatorium for the year ending November 30, 1941.
Table 1. — Admissions and Discharges
Patients in Sanatorium November 30, 1940 .
Patients admitted from December 1, 1940, to November 30,
1941, inclusive ........
Patients discharged from December 1, 1940, to November 30,
1941, inclusive ........
Patients remaining in Sanatorium November 30, 1941
Deaths ..........
Daily average number of patients .....
Vlales
Females
Total
106
124
230
58
56
114
87
77
6
89.8
71
109
8
122.4
138
186
14
212.1
Table 2 — Diagnosis and Stage of Disease on Admission
Primary phase tuberculosis .
Minimal .....
Moderately advanced .
Advanced .....
Miliary tuberculosis
Tuberculous pleurisy with effusion
Tuberculous peritonitis
Bronchiectasis ....
Lung abscess ....
Convalescent postoperative empyema
Tuberculous cervical adenitis
Undernourished ....
Nontuberculous ....
Observation ....
Deferred .....
Total
lales
Females
Total
Percentage
26
18
44
38.6
3
8
11
9.6
2
7
9
7.9
3
10
13
11.4
1
-
1
.9
2
3
5
4.4
1
—
1
.9
1
1
2
1.8
2
2
4
3.5
—
1
1
.9
1
1
2
1.8
1
-
1
.9
5
1
6
5.2
4
3
7
6.1
6
1
7
6.1
58
100.0
Table 3. — Ages of Patients Admitted
Males
Under 5 years ....... 23
5 to 9 years . . . . . . . 11
10 to 14 years ....... 15
15 to 19 years ....... 9
Total 58
Average age . . . . . . . 7.7
Table 4. — Condition on
Males
Apparently well ...."... 14
Arrested ........ 49
Apparently arrested ...... 5
Quiescent ........ 4
Improved ....... 5
Unimproved ....... 4
Died 6
Total 87
Females
Total
Percentage
10
33
29.0
11
22
19.3
23
38
33.3
12
21
18.4
56
114
100.0
10.4
9.1
.scharge
Females
Total
Percentage
5
19
12.0
25
74
46.8
12
17
10.8
9
13
8.2
9
14
8.9
3
7
4.4
8
14
8.9
71
158
100.0
Table 5. — Deaths by Length of Residence in Sanatorium
Females
4
1
2
1
Males
Less than 1 month ....
1 to 3 months .....
3 to 6 months .....
6 to 12 months .....
1 to 2 years .....
Over 2 years .....
1
1
3
'.'.'.'. 1
Total
6
Total
1
5
4
2
2
95
Table 6. — Causes of Death
Tuberculosis of lungs .
Tuberculous meningitis
Miliary tuberculosis
Tuberculosis of peritoneum
Bronchiectasis
Total
ales
Females
Tots
3
6
9
1
—
1
1
1
2
-
1
1
1
-
1
14
Table 7. — Clinic Examinations
New patients seen
Old cases ....
Number of visits
Diagnoses made (.new patients):
Pulmonary tuberculosis
Pulmonary tuberculosis suspect
Primary tuberculosis
Primary tuberculosis suspect
Extrapulmonary tuberculosis
Contact with negative X-ray
Negative for tuberculosis .
Consultation
Clinics Out-Patients Total
322 917 1239
413 1143 1556
786 2217 3003
22
21
43
48
118
166
2
2
4
11
32
43
-
1
1
87
101
188
52
643
795
Total
322
917
1239
Respectfully submitted,
Carl C. MacCorison, M.D.,
Superintendent.
96
RUTLAND STATE SANATORIUM
Ernest B. Emerson, M.D., Superintendent
To Paul J. Jakmauh, M.D., Commissioner, Department of Public Health:
I have the honor to submit the summary of activities of the Rutland State
Sanatorium for the year ending November 30, 1941.
Table 1. — Admissions and Discharges
Patients in Sanatorium November 30, 1940 ....
Patients admitted from December 1, 1940, to November 30,
1941, inclusive ... ....
Patients discharged from December 1, 1940, to November 30,
1941, inclusive. . . .....
Patients remaining in Sanatorium November 30, 1941
Deaths ..........
Daily average number of patients .....
Males
147
153
142
158
36
150.6
Females
128
115
119
124
29
136.8
Total
275
268
261
282
65
287.4
Table 2. — Diagnosis and Stage of Disease on Admission
Minimal
Moderately advanced
Far advanced
Unclassified
Tuberculous pleurisy
Carcinoma of lung
Chronic myocarditis
Pleurisy with effusion
Empyema .
Anthracosis
Arteriosclerosis .
Bronchiectasis
Males
15
36
92
7
Females
15
35
54
3
2
1
2
1
1
1
Total
268
Table 3. — Ages of Patients Admitted
Under 20 years
20 to 29 years .
30 to 39 years .
40 to 49 years .
60 to 59 years .
60 to 69 years .
70 years and over
Total .
Average age
Arrested .
Apparently arrested
Quiescent
Improved
Unimproved
Not considered
Nontuberculous
Dead
Table 4.
Males
Females
Total
Percentage
10
8
18
6.7
31
47
78
29.1
38
42
80
29.8
36
4
40
14.9
27
9
36
13.6
7
5
12
4.4
4
-
4
1.5
153
115
268
39.4
32.2
36.4
'on on
Discharge
Males
Females
Total
Percentage
4
5
9
3.5
3
6
9
3.5
62
44
106
40.6
14
10
24
9.2
10
15
25
9.6
4
4
8
3.1
9
6
15
5.7
36
29
65
24.8
Total
142
261
100.0
Under 1 month
1 to 3 months .
3 to 6 months
6 to 12 months
1 to 2 years
Over 2 years .
Total .
Table 5. — Deaths by Lengths of Residence
Males
Females
Tots
5
3
8
6
8
14
9
6
15
6
6
12
7
4
11
3
2
5
36
29
97
Table 6. — Causes of Death
Males
Pulmonary tuberculosis ..... ... 28
Pulmonary tuberculosis and diabetes mellitus . . . . -
Peritoneal tuberculosis and pulmonary tuberculosis . . . -
Pulmonary tuberculosis and intestinal tuberculosis ... 1
Pulmonary tuberculosis and laryngeal tuberculosis ... 2
Pulmonary tuberculosis and acute laryngitis .... 1
Chronic myocarditis ........ _
Carcinoma of lung ....... ; ■ 1
Pulmonary tuberculosis, tuberculous pleurisy, and peritoneal
tuberculosis . . . . ■ • ",".•' *
Pulmonary tuberculosis, intestinal tuberculosis, and amyloidosis
of liver and spleen . . . . . . 1
Arteriosclerotic heart disease, pulmonary fibrosis, and broncho-
pneumonia . . . . ■ • 1
Pulmonary tuberculosis, intestinal tuberculosis, and rheumatic heart
disease. ......••■■
Total 36
Females
22
2
1
1
1
Table 7. — Clinic Examinations
Consultation
Clinics Outpatients Total
New patients seen . . . 493 368 861
Old cases 282 368 650
Number of visits 775 736 1,511
Diagnoses made (new patients) :
Negative for tuberculosis ....... 339 348 687
Pulmonary tuberculosis ....... 15 10 25
Tuberculosis suspect. ........ 132 7 139
Primary phase tuberculosis ....... 7 3 10
Table 8. — Surgical Operations
Appendectomies
Other abdominal operations
Tonsillectomies
-Other minor operations
Phrenic emphraxis .
Bronchoscopies
Cystoscopies .
Blood transfusions .
Artificial pneumothorax refills
Aspirations of pleural cavity
Total number of inpatients receiving pneumothorax during the year
Total number of inpatients receiving pneumothorax at the end of the year
Total number of outpatients given pneumothorax during the year
Total number of outpatients receiving pneumothorax at the end of the year
8
10
8
14
2
94
4
2
4,988
185
152
106
116
75
The following were performed at the Massachusetts General Hospital: 34 thora-
coplasties, 14 apicolyses, 1 bronchoscopy, 1 phrenicotomy, and 1 plombage-
paraffin.
Respectfully,
Ernest B. Emerson, M.D.,
Superintendent.
98
WESTFIELD STATE SANATORIUM
Roy Morgan, M.D., Superintendent
To Paul J. Jakmauh, M.D., Commissioner, Department of Public Health:
I have the honor to submit the summary of activities of the Westfield State
Sanatorium for the year ending November 30, 1941.
Table 1. — Admissions and Discharges
Tuberculosis Patients
Males
Patients in Sanatorium November 30, 1940 .... 67
Patients admitted from December 1, 1940, to November 30,
1941, inclusive ........ 88
Patients discharged from December 1, 1940, to November 30,
1941, inclusive ........ 78
Patients remaining in Sanatorium November 30, 1941 . . 77
Deaths 19
Daily average number of patients . . . . . 75 . 3
Cancer Patients
Patients in hospital November 30, 1940 .... 18
Patients admitted from December 1, 1940, to November 30,
1941, inclusive ........ 311
Patients discharged from December 1, 1940, to November 30,
1941, inclusive ........ 309
Patients remaining in hospital November 30, 1941 . . 20
Deaths .......... 38
Daily average number of patients . . . . . 20.5
Females
102
84
93
93
14
98.5
25
355
363
17
23
20.2
Totals
169
.172
171
170
33
173.8
43
666
672
37
61
40.7
Total of Tuberculosis and Cancer Patients
Patients in Sanatorium November 30, 1940 .... 85 127
Patients admitted from December 1, 1940, to November 30,
1941, inclusive 399 439
Patients discharged from December 1, 1940, to November 30,
1941, inclusive . . 387 456
Patients remaining in Sanatorium November 30, 1941 . 97 110
Deaths 57 37
Daily average number of patients 95.8 118.7
Cancer Readmissions
Total patients treated ........ 329 380
Less old patients readmitted first time since December 1, 1940 42 59
Less other readmissions ....... 46 38
Less patients in hospital December 1, 1940 .... 18 25
New patients admitted from December 1, 1940 to November 30,
1941 223 258
Total number of different patients treated December 1 , 1940 to
November 30, 1941 283 342
212
838
843
207
94
214.5
709
101
84
43
481
625
Table 2. — Diagnosis and Stage of Disease on Admission
Tuberculosis
Advanced .....
Advanced with diabetes
Advanced with silicosis
Advanced with pleurisy with effusion
Minimal .....
Minimal with pleurisy with effusion
Minimal with pregnancy
Moderately advanced .
Moderately advanced with pregnancy
Pleurisy with effusion .
No evidence of tuberculosis .
Unclassified ....
Males
Females
Total
Percentage
.
35
79
45.9
3
3
6
3.5
2
-
2
1.2
1
—
1
.6
8
12
20
11.6
1
2
1.2
—
1
.6
15
21
36
20.9
-
1
.6
-
1
.6
3
4
2.3
11
8
19
11.0
Total
Cancer
Early
Moderately Advanced
Advanced .
Non-malignant .
Total
172
100.0
15
37
52
40
41
81
21
87
208
47
93
140
258
481
99
Table 3. — Ages of New Patients Admitted
Tuberculosis
Tuberculosis
Cancer
Combined
Males
Females
Total
Males
Females
Total
Total
Under 20 years
4
11
15
6
1
7
22
20 to 29 years
25
30
55
6
8
14
69
30 to 39 years
17
21
38
9
23
32
70
40 to 49 years
16
13
29
29
68
97
126
50 to 59 years
14
6
20
62
83
145
165
60 to 69 years
10
3
13
61
43
104
117
70 to 79 years
2
-
2
43
25
68
70
SO to 89 years
-
-
-
7
7
14
14
Total
88
84
172
223
258
481
653
Table 4. — Condition of Patients Discharged
Tuberculosis
Apparently arrested . . . .
Quiescent ......
Improved . . . . .
Unimproved .
Died
No evidence of tuberculosis
Males
29
4
8
15
19
3
Females
33
10
22
11
15
2
Totals
62
14
30
26
34
5
Percentages
36.3
8.2
17.5
15.2
19.9
2.9
Total
78
Cancer
93
171
100.0
Unimproved .
Died
198
73
38
266
74
23
464
147
61
69.0
21.9
9.1
Totals
309
363
672
100.0
Table 5. — Deaths by Length of Residence in Sanatorium
Tubercidosis Patients
Males
Females
Totals
Under 1 month ....
2
4
6
1 to 3 months ....
7
1
8
3 to 6 months ....
4
5
9
6 to 12 months ....
3
2
5
1 to 2 years .....
3
1
4
Over 2 years ....
.
2
2
Total
19
15
34
Table 6. — Causes of Death
Tuberculosis Patients
Pulmonary tuberculosis .......
Pulmonary tuberculosis and silicosis of lungs ....
Pulmonary tuberculosis, tuberculous laryngitis, enteritis,
tracheitis .........
Pulmonary tuberculosis, intestinal tuberculosis, hemangioma
left forearm .........
Pulmonary tuberculosis, carcinoma of bladder, asthma
Pulmonary tuberculosis, pericardial effusion, arteriosclerotic
heart disease .........
Pulmonary tuberculosis, tuberculosis of pelvis, rheumatic heart
disease ..........
Tuberculous meningitis, pulmonary tuberculosis
Tuberculous meningitis, miliary tuberculosis ....
Undiagnosed malignant tumor ......
Total •
Males
14
1
Females
11
Totals
25
19
34
100
Table 7. — Clinic Examinations
Tuberculosis
Consultation
Clinics Out-Patients Total
New patients seen 743 2,544 3,287
Old patients seen 99 3,443 3,542
Number of visits 1,110 4,441 5,551
Diagnosis made (new patients):
Negative for tuberculosis 683 2,306 2,989
Pulmonary tuberculosis ....... 17 117 134
Tuberculosis suspect ........ 27 121 148
Unsatisfactory films ........ 16 - 16
Cancer
Visits to regular Wednesday clinics
Average attendance .
New patients seen
Visits exclusive of Wednesday clinics
Total clinic visits
3,975
80
1,186
2,419
6,394
Table 8. — Surgical Re-port
Tuberculosis
Thoracoplasties :
First stage
Second stage .
Third stage
Fourth stage .
Phrenic crushings
Extra-pleural pneumolysis
Intra-pleural pneumolysis
Open pneumolysis
Total ....
Artificial pneumothorax treatments
Major operations
Minor operations
Biopsies
Endoscopies
Anesthetics given
Thoracoscopies .
8
Open thoracotomy
6
Drainage of empyema
3
Bronchoscopies .
1
Appendectomies
4
Biopsies
3
Cystoscopies
63
1
Minor operations
Cancer
310
370
636
505
1472
Procedures without anesthetics
X-ray treatments
Radium treatments
X-ray films exposed for diagnosis
2
1
1
15
2
6
6
32
154
6,107
540
6993
77
4935
Respectfully submitted,
Roy Morgan, M.D.,
Superintendent.
101
PONDVILLE HOSPITAL
George L. Parker, M.D., Superintendent
To Paul J. Jaukmauh, M.D., Commissioner, Department of Public Health:
I have the honor to submit the summary of activities of the Pondville Hospital,
for the year ending November 30, 1941.
Table 1. Admissions and Discharges
Males
Patients in hospital December 1, 1940 ..... 53
Patients admitted from December 1, 1940 to November 30, 1941 629
Patients discharged from December 1, 1940 to November 30, 1941 636
Patients remaining in hospital November 30, 1941 ... 46
Deaths 83
Daily average number of patients . . . . . . 55.9
Table 2. — Readmissions
Total patients treated ........
Less old patients readmitted first time since December 1, 1940 .
Less other readmissions .......
Less patients in hospital December 1, 1940 . . . .
Number new patients admitted from December 1, 1940 to No-
vember 30, 1941
Total number of different patients treated from December 1,
1940 to November 30, 1941
Males
682
121
124
53
384
558
Females
47
755
751
51
67
56.1
Females
802
139
124
47
Under 20 years
20 to 29 years
30 to 39 years
40 td 49 years
50 to 59 years
60 to 69 years
70 to 79 years
80 to 89 years
90 to 99 years
Unknown age
Table 3. — Ages of New Patients Admitted
Males
9
3
17
25
86
124
89
31
2
Totals
386
492
678
Females
6
22
52
110
117
104
67
12
490
Table 4. — Stage of Disease of New Patients Admitted
Early .
Moderately advanced
Advanced
Non-malignant
No diagnosis
Pending
Totals
386
490
Table 5. — Condition of Patients Discharged
Improved
Unimproved
Died .
Totals
Males
411
144
83
638
Females
551
131
67
749
Table 6
Visits to regular Thursday clinics
Average attendance .
New patients seen
Visits exclusive of Thursday clinics
Total clinicvisits
Clinic Examinations
Operations
Endoscopies
Transfusions
Table 7. — Surgical Report
1162 Anesthetics given
489 X-ray treatments
447 Radium treatments
417
Total
100
1,384
1,387
97
150
112
Total
1,484
260
248
100
876
1,236
Total
15
25
69
135
203
228
156
43
2
876
Males
Females
Total
65
62
127
106
109
215
129
111
240
82
202
284
—
2
2
4
4
8
876
Total
962
275
150
1,387
4,691
92
1,121
2,959
7,650
1,870
13,114
372
Respectfully submitted,
George L. Parker, M.D.,
Superintendent.
INDEX
Administration, Division of ............ 3, 14
Adult Hygiene, Division of . . . . . . . . . . . . 9, 14, 15
Antitoxin and Vaccine Laboratory ........... 8, 19
Appropriations and expenditures . ... r ..... . 14
Arthritis 5, 89
Audiometer testing .............. 25
Bacteriological Laboratory ............. 8
Bakery laws, Violation of ............ 55
Bedding and upholstered furniture law, Violation of ....... . 56
Biologic Laboratories, Division of . . ' . . . . . . . . . 14, 19
Biologic products, distribution of ........... 19, 20
Birth rate per 1,000 population for 1941 . 26
Camps ................ 5
Cancer patients 17, 18, 98-101
Cancer program .............. 15-18
Carbonated, nonalcoholic beverages, Violation of law and regulations relative to 56
Child growth and development ............ 25
Child Hygiene, Division of 8, 14, 23-26
Cities and towns, water supplies ............ 68-81
Sewage disposal works .......... 86-87
Clams ................ 53
Clinics 16, 23, 88
Cold storage 59-63
Commissioner of Public Health, report of ......... 1
Communicable diseases ............. 6
Cases and deaths for all reportable diseases by months, 1941 ...... 32
Cases and deaths from diseases dangerous to the public health, 1941 .... 39
Cases and deaths, with case and death rates per 100,000 population, for reportable diseases
during year 1941 ............. 31
Cases of reportable diseases by ages, 1941 ......... 33
Cases of reportable diseases by counties, 1941 ........ 34
Division of 14, 27-51
Laboratory examinations ............ 30
Outbreaks of 27
Prevalence of certain ............. 6
Crippled children, Services for ............ 6
Cross connections .............. 10
Death rate per 1,000 population, 1941 ........... 26
Deaths, Cancer .............. 17
Dental hygiene ............... 24
Drugs, adulterated .............. 56
Eggs 55
Expenditures for year ended Nov. 30, 1941 .......... 14
Federal grants .............. 14
Financial statement . . ........... 14
Food and drug laws, Violations of .......... . 52-55
Food and drugs, Division of . . . . . . . . . . . 10, 14, 52-64
Food samples, Summary of analysis of ........... 58
Genitoinfectious Diseases, Division of ......... 7, 14, 65-67
Gonorrhea and syphilis ............. 65-67
Hamburg steak .............. 53, 54
Health education .............. 25
Infant mortality rate per 1,000 live births, 1941 ......... 26
Laboratories . . . . . . . . . . . . . . . 4, 8, 19
Lakeville State Sanatorium . . . . . . . . . . . . 15, 90
Lamb patties ............... 54
Lawrence Experiment Station ............ 10
Legislation, New .............. 4
Local health administration ............ 5
Maternal, infant, and preschool hygiene .......... 23
Maternal mortality study ............. 23
Maternal mortality per 1,000 live births, 1941 ......... 26
Merrimack River, Flow of ............ 83, 84
Milk 5, 57, 58
Mortality statistics .............. 26
Nashua River, average yield ............ 83, 84
National defense 3, 66, 89
New England Health Institute j* .... i ....... . 5
North Reading State Sanatorium . . . . . . . . . . . 15, 94
Nursing, Public health ............. 5, 24
Nutrition 24
Olive oil ... 53
Parent education .............. 25
Poliomyelitis patients ............. 90, 91
fathers
P.D. 34
Pondville Hospital ....
Population estimated as of June 30, 1941
Premature infant program
Prenatal and postnatal letters and letter to
Prenatal clinics ....
Prevalence of certain diseases
Prosecutions for violations of the food and drug laws
Public Health Council
Public water supplies
Analyses of ground water sources
Analyses of surface water sources
Rainfall . . . . . .
Regulations .....
Rivers ......
Rutland State Sanatorium
Sanatoria, state, county, and municipal
Sand filters, Efficiency of
Sanitary Engineering, Division of
Sanitary f ood law, Violation of
School hygiene . . . .
Serums and vaccines, Distribution of .
Sewage disposal ....
Sewage disposal works, Efficiency of
Extent, rate of flow, and rate of operation
Shellfish
Slaughtering report ....
Social work .....
State-aided clinics ....
Sudbury River, average yield
Summer Round-Up ....
Syphilis and gonorrhea
Tuberculosis, Division of
Tuberculosis patients
Typhoid carriers, Discovery of
Vaccines, Distribution of
Wassermann Laboratory
Water and Sewage Laboratories .
Water, Analyses of public supplies
Average daily consumption of
Well child conferences
Westfield State Sanatorium
103
15, 101
26
23
23
23
6, 28
52
2
68
76
70
9, 82, 83
11
52, 83, 84
15,96
85
14, 68-87
55
54, 55
23
19, 20
87
9
64
6, 25
16
82, 84
23
65-67
7, 14, 88-100
. 90-100
27
19, 20
8, 21
10
70
68
23
. 15, 98
Public Document
No. 34
SS,
:s.
Cfje CommontoeaUfr of fflasHtatfyMstettti
ANNUAL REPORT
Department of Public Health
Years 1942 Through 1949
tK&e Commontoealti) of ^Massachusetts
ANNUAL REPORT
Department of Public Health
Years 1942 Through 1949
Publication of this Document approved by Geobge J. Cronin, State Purchasing Agent
lM-ft-50-902664
ii P.D. 34
TABLE OF CONTENTS
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH
CONSOLIDATED REPORT— 1942 THROUGH 1949
Report of Public Health Council .
Report of the Commissioner of Public Health
War Activities . . ...
Approving Authority for Medical Schools
Rating Board ......
Milk Regulation Board ....
State Planning Board .....
Special Projects ......
New Projects ......
Departmental Reorganization
Personnel ...
Department Quarters .....
Expenditures — Dept. of Public Health .
Report of Division Local Health Administration
Public Health Nursing .
Social Service
Crippled Children's Services
Nutrition
Sanitation .
Dental Health
Committee on Local Health Units
Report of Proposed Reorganization of Department
Report of Division of Cancer and Other Chronic Diseases
Epidemiology and Biometrics
Service ....
Education ....
Attendance at Teaching Clinics
American Cancer Society
Visitors to the Division
Publications
Outstanding Accomplishments
Massachusetts Cancer Deaths
Total Attendance at Individual State-Aided Cancer CliDics
Number of Social Service Contacts at State-Aided Cancer Clinics
Attendance of New Patients at the Massachusetts Cancer Clinics
Promptness in Seeking Medical Advice .
Stage of the Disease by Site .....
Status of Patients at end of 5, 10, and 15 Year Intervals
Report of Division of Maternal and Child Health
Maternal, Infant and Preschool Hygiene
Child Growth and Development
School Health
Health Education
Nutrition ....
Medical Social Work
Dental Health
Crippled Children's Services .
General . . . .
Legislation . . .
Personnel Changes
Vital Statistics — Massachusetts
Special Projects .
Report of Division of Communicable Diseases
General Statement
Prevalence of Certain Diseases
Reorganization
Epidemiology
12
3
5
5
5
5
6
6
6
6
7
8
9
10
11
12, 13, 14
12, 13, 14
12
12, 13
13, 14
12
13
13, 14
15
15
18
20
20
22
22
22
22
22
23
23
23
24
24
25
26
26
30
31
33
33
34
34
35
36
36
36
36
36
39
39
39
42
42
P.D. 34
Special Projects and Studies ......... 43
Revisions and Regulations ......... 44
Bacteriological Laboratory ......... 44
Wasserrnann Laboratory ......... 45
Publications ........... 45
Outbreaks — 1942-1949 . 46
Incidence of Certain Communicable Diseases Reported 1940-1949 . . 74
Cases and Deaths for all Reportable Diseases by Months — 1942-1949 . 76
Cases of Reportable Diseases by Age — 1942-1949 . . . . .84
Cases Reportable Diseases by Counties — 1942-1949 .... 92
Bacteriological Laboratory .........
Number and Kind of Specimens ........ 100
Specimens and Examinations — 1942-1949 . . . . . . 100
Salmonella Types Found During the Years 1940 through 1949 . . . 108
Wassermann Laboratory ..........
Tests and Examinations ......... 109
Laboratory Examinations for Rabies . . . . . . .110
Index to Line numbers in the Table of Cases and Deaths from Diseases
Dangerous to Public Health . . . . . . . .110
Cases and Deaths from Diseases Dangerous to Public Health by Communities 1 12
Incidence Table by Communities ........ 200
Report of Division of Venereal Diseases ...... 227
Administration . . . . . . . . 227
Division Budget . . . . . 227
Contact Investigation .......... 229
Screen Examinations .......... 230
War Program 230
Education 230
Treatment 231
Reported Cases Gonorrhea and Syphilis — 1942-1949 . . .232
Reported Cases Primary and Secondary Syphilis by Age and Sex — 1942-1949 232
Reported Cases Latent and Late Syphilis — 1942-1949 .... 233
Sources of Reports of Gonorrhea ........ 233
Sources of Reports of Syphilis ........ 233
Military Contacts Reported to Mass. Dept. Public Health — 1942-1949 . 234
Report of Division of Tuberculosis and Sanatoria ..... 235
General Statement .......... 235
Tuberculosis Deaths and Death Rates — 1941-1949 . 235
State Sanatoria ........... 235
County and Municipal Sanatoria ........ 236
Federal Grants ... . . . . . . .236
Arthritis Hospitalization ......... 236
Field Clinic Program .......... 236
Breakdown by Year Groups of Number X-rayed ..... 236
Lakeville State Sanatorium
Admissions and Discharges — Tuberculosis ...... 237
Admissions and Discharges — Poliomyelitis ...... 238
Admissions and Discharges — Crippled Children ... 238
Admissions and Discharges — Total of Tuberculosis, Poliomyelitis and
Crippled Children Patients . 239
Diagnosis and Classification on Admission — Tuberculosis Patients . 240
Diagnosis and Classification on Admission — Poliomyelitis Patients . . 241
Diagnosis and Classification on Admission — Crippled Children . 241
Ages of Patients Admitted — Tuberculosis . . . . . 242
Ages of Patients Admitted — Poliomyelitis ...... 242
Ages of Patients Admitted — Crippled Children ..... 242
Condition on Discharge — - Tuberculosis Patients ..... 243
Condition on Discharge — Poliomyelitis Patients ..... 244
Condition on Discharge — Crippled Children ...... 244
Surgical Report — Tuberculosis ........ 245
Surgical Report — Poliomyelitis ........ 245
Surgical Report — Crippled Children ....... 245
Deaths of Tuberculosis Patients by Length of Residence in Sanatorium . 245
Causes of Death . . . . . . . . . . . 246
North Reading State Sanatorium
Admissions and Discharges — Tuberculosis Patients .... 246
Admissions and Discharges — Rheumatic Fever Patients .... 246
IV
P.D. 34
Stage of Disease on Admission — Tuberculosis Patients . . .
Ages of Patients Admitted — Tuberculosis .....
Condition on Discharge — Tuberculosis ......
Deaths of Tuberculosis Patients by Length of Residence in Sanatorium
Causes of Death — Tuberculosis .......
Rutland State Sanatorium
Admissions and Discharges .
Stages of Disease on Admission
Ages of Patients Admitted
Condition on Discharge
Surgical Report — Operations on Patients
Surgical Report — Operations at Mass. General Hospital
Deaths of Tuberculosis Patients by Length of Residence in Sanatorium
Causes of Death — 1942-1949 . .
Westfield State Sanatorium
Admissions and Discharges — Tuberculosis Patients
Admissions and Discharges — Cancer Patients
Stage of Disease on Admission — Tuberculosis Patients
Stage of Disease on Admission — Cancer Patients .
Ages of Patients Admitted — Tuberculosis Patients
Ages of Patients Admitted — Cancer Patients
Condition on Discharge — Tuberculosis Patients
Condition on Discharge — Cancer Patients
Surgical Report — Tuberculosis ....
Surgical Report — Cancer .....
Deaths of Tuberculosis Patients by Length of Residence in Sanatorium
Causes of Death — Tuberculosis Patients — 1942-1949 .
Pondville Hospital
Admissions and Discharges .
Stage of Disease on Admission
Ages of Patients Admitted
Condition on Discharge
Surgical Report .
Clinic Examinations
Report of Division of Biologic Laboratories
General Statement
Distribution of Products
Division Budget ....
Report of Division of Dental Health
General Statement
Dental Division ....
Incidence of Decayed and Filled Deciduous Teeth — 1950
Incidence of Decayed, Missing and Filled Permanent Teeth — 1950
Findings Made During Topical Fluoride Demonstration — 1949
Report of Division of Hospitals
General Statement
Number Hospitals Licensed .
Hospitals Closed .
Type of Hospital Licensed
Number Hospitals and Clinics Licensed in Health Districts
Nursing, Convalescent Homes and Boarding Homes for the Aged by Health
Districts ............
Report of Hospital Survey and Construction
General Statement .....
Distribuiton of Hospitals by Type
Distribution of General Hospitals by Size
Acceptable and Non-acceptable Beds by Type of Area
Summary of Projects Approved Under Public Law 725
Report of Division of Food and Drugs
General Statement
Inspections and Investigations
Milk Pasteurization
Emergency Milk Supply
Research Studies .
Prescription Compounding Checks
Legislation .....
247
247
247
248
248
248
249
249
249
250
250
250
250
P.D. 34 v
Shellfish Inspection . . . . . . . . . 277
Summary of Laboratory Examinations . . . . . . 279
Summary of Food Confiscations ........ 279
Summary of Slaughtering Reports Submitted by Local Slaughtering Inspectors 279
Summary of Extensions of Time Granted on Food in Cold Storage Warehouses 279
Summary of Prosecutions . . . . . . . . . 279
Licenses and Permits Issued ......... 280
Report of Division of Sanitary Engineering . . . . . . 281
Introductory Statement . . . . . . . . .281
Applications for Advice of the Division ....... 281
Routine Work . ........ 281
Special Legislative Investigations . . . . . . . . 282
Special Activities During War Years ....... 284
Water Shortages ........... 284
Examination of Public Water Supplies . . . . . . . 285
Establishment of Public Water Supplies ...... 285
Additions and Improvements in Source of Supply ..... 285
Quality of Public Water Supplies ........ 291
Analyses of the Water of Public Water Supplies — Averages of Chemical
Analyses of Ground Water Sources for 1949 ..... 292
Sanitary Protection of Public Water Supplies ...... 306
Acquisition of Land for Protection of Water Supplies .... 307
Consumption of Water ......... 308
Average Daily Consumption of Water in Various Cities and Towns —
1941-1949 . . . ' ' . 309
Climatological Data .......... 314
Flow of Streams ........... 315
Examinations of Rivers . . . . . . . .317
New England Interstate Water Pollution Control Commission . . . 318
Municipal Sewage Treatment Works ....... 322
Sewage Treatment Plant Data ........ 324
Sewage Analyses . . . . . . . . . . 326
Examination of Sewer Outlets Discharging Into the Sea .... 328
Shellfish 328
Cross Connections . . ..' . . . . . ■ 329
Fluoridation of Water Supplies . . . . . . .331
Radioactive Isotopes .......... 332
Bathing Places ........... 332
Work at Institutions . . . . . . . . . . 333
Housing ............ 335
Fish Dehydrating Plants ......... 335
Water and Sewage Laboratory ........ 336
Corrosion Control . ........ 336
The Effects of the Use of HexametaphosDhate Compounds on the Corrosion
of Metallic Piping 337
Inhibitors ............ 337
The Use of Antifreeze Materials in Water Supply Lines .... 338
Corrosion of Lead Pipes ......... 338
Effect of High Chlorine Residuals of the Corrosion of Lead Pipe . . 339
Corrosion of Aluminum .......... 340
Experiments of Iron and Manganese Removal ...... 340
Phosphoros in Surface Water ........ 341
Use of Marble Pipes in the Treatment of Acid Waters .... 341
Treatment of Fish Stick Waters 342
Treatment of Combined Municipal and Industrial Wastes . . . 343
Treatment of Wool Scouring Wastes ....... 343
Treatment of Cyanide Wastes . . . . . . . . 345
Effect of Storage on Distillery Wastes . . . . . . . 345
Treatment of Tannery Wastes ........ 347
Results of Treatment of Municipal Sewage and Tannery Wastes . . 347
Miscellaneous Research ......... 348
Lawrence Experiment Station ........ 348
Shellfish Research 350
Water Bacteriology Research ........ 351
Water Treatment Research ......... 352
Sewage Treatment Research ......... 354
Industrial Wastes Research . . . . . . . . . 358
Operation of Trickling Filters ........ 362
P.D. 34
Purification of Merrimack River Water by Storage and Filtration — Average
Chemical Analyses .... ..... 363
Secondary Sand Filtration of Trickling Filter Effluent — Average Chemical
Analyses ............ 363
Average Solids in Samples Collected in Connection with Lawrence Supply . 364
Purification of Merrimack River Water by Storage and Filtration —
Average Bacterial Analyses ........ 364
Average Suspended Solids ......... 364
Septic Tanks — Data on Operation ....... 364
Operation of Septic Tanks — Biochemical Oxygen Demand . . . 365
Secondary Sand Filtration of Trickling Filter Effluents — Average Sus-
pended Solids ........... 365
Operation of Septic Tanks — Average Suspended Solids .... 365
Average Chemical Analyses of Samples Collected in Connection with the
Lawrence Supply . . . . . . . . . 366
Average Chemical Analyses ......... 366
Average Results of Bacterial Analyses of Samples Collected in Connection
with Lawrence Supply ......... 366
Operation of Septic Tanks — ■ Average Chemical Analyses . . . 367
Operation of Trickling Filters — Average Chemical Analyses . . . 368
Amherst Laboratory Report ......... 369
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH
1949
Commissioner of Public Health, Vlado A. Getting, M.D., Dr.P.H.
Public Health Council
William H. Griffin, M.D.
Gordon Hutchins
Paul Jakmauh, M.D.
Florence L.
Division of Administration
Division of Tuberculosis
Division of Local Health
Administration
Division of Sanitary Engineering
Division of Biologic Laboratories
Division of Cancer and Other
Chronic Diseases
Division of Communicable Diseases .
Division of Dental Health .
Division of Food and Drugs
Division of Hospitals ....
Division of Maternal and Child
Health
Division of Venereal Diseases
Francis H. Lally, M.D.
Raymond L. Mutter
Charles F. Wilinsky, M.D.
Wall, Secretary
Under direction of Commissioner
Director and First Deputy Commissioner
Alton S. Pope, M.D.
Director and Second Deputy Commissioner,
Robert E. Archibald, M.D.
Director and Third Deputy Commissioner
Clarence I. Sterling, C.E.
Director, Geoffrey Edsall, M.D.
Director, Herbert L. Lombard, M.D.
Director, Roy F. Feemster, M.D.
Director, William D. Wellock, D.M.D.
Director, Carl S. Ferguson, B.S.
Director, Richard P. MacKnight, M.D.
Director, Florence L. McKay, M.D.
Director, Nicholas J. Fiumara, M.D.
First Assistant to the Commissioner, Loren D. Moore, M.D.
Southeastern District
State District Health Officers
Harold W. Stevens, M.D.
South Metropolitan District
North Metropolitan District
Northeastern District .
South Central District
North Central District
Connecticut Valley District
Berkshire District
Autino Fiore, M.D.
Robert E. S. Kelley, M.D.
Walter J. Pennell, M.D.
Arthur E. Burke, M.D.
Arthur E. Burke, M.D.
Walter W. Lee, M.D.
Charles E. Gill, M.D.
Institutions and Superintendents
Lakeville State Sanatorium . . Leon A. Alley, M.D.
North Reading State Sanatorium
Rutland State Sanatorium .
Westfield State Sanatorium
Pondville Hospital
Claire W. Twinam, M.D.
Paul Dufault, M.D.
Wilson W. Knowlton, M.D.
George L. Parker, M.D.
€|>e CommontoealtJ) of jtta&e?acJ)u£ettg
CONSOLIDATED REPORT
OF THE
DEPARTMENT OF PUBLIC HEALTH OF MASSACHUSETTS
FOR THE
Years 1942 through 1949
REPORT OF PUBLIC HEALTH COUNCIL FOR THE YEARS
1942 THROUGH 1949
The Department of Public Health as defined in General Laws, Chapter 17," Sec-
tion 1, consists of the commissioner of public health and the public health council,
the commissioner serving ex officio as chairman. Following is the membership of the
Public Health Council during the period covered by this Report :
Commissioner of Public Health
Paul J. Jakmauh, M.D. . ...'••
Vlado A. Getting, M.D., Dr. P.H.
1938 - 1943
1943-
Public Health Council
Richard P. Strong, M.D.
James L. Tighe, C.E.
Francis H. Lally, M.D.
Gordon Hutchins
Richard M. Smith, M.D.
R. Nelson Hatt, M.D. .
Cecil K. Drinker, M.D.
Elmer S. Bagnall, M.D.
George L. Schadt, M.D.
William H. Griffin, D.M.D.
Charles F. Wilinsky, M.D.
Raymond L. Mutter
Paul J. Jakmauh, M.D.
1921
1923
1924-
1926 - 1937
1940-
1934-
1940-
1943-
1943-
1942-
1945-
1946 -
1947-
1949-
1943
1947
1949
1942
1946
1945
1943
Regular monthly meetings of the Public Health Council have been held as re-
quired by General Laws, Chapter 17, Section 3, as amended. In addition, special
meetings were held from time to time, as a result of which the Council visited prac-
tically every county to become as familiar as possible with all public health activi-
ties in the Commonwealth. Since 1947 members of the Council have regularly at-
tended the annual Massachusetts Public Health Conference at the University of
Massachusetts, Amherst. Several meetings were held at the Department's institu-
tions where opportunity was provided for inspection of the institution facilities.
Joint meetings were held with the State Advisory Council for the Administration of
the Hospital Survey and_ Construction Act to consider applications for financial as-
sistance in the construction of hospitals, health centers or teaching facilities.
The Council has carried out its regular duties as imposed by General Laws, Chap-
ter III, Section 3, and other laws. Prior to the passage of Chapter 152 of the Acts
of 1946, all public hearings were held before the Commissioner and Public Health
Council, but under authority of this act the Department in some instances has au-
thorized division directors to hold hearings with the understanding that a report
will be presented for consideration at the next meeting of the Department.
4 PD. 34
An entirely new activity, delegated to the Department by Chapter 661 of the
Acts of 1941, was the licensing of hospitals and sanatoria. Under authority of this
act, on April 14, 1942 "Hospital Standards" were adopted by the Department as
minimum requirements for the licensing of hospitals and sanatoria. Chapter 618
of the Acts of 1948 assigned to the Department the licensing of convalescent and
nursing homes and boarding homes for the aged, and on November 3, 1948, rules
and regulations governing the licensing of these homes were adopted by the De-
partment.
With regret the death on April 6, 1947 of Mr. James L. Tighe of Holyoke is re-
ported. Mr. Tighe served the Department faithfully as a member of the Public
Health Council from 1923 until his death at the age of 82. As one of the outstand-
ing consulting engineers of the United States, his advice and counsel on sanitary
engineering matters in particular and public health work in general have proved of
inestimable value to the Department, and his contributions to the furtherance of
the protection of the public health in Massachusetts have been outstanding.
With regret also we report the deaths of Dr. Richard P. Strong, a faithful member
of the Public Health Council from 1921 to 1943, whose successful work in the field
of tropical medicine was outstanding, and of Dr. R. Nelson Hatt, a member of the
Public Health Council from 1940 to 1942, who, because of his untiring efforts in be-
half of crippled children made significant contributions to the development of the
Department's program in this field.
P.D. 34 5
CONSOLIDATED REPORT OF THE COMMISSIONER
OF PUBLIC HEALTH
To the Public Health Council:
Gentlemen: Due to war restrictions, the Department did not print annual re-
ports for the years 1942 through 1949. This report is a consolidation of pertinent
information, along with the morbidity, mortality and statistical data for these years,
Chapter 292 of the Acts of 1945 required that the annual report of the Depart-
ment be made on the basis of a fiscal year beginning July 1 and ending June 30 of
the following calendar year, rather than on the basis of a calendar year. The 1945
report, therefore, covers a six-month period, January 1 through June 30 and does
not contain any morbidity and mortality report. All of the subsequent annual re-
ports based on the fiscal year will contain morbidity and mortality data for the pre-
ceding calendar year.
An item of particular importance during this period was the celebration of the
75th Anniversary of the Department during 1944. These activities were concluded
with a banquet given by His Excellency, the Governor, on December 6, 1944.
War Activities
During the war and in the immediate post war years, the Department, along with
the Armed Forces, developed plans to safeguard the public water supplies in the
Commonwealth ; to decontaminate areas contaminated by war gas ; to train chemists
and bacteriologists to identify war gases and to detect pollution of water mains fol-
lowing bombing and other enemy action; to study the public health aspects of low-
ered room temperature due to fuel conservation and make recommendation to the
citizens of the Commonwealth; to control communicable diseases within the state,
particularly in the extra-cantonment areas, and to observe and follow-up discharged
service personnel returned to the Commonwealth with tropical diseases.
Co-operating with the Massachusetts Committee on Public Safety, plans were
made to use the state and county sanatoria as "base hospitals" for the evacuation
of patients from general hospitals in cities and towns.
Plans were developed with state and Federal agencies for the care of young chil-
dren of mothers employed in war industries, and the Emergency Maternal and In-
fant Care Program was begun in Spetember, 1943.
Approving Authority for Medical Schools
In 1943, the Board inspected the Middlesex University Medical School and pre-
medical courses, and considered the findings and reported to the Middlesex authori-
ties the steps that should be taken by them to obtain approval of their school. A
reinspection of this school was made in 1944, and after a public hearing, approval
was denied. This case was appealed to the Suffolk Superior Court, and Judge
Charles Cabot returned a decision upholding the Approving Authority in refusing
to give approval to Middlesex University Medical School.
Section 2, Chapter 112, General Laws, amended by Chapter 396 of the Acts of
1945, expanded the Approving Authority to include not only the Secretary of the
Board of Registration in Medicine, the Commissioner of Education and the Com-
missioner of Public Health, but also the osteopathic member of the Board of Regis-
tration in Medicine and a layman.
During the years, the Approving Authority held hearings with reference to ap-
proving certain medical schools, whereby graduates could become candidates for
registration to practice medicine in the Commonwealth.
Rating Board
The Commissioner, as Chairman of the Rating Board, presided over hearings at
which applicants, from the Department of Public Safety were interviewed, the ap-
plications were investigated, reviewed and passed upon for retirement because of
illness or injuries sustained in line of duty.
6 P.D. 34
Milk Regulation Board
In 1943, the forms used for the inspection of milk were revised, and by an agree-
ment with the local milk inspectors and restauranteurs, arrangements were made
for the display of placards to inform the consumer that mixtures of milk and cream
were being used in lieu of cream.
During 1944, the principle concern was the admission of milk into the state be-
cause of a shortage in the local supply. In 1946, the Board considered the alleged
milk shortages in the Commonwealth, but in no instance was a shortage determined
to be in existence. On evidence presented by milk dealers, the Board declared that
an emergency milk shortage existed from October 23, 1947 to March 4, 1948. Dur-
ing this period, the Director of the Division of Dairying and Animal Husbandry,
Department of Agriculture, was authorized to issue permits to Massachusetts
dealers and distributors for the importation of uninspected milk.
On June 8, 1946, Chapter 496 of the General Laws, relieved the Commissioner of
Public Health as Chairman of the Board and designated the Chairman of the Milk
Control Board as Chairman of the Milk Regulation Board. The act further au-
thorized the Commissioner of Public Health to designate an individual to represent
him on the Board, and the Director of the Division of Food and Drugs was so desig-
nated.
After public hearings during 1947, the Board adopted new regulations pertaining
to milk plants, to pasteurization plants, and to the transportation of milk located
outside of the Commonwealth and these regulations became effective July 1, 1948.
During the fiscal year 1949, regulations relative to the grades of milk were re-
vised by the Board and were approved by the Governor and Council.
State Planning Board
The Commissioner, or his representative from the Division of Sanitary Engineer-
ing, has been active in the Board's post war planning for the Commonwealth. Plans
were discussed and developed for community planning; housing; industrial activi-
ties ; flood control and harbor improvements ; the development of recreational areas,
including ocean beaches; vehicle traffic and rapid transit improvement in Boston
and the Metropolitan district, and further development of the Logan National
Airport and air programs for all sections of the Commonwealth.
Special Projects
Chapter 37, of the Resolves of 1941, directed the Department to study the eradi-
cation and control of ragweed in the Commonwealth. The results of this survey
indicated that eradication of this weed would require a large, long-range program,
and such an expensive and time-consuming project could not be considered at this
time.
The cooperative project with the Massachusetts General Hospital for the in-
vestigation and treatment of arthritic patients has been continued. It is hoped
that this project will provide information for better treatment and rehabilitation
of those individuals suffering from this chronic disease.
New Projects
Plans for the development of a state- wide whole blood, plasma and plasma frac-
tionation program were begun in 1944 and provided for the donation of blood by
volunteers and the processing and distribution of blood and blood products from the
Division of Biologic Laboratories. The American Red Cross had charge of donor
procurement in this program. The Godfrey M. Hyams Foundation provided funds
for the construction of a new addition to the Biologic Laboratories at Forest Hills
to be used for the processing, storage and distribution of whole blood and the frac-
tionation of blood plasma and the subsequent distribution of the blood derivatives.
In 1947 and 1948, the Division of Biologic Laboratories was relieved of a good
part of the blood program by the American Red Cross. The division provided cer-
tain laboratory services at cost for the Red Cross, and the fractionation laboratory
assisted in developing new agents and improving established procedures for the
blood program. During the fiscal years 1948 and 1949, the American National Red
Cross completely absorbed the Massachusetts Blood Program into the Red Cross
National Blood Program. The laboratory continued to provide facilities and per-
P.D. 34 7
sonnel for some of the activities and research and special studies, which were fi-
nanced on a cost basis by the Red Cross.
In 1944, a state- wide Rheumatic Fever Program, recommended by the Depart-
ment, was approved in principle by the Massachusetts Medical Society. Chapter
453 of the Acts of 1945, provided for the hospitalization of rheumatic fever patients
in the North Reading Sanatorium.
In 1945, the Legislature authorized the expenditure of 250 thousand dollars for
plans for an 800 bed chronic disease hospital, and architects were employed to draw
up detailed plans.
In 1946, the Department received an appropriation of 7 million dollars for the
construction of this hospital, but the appropriation lapsed because the bond issue
was not floated in 1947.
By authority contained in Chapter 770 of the Acts of 1949, the location of the
hospital was changed from the Middlesex Fells area immediately adjacent to the
New England Sanatorium to land donated by the City of Boston in Franklin Park
on Morton Street, Jamaica Plain.
Chapter 790 of the Acts of 1949 provided 11 million dollars for the construction
of the chronic disease hospital, but the size of the hospital was reduced from 800 to
600 beds.
Departmental Reorganization
Since the last reorganization of the Department in 1917, the activities have more
than doubled. New offices and new divisions have been created without complete
coordination within the Department. Certain arrangements, originally beneficial,
through the passage of years have proved no longer of value, and it was deemed de-
sirable to make alterations in these arrangements.
Chapter 661 of the Acts of 1941, delegated to the Department the licensing of
hospitals and sanatoria. With the assistance of an advisory committee, minimum
standards were established and rules and regulations promulgated.
On January 7, 1942, a Public Health Nursing unit was created in the Division of
Administration by the transfer of personnel and activities from the Division of
Child Hygiene. A nurse was assigned to each of the District Health offices to func-
tion as supervising nurse and act as consultant to the District Health Officer.
In 1942, a dental unit was established in the Division of Administration to co-
ordinate the dental activities of the Department with Federal local public and
private agencies in the field for further education in the promotion of dental health.
Chapter 16 of the Acts of 1943 authorized the Department to license dental
clinics similar to the licensing of medical clinics throughout the Commonwealth.
In 1944, the Public Health Council changed the name of the Division of Hygiene
to the Division of Maternal & Child Health, and that of the Division of Adult Hy-
giene to the Division of Cancer & Other Chronic Diseases, and effective July 1,
1945, the name of the Division of Genitoinfectious Diseases was changed to the Di-
vision of Venereal Diseases.
The creation of the new Division of Local Health Administration, with the trans-
fer of certain activities from the Divisions of Administration, Communicable Disease
Maternal & Child Health, and the creation of new Bureaus of Dental Health, Pub-
lic Health Nursing, Nutrition, Social Service and Sanitary Inspection were made in
1944.
The Wassermann Laboratory was transferred from the Division of Biologic Lab-
oratories to the Division of Communicable Diseases during 1944. Personnel from
the Maternal & Child Health Division was transferred to the Division of Adminis-
tration to create a Bureau of Health Information. The Bureau of Crippled Chil-
dren's Services was transferred to the Division of Maternal & Child Health.
Chapter 527 of the Acts of 1945, in amending Chapter 661 of the Acts of 1941,
enabled building inspectors of the Department of Public Safety to issue a certificate
of acknowledgement for a period of 90 days until an inspection with recommenda-
tions or changes was made. The Department of Public Health requested a change
in the law so that the Department, acting upon the acknowledgement issued by the
Department of Public Safety, could issue a certificate of acknowledgement for the
8 P.D. 34
same period of time as that issued by the Department of Public Safety. If and when
the hospital obtained approval from the Department of Public Safety and other
papers were in order, then the Department would issue a license to the hospital.
In 1945, His Excellency, the Governor, appointed a State Advisory Committee
on Hospitals and Health Centers, with the Commissioner, Department of Public
Health, serving as Chairman. This Committee surveyed the hospitals and health
centers of the Commonwealth under authority contained in Section 2 of Chapter
736 of the Acts of 1945. The data collected were analyzed by the Commission on
Hospital Care, Chicago, Illinois. No state matching funds were appropriated for
the fiscal year beginning July 1, 1947, which prevented the Commonwealth from
qualifying for grants under Public Law 725, the Hospital Survey and Construction
Act. However, the state plan for the administration of Public Law 725, prepared
and submitted during the fiscal year 1947-48, was approved by the Public Health
Service on December 2, 1947. The construction on the first project began on June
14, 1948.
In 1946, the Department re-introduced a bill in the Legislature for the licensing
of convalescent and nursing homes. A Resolve, Chapter 71, of the Acts of 1946,
provided for a study by a joint board, consisting of the Departments of Public
Health, of Public Welfare and of Public Safety, relative to the regulation of certain
hospitals, sanatoria, convalescent and nursing homes by the Department of Public
Health.
Chapter 618 of the Acts of 1948, transferred from the Department of Public Wel-
fare to the Department of Public Health the licensing of convalescent and nursing
homes and boarding homes for the aged, to be effective in September, 1948. This
new service was taken over by hospital licensing and carried out by the Division of
Hospitals.
In 1948, plans were developed to consolidate the Bureau of Hospital Licensing
and the newly organized Division of Hospital Survey & Construction into a Division
of Hospitals,' effective July 1, 1948.
In 1947, with the appointment of a Chief Co-ordinator for the Bureau of Health
Information and the transfer of health education personnel from the divisions and
from some of the district offices, the establishment of the Bureau of Health Infor-
mation in the Division of Administration was accomplished. This provided a gener-
alized health education program emanating from a central service bureau.
Personnei
By 1943. over 200 employees of the Department had entered the Armed Forces,
and this necessitated many temporary appointments and promotions. The loss of
personnel seriously undermined both the state hospitals and sanatoria and the cen-
tral offices, but all routine work, together with extra war activities, was carried on
by the extended effort of those remaining.
" Studies by the Department have indicated that the low salary range in the Com-
monwealth as compared to other state departments was a prime factor in the loss
of personnel and the inability to obtain replacements. The Department recom-
mended that Civil Service regulations be liberalized to permit employment of out-
of-state qualified professional personnel when this practice was beneficial to the
state. The Department also recommended preparation of a classification schedule
of all personnel, with recommendations for increases in salaries. The reclassification
of personnel was made in the interest of simplification of titles and more equitable
compensation for the services rendered. In 1947, Legislature passed legislation pro-
viding for reclassification of physicians and provided for some salary increases for
physicians.
In 1944, the Department introduced legislation for authority to designate one or
more, but not more than three Division Directors as Deputy Commissioners. Sec-
tion 1, Chapter 323, of the Acts of 1948, gave the Commissioner authority to desig-
nate two additional Deputy Commissioners. The Director, Division of Tuberculosis
and Sanatoria was designated as the first Deputy Commissioner by Section 5, Chap-
ter 111 of the General Laws. The Director, Division of Local Health Administra-
tion was designated as the second Deputy Commissioner, and the Director of the
Division of Sanitation was designated as the third Deputy Commissioner.
P.D. 34 9
Department Quarters
The new public health programs and the expansion of the Department activities
have materially increased over the past several years. These changes have increased
the number of employees and brought about the need for additional office space.
However, during this period, there has been very little opportunity to increase the
office space in the State House, which totals about 34,000 square feet. Due to the
lack of space and the crowding in the State House, it has been necessary to rent ap-
proximately 18,000 square feet on the outside. None of the offices provide adequate
and safe storage space for records, most offices are overcrowded and are unsuited
for the needs of the Department. Several attempts have failed to obtain more ade-
quate office space for the Department because of the war restrictions and the in-
ability to find a suitable building. Plans and changes are still being made for ad-
ditional office space, and it is hoped that eventually all of the Department, with the
exception of the Biologic Laboratories, the Diagnostic Laboratory, the Lawrence
Experimental Station and the Westfield Laboratory will be housed in a new build-
ing especially designed for the needs.
The heavy statistical machinery, the need for the adequate storage facilities and
the protection of morbidity and mortality records, the necessity for interdepart-
mental conferences and planning, and the availability of the various departments
for professional and lay visitors to the Department adequately justify a new build-
ing designed especially for the needs of the Department.
Respectfully submitted,
Vlado A. Getting, M.D.,
Commissioner of Public Health
William H. Griffin Raymond L. Mutter
Gordon Hutchins Paul J. Jakmauh
Francis H. Lally Charles F. Wilinsky
Public Health Council
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P.D. 34 11
DIVISION OF LOCAL HEALTH ADMINISTRATION
CONSOLIDATED REPORT 1942-1949
Robert E. Archibald, M.D., M.P.H., Director
The beginning of 1942 saw the completion of the first State fiscal year in the
Worcester Health District and almost a year of activity in the Northern Connecticut
Valley District. These were the first units established to coordinate and distribute
the activities of the Department more effectively, to reduce to a minimum duplica-
tion of promotional efforts, to give more thorough insight into health practices and
needs of the local communities, and to exert more concentrated effort to improve
existing conditions. The direction of this local health administration was under
Dr. John J. Poutas, Assistant to the Commissioner, up to October, 1942, and then
under Dr. S. L. Skvirsky. Each district was under direction of a district health
officer with a staff consisting of public nurses, sanitary officer, medical social work-
ers, nutritionist, physiotherapist, and clerks, whose duties were to carry out objec-
tives, principles and policies of the Department of Public Health under the
district plan. The remaining six districts were as yet not decentralized and were
represented in the field by a district health officer.
During 1942 three additional districts (Southeastern, North Central and Berk-
shire) were organized on the district plan. A unit of public health nurses was trans-
ferred to the Division of Administration from the Division of Child Hygiene form-
ing a nucleus for the Bureau of Public Health Nursing which assigned one nurse to
each district office to serve as a supervising nurse in that area and an advisor to the
District Health Officer on nursing matters. Also a dental unit was transferred from
the Division of Child Hygiene and continued to promote dental services in local
communities by lectures to professional and lay groups.
During 1943 there were several changes due to exigencies of Departmental work
and of the war. In April, the general supervision of the districts was transferred to
Dr. Roy F. Feemster, head of the Division of Communicable Diseases, while the
bureaus remained under Doctor Skvirsky. The district lines were revised in order
to provide more direct service to the public. At the request of the Office of Defense
Transportation, some of the promotional activities were curtailed to eliminate un-
necessary travel ; this resulted in less field work by members of the staff. During
this year also the remaining districts (South Metropolitan, North Metropolitan
and Northeastern) were organized into functioning units of the district plan. The
Bureau of Public Health Nursing planned an educational program for improving
and developing local health nursing services. The Medical Social Service Bureau
decentralized, putting a supervising social worker in each district. Through federal
funds the EMIC was added to the existing medical care programs (tuberculosis con-
trol, crippled children clinics, venereal disease clinics, cancer clinics and dental
clinics) .
Studies were undertaken in the local application of fluorides to teeth for the pre-
vention of caries. A dental advisory committee was named and several meetings
were held. Under Chapter 16 of the Acts of 1943, rules and regulations for the li-
censing of dental clinics were prepared, presented and approved.
In 1944, under Doctor Feemster, the district health offices made further progress
in organizing, adding personnel, purchasing furniture and equipment, outlining the
responsibilities of certain workers, and setting up administrative procedures. Meet-
ings of division directors and bureau chiefs, acting as technical supervisors for dis-
trict personnel, were held to plan the coordination of the program of the workers in
the districts; furthermore, these technical supervisors attended district staff con-
ferences to aid in orienting all workers in regard to their programs. The work in
some districts had been handicapped during the year by the lack of a district health
officer to supervise the work. Six sanitary officers were covering the eight districts.
Health educators from the Division of Adult Hygiene, who had been doing cancer
work only, were assigned to the districts and were to engage in general health edu-
cation. Three clerical positions were created in each district office by an increase in
the federal budget. A "resources and activities" file was compiled in each district
to familiarize the personnel with programs and problems of their local communities
12 P.D. 34
to aid in better planning for work in these communities. Continued progress was
made in the varied medical care programs. Assistance was given to the APHA
Committee on Local Health Administration preparing plans to serve all areas in the
United States by full-time medical health officers trained in public health.
Under Doctor Skvirsky the bureaus functioned to provide close and continuous
working relationships for the successful operation of the district plan. In July 1944,
the nutritionists in the Department were transferred from the Division of Child
Hygiene to the Division of Administration with four being assigned to the Nutrition
Bureau and eight to the district offices to give routine community nutrition services.
The Public Health Nursing Bureau planned educational programs for local nurses
by the nursing education consultant, gave two institutes on tuberculosis and one on
maternal health, and assisted in reorganizing or coordinating local public health
nursing programs upon request from various communities. The Medical Social
Service Bureau contributed greatly to the effectiveness of the district plan by in-
creasing opportunities for cooperation with other members of the district staffs
with consultation on social aspects for the successful care of the sick or the physically
handicapped. The activities of this bureau fell chiefly into division activities (tuber-
culosis control, ciippled children services, maternal and child health, cancer and
venereal disease control), community agencies and education. The Dental Bureau
carried on a routine educational program, assisted in the licensing of dental clinics,
and projected various studies relative to oral prophylaxis. In March of 1944 a
supervisor for the district sanitary officers was appointed to coordinate and direct
the ever-increasing amount of work done in this field.
Creation of a Division of Local Health Administration was approved by the
Public Health Council and on July 1, 1945 was established with Dr. Roy F. Feemster
as acting director. Through the district offices and bureaus the division continued
to implement and interpret the programs and services of the various divisions of the
Department in the local communities of the State. Dr. John J. Poutas returned
from military leave in March 1946, and assumed the duties of director only to re-
sign after three months. On July 1, 1946 Dr. Robert E. Archibald was appointed
to the position.
The Bureau of Public Health Nursing during the year added to the staff consult-
ants in maternal, pediatric nursing and rheumatic fever activities; continued to give
basic courses of newer concepts in public health nursing to local nurses; assisted
communities in regard to their administrative problems particularly relative to
record systems and educational programs ; demonstrated the need of bedside nursing
in the western part of the state as a result of the American Red Cross relinquishing
their services to local auspices; and developed an "in-service" training program.
The Bureau of Social Service made progress in the development of community re-
lations and in the services rendered local workers in contacts with State, local, social
and medical agencies. The departmental medical care program in maternal and
child health, crippled children sendees, tuberculosis control and EMIC have had
their scope markedly widened by this bureau.
The census of the physically handicapped children was transferred from the De-
partment of Public Welfare to Crippled Children Services in this Department. This
has resulted in more effective integration of the child's school and health problems
by the social worker.
The Bureau of Nutrition has been concentrating on reorganization and reorienta-
tion of its program but carried on the routine community nutrition services by con-
sulting on school lunch problems, participating in Well Child Conferences, Tubercu-
losis Consulting Clinics, Crippled Children Clinics, and giving education talks. It
has been compiling an outstanding work also, to be called the "Community Nu-
tritionist's Handbook".
The services of the Bureau of Sanitation increased tremendously giving assistance
to school, state, and county institutions, local boards of health (restaurant sanita-
tion program and courses of instruction for food handlers), and planning an "in-
service" training program for local inspectors.
The Bureau of Dental Health continued its educational and research program.
On July 1, 1946 the bureau was absorbed into the newly formed Division of Dental
Health.
P.D. 34 13
The Division had a large share in preparing legislation which the Department
submitted. Members of the staff appeared before the legislative committee and sup-
plied specific information as requested.
The Connecticut Valley District Health Office was moved from Greenfield to the
University of Massachusetts on July 1, 1947. This change effected a more central
location in the district and encouraged a much closer relationship with the faculty
at the University of Massachusetts.
Dr. Fred L. Moore, a well-trained and experienced public health man, was ap-
pointed County Health Officer in Barnstable. The Division assisted in providing
Dr. Moore with orientation and indoctrination as to the activities of ourDepart-
ment.
Much time and effort was devoted to securing a physician for the Nashoba
Health Unit which was without a director since 1943. Dr. Sidney Cobb was finally
appointed July 1, 1948.
The Division had considerable responsibility in planning for the first Massa-
chusetts Public Health Conference which was held at the University of Massachu-
setts, Amherst on September 11 and 12, 1947. The need for the development of
adequate local health departments was highlighted at this conference.
In addition to the Massachusetts Public Health Conference, a conference for the
Commissioners of Health and Directors of Local Health Services from all states in
the nation was held at the University of Michigan in Ann Arbor. This conference,
lasting one week, was for the purpose of reviewing Dr. Haven Emerson's plan for
local health units for the nation. A drive was initiated at this meeting to organize
local health departments.
The Bureau of Social Service this year concerned itself particularly with the
Emergency Maternity and Infant Care Program and Crippled Children's Services
as well as well child conferences, school programs and problems relating to patients
with tuberculosis. This Bureau began to place increasing emphasis on developing
in community agencies an awareness of their own responsibilities and potential
skills, thus acting as consultant rather than providing direct services.
The Bureau of Public Health Nursing conducted a series of six institutes for
school nurses and school administrators to discuss the "Proposed Functions of the
Nurse Serving the School." Classes were also held for local nurses on "Maternity
Nursing" and on "Growth and Development of the Child."
The Bureau of Nutrition, in addition to its program connected with statewide
school lunches, also undertook institution food surveys at the request of the Com-
mission on Administration and Finance.
The Bureau of Sanitation had as its objective the improvement of environmental
sanitation at the local level by rendering assistance at the request of local sani-
tarians. The Bureau rendered assistance to more than 80% of the municipalities
in the Commonwealth as compared with 65% during the preceding j-ear. Thirty-
four courses in restaurant sanitation were held this year with 119 sessions and a total
attendance of over 8,000.
During 1948 the second Massachusetts Public Health Conference was held at the
University of Massachusetts in conjunction with the Massachusetts Public Health
Association and the University of Massachusetts.
On June 28, 1947 the General Court authorized an unpaid Special Recess Com-
mission under Chapter 73 of the Acts of 1947 to study certain public health matters
in Massachusetts and on December 3, 1947 the Commission issued their report
(H1766). The Commission appointed as one of four technical sub-committees a
Committee on Local Health Units. The Director of the Division served as a member
of this Committee. The Division, at the request of this Committee, prepared several
possible plans for districting the state in order that adequate local health depart-
ments might be established.
As an appendix to this report, Dr. Carl Buck, Field Representative of the Ameri-
can Public Health Association, studied and reported a proposed reorganization of
the Department as follows :
The Nutrition, Social Service and Public Health Nursing Bureaus were trans-
ferred to the Division of Administration, and the Bureau of Sanitation was trans-
ferred to the Division of Sanitary Engineering. The Director of the Division of
14 P.D. 34
Local Health Administration was also made Second Deputy Commissioner in
charge of the newly-formed Section on Preventive Medicine which comprises the
Divisions of Communicable Diseases, Venereal Diseases, Maternal and Child
Health, Dental Health and Local Health Administration. These changes were
effected January 1, 1948.
This year the Department established an Advisory Committee on Accident Pre-
vention with the hope that some program could be developed to reduce not only
deaths from accidents but the great amount of disability and crippling which occurs
from accidents in the home, school and on the farm. The first meeting of this Com-
mittee was held on March 25, 1948.
The Bureau of Social Service undertook a new project in the field of education of
medical social workers for public health programs. This project was made possible
by funds from the Children's Bureau and is carried on in cooperation with the three
schools of social work in Boston and the Harvard School of Public Health. The
Emergency Maternity and Infant Care Program continued to demand many ser-
vices from this Bureau.
The Bureau of Public Health Nursing participated in conferences relative to a
project for the care of children of veterans attending Harvard University. This
year also saw the continuation of demonstrations of public health nursing which had
been undertaken the previous year in the towns of Princeton and Sterling. Nursing
manuals were developed which could be used as a guide for public health nurses.
The Chief of the Bureau of Nutrition was on leave of absence to study at Western
Reserve University. Her absence during the year tended to decrease the activities
of this Bureau.
The Bureau of Sanitation's activities in the field of restaurant sanitation surveys
increased as did the number of courses for food handlers. A total of 36 courses were
given with a total of 8400 in attendance. The number of communities in the state
which had adopted compulsory pasteurization regulations reached 100 this year.
In the fall of 1948 the Legislative Special Recess Commission appointed in 1947
and continued in 1948, submitted its report under Chapter 78 of the Resolves of
1948. The Commission report contained 20 bills. Appendices 6 and 7 were of par-
ticular interest to this division.
The districts continued to function satisfactorily except for the loss of the district
health officer in the South Central District on March 1, 1949. Since that time Dr.
Burke has been covering not only the North Central District, but the South Central
District as well. This year also saw the transfer from the Department of Public
Welfare of four hospital inspectors who were assigned to cover the eight health
districts.
P.D. 34 15
DIVISION OF CANCER AND OTHER CHRONIC DISEASES
CONSOLIDATED REPORT 1942-1949
Herbert L. Lombard, M.D., M.P.H., Director
Massachusetts became a pioneer in cancer control under government auspices on
May 29, 1926. With no precedent to follow, with no knowledge of the public health
aspects of the disease, without even a clear-cut idea that cancer was a public health
problem, the Massachusetts Department of Public Health launched a cancer con-
trol program.
At that time the Department was less than half its present size, and its functions
were far less than at present. The million-volt x-ray machine had not yet been in-
vented, only a few carcinogenic agents were known, and our knowledge of malignant
tumors was far less than it is at the present. Nearly a quarter of a century has
passed. In 1949, instead of Massachusetts being the lone exponent of a well-inte-
grated cancer program, the forty-eight states and four territories now have some
form of cancer program, while the Public Health Service and the American Cancer
Society are expanding their activities in cancer control.
On July 1, 1945 the Division name was changed from Adult Hygiene to Cancer
and Other Chronic Diseases.
The Department has been aided by the Advisory Cancer Committee, the Ad-
visory Chronic Disease Committee and the Advisory Cytology Committee.
Epidemiology and Biometrics
Genetic and Environmental Research — The American Cancer Society, Massa-
chusetts Division, Inc. has made several grants to the Division which have enabled
the continuation of the study of genetic and environmental factors in cancer, first
started under a grant from the Rockefeller Foundation. This study enables a com-
parison of the relative importance of many variables in individuals with cancer of
different sites, and in control populations. Those variables which exhibit significant
differences between the two groups are treated by partial association and partial
correlation in order to eliminate the possibility that mixed classification may be ob-
scuring the results.
Data have already been collected from individuals with cancer of the cervix,
cancer of the skin, and several groups of individuals without cancer. The grants
from the American Cancer Society enable the Division to employ assistant bio-
metricians to collect data. Analysis of the data is done by the regular staff of the
Division.
A preliminary paper on cancer of the cervix and breast which was presented at
the Fourth International Cancer Congress in St. Louis is being published this year
in Revue Acta, Union Intern. Contre le Cancer. At the present time additional
data, using a new set of controls, is being analyzed. While several months will
elapse before this analysis is completed, some of the more important findings in the
paper have been substantiated. The most important, that dealing with the strong
association between early marriage and cancer of the cervix, has been confirmed.
Further studies will be necessary to determine what factors connected with early
marriage are responsible for this relationship.
While several workers are analyzing the material on breast and cervix cancers,
others have begun the collection of data on environmental factors pertaining to skin
cancer; while still others are working on codes for other sites of cancer.
Multiple Malignant Growths — In an effort to refute the hypothesis advanced by
Peller that "A cured tumor leaves protection of the body against the development
of other malignant neoplasms" data from the Massachusetts cancer clinics and the
Palmer Memorial Hospital were analyzed. This study made by Lombard and War-
ren, and printed in the American Journal of Public Health, shows that more indi-
viduals were found to have multiple malignant growths than would be expected by
chance, and that there was a considerable difference between data based on cancer
histories in hospital records and those obtained by long-continued follow-up of
cancer patients. The validity of this finding was questioned on the grounds that
16 P.D. 34
(1) skin cancer was classified by itself and not combined with lip cancer as was done
by Peller, and (2) an erroneous conclusion majr have been made because of mixed
classification.
A paper by Lombard, Levin and Warren substantiating the previous findings of
Lombard and Warren is being published in "Cancer Research".
The Changing Cancer Death Rate — Results of a study on the changing cancer
death rate were reported at the annual meeting of the Public Health Cancer Associa-
tion in November, 1946. A summary of the study follows: During the past twelve
years the adjusted mortality rates for cancer of the stomach, buccal cavity, skin,
uterus and liver have shown downward trends for the white population of Continent-
al United States. The rates for cancer of other sites, including pancreas, testes,
prostate, intestines, lung and "other respiratory" sites, have shown upward trends;
whereas for the larynx (female), vulva- vagina, breast, scrotum, bladder, esophagus,
kidney (female), and rectum (female) no significant trend was apparent. The sites
of origin showing downward rate trends may be divided into two categories : those
that probably have been influenced by education and improved therapy, and one
site (stomach) in which improvement may be the result of better living conditions.
Epidemiology of Diabetes — A study conducted by Joslin and Lombard in 1936
was repeated in 1946 and was in agreement with the preceding one. The records of
about one-quarter of all cases known to have had diabetes failed to have the word
diabetes on the death certificate. The average age of onset of diabetes in this study
was a little over two years greater than on the first, and the average age at death
was about five years greater.
Cytology Study — A cytologic research project, financed by the Commonwealth
Fund, was inaugurated in 1945. The objective of this project was to determine the
incidence of cancer of the uterus in women without gynecological symptoms. Most
of the clinics under State supervision agreed to participate in this research.
Beginning January 1, 1945, vaginal smears were obtained from 3,586 women at-
tending the cancer clinics and they were examined by the Papanicolaou technique.
Some of the women had gynecological symptoms ; others did not. The results of the
examination of the smears have been tabulated and a report published. A three-
year follow-up is now being carried out. The complete follow-up consists of a his-
tory, a pelvic examination and an additional smear taken three years after the
original smear. Only a history is secured on those individuals who refuse to return
to the clinic. Individuals with positive biopsies at the time the original smear was
taken have not been followed. The follow-up of the entire series will be completed
in July, 1950. The results of the first smear examination will be compared with this
later information and an evaluation of the procedure made.
Cancer Detection Center — The Cancer Detection Center study was inaugurated
to determine the place of a Detection Center in a cancer control program. The De-
tection Center project was inaugurated in May, 1948 although the Center itself was
not officially opened until November 7, 1948. In the interim between the beginning
of the project and the official opening, several pilot sessions of the Center were held
in order to develop an adequate record form and to perfect an examination tech-
nique. It was known that in several other Detection Centers, efforts were being
made to shorten the time of the examination, either by a more rapid examination
or by limiting the areas of the body to be examined. In this study, emphasis has
been placed on thoroughness rather than on speed, and the value of such an exami-
nation is to be measured.
During the time the Center has been in operation it has been shown that fear,
familial history of cancer, and s3nnptoms are three strong motivating causes for
visiting the Center. It is felt that those having symptoms should not be examined
at the Cancer Detection Center but referred to a diagnostic clinic. This will, of
course, lessen the number of cancers found in the Center and increase the number
seen in diagnostic clinics.
The importance of screening is one of the principal objectives of this study. In
order to screen out individuals with any one of the seven danger signals of cancer
from attending the Detection Center, each individual is interrogated by a non-
medical member of the clinic staff, usually a medical social worker, for approxi-
mately one-half hour, or as long as necessary. Those complaining of any of the
P.D. 34 17
signs or symptoms are referred to their family physician. This procedure is expected
to limit greatly the number of individuals with cancer found at the Center.
The Center will endeavor to determine which part of the examination can be
made easily in the physician's office; which part cannot be made in the physician's
office and which part may be done in the physician's office if facilities are available
and proper instruction is given the physician.
The study will include epidemiological data on the patients attending the Center
as well as the measurement of publicity, the cost per patient and the time required
for a satisfactory examination.
Methodology for Evaluating Cancer Education — Beginning June, 1949, a method-
ology study was conducted in Waltham, Massachusetts. Surveyors collected data
to test the comparative merits of several types of interview which will determine the
level of cancer knowledge and attitudes toward the disease existing among the
people of Massachusetts.
The results of this study will furnish a base line for future evaluation studies of
cancer education. At the present time the Cooperative Cancer Control Committees,
which were originally organized by the Division, and now being activated by the
American Cancer Society, are continuing to disseminate cancer education on a local
level. It is planned to measure the work of some of these committees by means of
the evaluation method selected as a result of the Waltham study.
Prior to the Waltham study, somewhat similar surveys had been done in Arling-
ton, Brockton, Cambridge, Fall River, Fitchburg, Greenfield, Hyde Park, Lawrence,
Lynn, Maiden, New Bedford, North Adams, and Springfield. Several of these com-
munities were selected at the request of the American Cancer Society, Massa-
chusetts Division, Inc. Some of the communities have been resurveyed and a de-
cided improvement in cancer knowledge was noted.
The Statistical Approach to the Cancer Problem in Massachusetts — A papei demon-
strating the integration of statistics in the Massachusetts Cancer Program was pre-
sented at the 1944 Symposium of the Public Health Cancer Association of America,
and published in the American Journal of Public Health in May, 1945. Most of
the material selected for this report was from studies that have not been incorporated
into the literature either because these studies were substantiation of previous ones
or because their brevity did not warrant an independent report. Examples were
given from studies prepared from data in the clinic records, hospital records, house-
to-house surveys, and selected sample surveys.
Methodology for the Treatment of the Fourfold Table by Partial Association and
Partial Correlation as it Relates to Public Health Problems — For several years an
attempt has been made to develop a satisfactory methodology for the treatment of
the fourfold table, when mixed classification is operating. A paper embodying the
results of these studies was prepared by Lombard and Doering and read before the
Biometrics Section of the American Statistical Association held in conjunction with
the American Association for the Advancement of Science at a meeting held in
Boston in December, 1946.
Chronic Disease Studies — Surveys were conducted in Waltham in 1946, in Ar-
lington in 1949 and in the Nashoba Health District in 1949, to determine the in-
cidence of chronic disease and methods of care and treatment in these localities and
to compare the results with the survey of 1929-1931 carried on throughout Massa-
chusetts. If the incidence had been found to differ greatly from the preceding sur-
vey, it was planned to expand these surveys in order to sample the entire state.
The incidence of the various diseases did not differ enough from the preceding study
to warrant the expense of a new survey.
Waltham Chronic Disease Study Follow-Up — In the winter of 1946-1947, 1,000
residents of Waltham, over the age of forty, chosen by means of the small sample
survey technique, were interviewed regarding the presence of chronic disease. The
Waltham death records will be checked continually to determine the cause of death
of these 1,000 individuals and the interval between the survey interview and death.
The death record data will be studied in relation to the original record. This pro-
cedure should enhance the accuracy of the survey and be a measure of how much
reliance can be placed on such a survey without supplementary data.
18 P.D. 34
Service
State-Aided Cancer Clinics — State-aided cancer clinics are conducted in hos-
pitals in various parts of the State. They are administered by the local medical
profession, and receive advice and financial help from the State in the form of pay-
ment for diagnostic services rendered to the medically indigent. These clinics fur-
nish group diagnosis for any individual in the Commonwealth regardless of his
financial status. Individuals may come directly to the clinics but it is more satis-
factory to have them referred by the family physician who has knowledge of the
patient's previous condition. The Massachusetts cancer clinics offer an oppor-
tunity for individuals to receive expert advice from a group of physicians who are
all thinking in terms of cancer. Follow-up service is maintained, and medical social
service consultation is available.
In 1941, at the request of the Department, the Massachusetts Medical Society
appointed Dr. Channing C. Simmons to survey the clinics. Dr. Simmons made an
exhaustive study and reported to the Council of the Society. As a result of this sur-
vey improvement has been noted in the conduct of several clinics.
New Cancer Clinic Law and Regulations — Chapter 433 of the Acts of 1943
amended Chapter III of the General Laws.
A change in the method of clinic payment occurred in 1943.
New cancer clinic regulations were approved by the Public Health Council on
April 11, 1944. These were compiled after consultation with the Comptroller's
Office, the Attorney General's Office and the Clinic Chiefs. They were approved
by the Council of the Massachusetts Medical Society.
Changes in Cancer Clinics — The Pittsfield clinic was closed at the end of 1942.
The local committee felt that the attendance did not warrant its continuation and
the Medical Society voted to discontinue it. Arrangements were made with the
Visiting Nurse Association to conduct such follow-up of old patients as was neces-
sary.
Some of the prime movers in the Newburyport clinic left for the service and the
clinic closed temporarily for the duration of the war. Arrangements were made for
patients to be seen in the Beverly clinic and for the follow-up to be done locally.
The small attendance at the Quincy clinic did not warrant its continuation and
it closed in 1942.
In 1944, on account of the sickness and death of Dr. Farrar Cobb, the Cape Cod
clinic was limited to teaching clinics.
Because of operating difficulties and poor attendance, the Gloucester Clinic was
discontinued on November 9, 1944. This clinic was reopened in May, 1949.
Applications have been received for the establishment of new clinics at the Peter
Bent Brigham Hospital, Mount Auburn Hospital, Cambridge, and the New Eng-
land Hospital for Women and Children. The Cancer Advisory Committee has re-
ported favorably on all of these proposed clinics, but it has been impossible to in-
clude them because of lack of funds.
The average cost per patient at the clinics during the calendar year 1948 was
13.92; four years previously the amount was $3.14. While the increase per patient
seems comparatively small, the number of patients serviced accounts for a con-
siderable increase in clinic costs.
In Februaiy, 1948, Dr. Harold H. Hennessey from the American College of
Surgeons surveyed the cancer clinics.
Cancer Registration System for the Clinics — During the year of July 1, 1948-
June 30, 1949, an important activity was the inauguration of a revised cancer regis-
tration record form. This required instructing the clinic workers regarding the use
of the new form, and the transferring of approximately six thousand living case
records to this revised card. This will enable the Massachusetts clinic data to be
compared with that of other states without adopting a new reporting system. The
new form has certain advantages over the old. One card replaces the two which
were formerly used ; eliminates questions which have not proved to be of value or
have been sufficiently well answered ; and adds information that is contained on the
forms recommended by the American Cancer Society and the Public Health Serv-
ice for use in reporting systems. During the year of July 1, 1949 - June 30, 1950,
such difficulties as may be encountered with the new card will be studied and over-
P.D. 34 19
come if possible. When the card is considered to be completely adequate for the
clinics, it is hoped to extend this system into the hospitals in which the clinics are
located and later into all hospitals in the State.
Heart Program — The new Heart Program of the Massachusetts Department of
Public Health began officially in April of 1950 as a demonstration program subsi-
dized by the federal government. It has as its objective the control of heart disease
by promoting service, education, and research throughout the Commonwealth.
Efforts have been directed first, toward service to the cardiac patient by setting up
a cooperating cardiac clinic program; and second, by an educational program.
The major activity, the Cooperating CardiaG Clinic Program, is made up of
sixteen previously established cardiac clinics located in various general hospital
out-patient departments furnishing diagnosis and treatment to indigent patients.
The clinics were accepted into the program on the basis of application and agree-
ment to fulfill the requirements of the Department of Public Health, namely:
1. Conform to the standards of the American Heart Association.
2. Fill out a brief record form for each new patient attending the clinic.
3. Agree to periodic survey by a physician representing the Department.
4. Submit a monthly report of activities containing the number of old patients,
the number of new patients, and the amount of money received from these
patients.
5. Maintain the funds paid to the cardiac clinic in a separate account to be used
at the discretion of the cardiac clinic staff.
At present there are sixteen active cardiac clinics which have received during the
first three months a total of $9,136.22.
Our second important activity has been the educational program. One of its
features was the Institute on the Public Health Aspects of Heart Disease held on
April 27 and 28, 1949. This consisted of a series of meetings with talks by leading
cardiologists and other workers in the field of heart disease for the purpose of ac-
quainting those engaged in public health activities with the public health aspects
of heart disease. In addition to the Institute, the Heart Program contributed $900
to the Massachusetts Medical Society for a series of thirty-six hours of post-graduate
instruction in heart disease at Sanders Theatre, Cambridge, Massachusetts.
Epidemiological Consultation — All research papers containing statistics, pre-
pared by Pondville and Westfield physicians, are reviewed by this Division to de-
termine the statistical soundness of the conclusions drawn. In addition, many
physicians throughout the State are requesting that papers prepared by them be
verified statistically.
Tumor Diagnosis Service — With the exception of the period following the open-
ing of the Pondville Hospital laboratory, and that following the changes in medical
practice produced by World War II, there has been an almost continuous increase
in the number of specimens examined. At the present time the percentage of malig-
nancy among surgical specimens averages about 15 per cent.
Surgical
Year
Specimens
Doctors
Hospitals
1926
2,484
371
52
1948
8,431
972
132
Dr. Shields Warren, in charge of the Tumor Diagnosis Service, has felt that the
diagnosis of specimens submitted to this laboratory while of immediate concern, is
only one aspect of the function of the Tumor Diagnosis Service. Of equal impor-
tance is the use of the material for enlarging the available body of knowledge con-
cerning cancer. This work has been approached in three ways: (1) by advice and
recommendations, as occasion required, to physicians using the service; (2) by
training those doctors who are interested in the basic knowledge of tumors; (3) by
histologic and statistical studies of material submitted to the Tumor Diagnosis
Service.
20
P.D. 34
Education
Professional Education — The educational activities of the Department are con-
ducted in close cooperation with the Massachusetts Medical Society, the American
Cancer Society, Massachusetts Division, Inc., and the Harvard School of Public
Health. Professional education has consisted in graduate instruction, the distribu-
tion of a book "Cancer, A Manual for Practitioners" to every practicing physician
in the State, an abstract bulletin for all physicians requesting it, a series of special
teaching clinics held in different parts of the State conducted by specialists in cancer.
The students at the Tufts Medical School, the School of Nursing at Boston College,
Yale School of Public Health and the Harvard School of Public Health have been
given instruction in cancer control.
Graduate Instruction for Physicians and Dentists — The Department participated
in the graduate instruction in cancer and heart disease furnished by the Massa-
chusetts Medical Society.
The Department cooperated with the Massachusetts Dental Society by furnish-
ing a lecturer on cancer for the various district dental societies.
Teaching Clinics — It has long been recognized that the general practitioner sees
a relatively small number of cases of cancer, particularly in the early stages. Numer-
ous studies have indicated that the average practitioner may see from two to four
cases yearly and these of different types of cancer. The cancer clinics offered the
public a means for diagnosis, but did not offer the general practitioner the help he
needed. In the early part of the program, attempts were made to remedy this situ-
ation by the Graduate Course in Cancer held April 23-25, 1929; by the regional
demonstration clinics held during 1931; and by the Cured Caner Clinics held April
5-6, 1932.
Since 1933, teaching clinics have been held to enable the general practitioner to
see many more cases of cancer than he did otherwise. Men experienced in cancer
have conducted these clinics and the general practitioner has been invited to attend
those nearest his home. Many physicians who have found it difficult to spend one
or two days in Boston have arranged to spend two or three hours at the local clinic.
For several years, prior to the war, approximately 70 teaching clinics were held
yearty with an average attendance of twenty-five physicians.
Attendance at the Teaching Clinics
Year
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
Cancer Institute - — A one-week institute on cancer sponsored by the Massa-
chusetts Department of Public Health; the Harvard School of Public Health; the
American Cancer Society, Massachusetts Division, Inc. ; the Massachusetts Medi-
cal Society, Cancer Committee ; the Massachusetts Dental Society ; and the Boston
Health League, was held in Boston the week of November 16, 1947.
During the week, sessions were conducted for the staffs of the State-aided cancer
clinics, a selected group of dentists, follow-up workers in the cancer clinics, and
social workers.
"Fact Book" and "Cancer Statistics" — Two mimeographed booklets were pre-
pared which depict the cancer situation. One, a comprehensive summary of the
attendance, services, and follow-up of the Massachusetts cancer clinic patients was
prepared on a chronological basis. These figures, together with other pertinent data,
. or Clinics
Attendance of Physicians
2
75
6
190
16
422
42
843
69
1384
74
1796
63
1364
49
1106
29
636
8
170
10
252
13
273
18
655
14
524
13
537
15
621 (19 dentists)
P.D. 34 21
were incorporated in a booklet called "The Fact Book" and distributed to the clinic
staffs in Massachusetts and to individuals interested in cancer control throughout
the country.
The other booklet, "Cancer Statistics" was composed largely of graphs, with a
few tables interspersed, dealing with such subjects as the cancer deaths by sites,
the age-specific cancer death rates from 1921-1946, the delay of cancer patients in
seeking treatment, and the percentage of individuals alive 5, 10 and 15 years after
clinic admission. This booklet, a joint project of the Massachusetts Department of
Public Health and the American Cancer Society, Massachusetts Division, Inc., was
distributed throughout the country and already has appeared in one bibliography.
"Cancer Bulletin" — The "Cancer Bulletin" is a publication of abstracts sent to
all physicians in the State who requested that they be placed on the mailing list.
It attempts to cover the important developments in cancer and its control.
Lay Education — In 1943 the Division completed the organization of a Coopera-
tive Cancer Control Committee in every city and town. These committees were
composed of a representative from each organization that met in a given community.
The following activities of the committees have been worked out to a satisfactory
conclusion in one or more city or town.
(1) Talks by local physicians
(2) Inauguration of school programs (supervision left to school authorities)
(3) Use of cancer films
(4) Conduction of cancer symposia
(5) Health talks and distribution of cancer literature in industrial concerns
(6) Display of exhibits and posters in public libraries
(7) Publication of newspaper and magazine articles (using Department ma-
terial)
(8) Radio programs discussing cancer
(9) Translation of Department publications into foreign languages
(10) Cancer knowledge polls in communities
(11) Designing of posters
(12) Production of plays on cancer by individual clubs
(13) Formation in clubs of study committees on cancer
(14) Competition of committees and subsequent publicity
(15) Local public meeting on cancer (Symposium)
(16) Original ideas by local committees
Since 1948, the education of the public in cancer has become a joint responsibility
of the Department, the American Cancer Society, and the Harvard School of Public
Health. The Department furnishes some pamphlets, gives occasional lectures and
devotes a considerable amount of time to evaluating education activities. The
American Cancer Society is developing the Cooperative Cancer Control Com-
mittees originally organized by the Department, while the Harvard School of
Public Health helps to unify the activities.
Cancer Education in the Schools — Beginning in 1942, the Department pioneered
in the development of the teaching of cancer control in both junior and senior high
schools. The keynote of cancer education of students has been the acquisition of
knowledge for service to the community rather than the acquisition of knowledge
for personal safety. This placed the emphasis on the social and economic phases of
the disease, the service that students can render, rather than on the clinical aspects.
It was hoped that some information would be conveyed to the parents. A junior
high school and a senior high school participated in the experiment. When the proj-
ect was inaugurated the Department assisted in both an advisory and teaching ca-
pacity. Later it evaluated the results of the experiment which established the value
of the instruction of students. It was found that the parents of junior high school
students had received more information on the subject than the parents of high
school students.
22
P.D. 34
American Cancer Society
The American Cancer Society allocated funds for two educational workers and
two statisticians in 1945. Later they increased the number of statistical workers
to four and transferred the educational workers to their own office.
Visitors to the Division
Representatives of the Department of Public Health, Medical Societies or similar
organizations interested in cancer control from 36 states and 21 foreign countries
have consulted the Department relative to the Massachusetts Cancer Program
over the years.
The majority sent representatives who spent from one day to one month with the
Department, studying the program. Others limited their inquiries to letters.
Representatives from four Canadian provinces — New Brunswick, Quebec,
British Columbia and Manitoba — where cancer programs were being inaugurated
consulted the Department. Other representatives came from the Philippine Island
and Hawaii.
Publications
During this period sixteen publications were published by members of this Di-
vision.
Table I — Outstanding Accomplishments
+3
1 C cS
'So
Cj3 a
as -^ £
rt > m
Specimens examined
at the Tumor Diag-
£
"^ a> "5
=8.2
nosis Service
a
B*
fe * *<
a
a
-,3
'55
"55
c3
■Sec
P/S .
9 b *
3
3
Statistical
CI
1 '-§ ^
!? >i O
gg;s
a
to
.2
Studies
Publications
Year
>>§.!
o a>S
t,
a
O
C3 O
o
u
0)
3.9
Median del
of cancer
first sympt
physician
Percentage
going to a
one month
toms
Percentage
attending
ferred by p
a
o
0
6
a
CO
o
6
No. of Do
the service
° m
o o
£5
1931
3122
6.7
11.6
38.2
12
3285
772
so
8
8
1940
5498
4.6
21.0
86.4
23
3907
798
115
7
7
1941
5010
4.0
23.5
84.3
23
4200
890
120
5
2
1942
4377
3.8
22.7
84.5
20
3322
791
107
7
1
1943
3793
3.3
23.9
84.6
20
2926
648
105
7
2
1944
3863
4.2
19.0
88.4
19
3725
644
105
8
1
1945
3820
3.3
27.5
88.1
19
4700
686
103
5
1
1946
4026
3.8
23.0
87.0
19
5264
809
108
6
2
1947
4516
4.3
20.5
89.0
18
8474
1005
126
7
3
1948
4754
3.9
23.3
88.0
18
8444
1068
132
8
5
Table II — Massachusetts Cancer Deaths*
Average Age of Those
Dying from Cancer
Age-Adjusted
Year
Number of Deaths
Cancer Death Rate
per 100,000
7092
64.2
Male
Female
1939 ....
138.2
143.0
1940
7390
64.2
139.8
148.4
1941
7486
64.4
145.9
141.7
1942 .
7534
64.3
144.5
140.5
1943 .
7587
64.4
142.1
140.4
1944 .
7690
64.4
140.6
140.2
1945 .
7922
64.8
146.1
138.5
1946
7932
64.8
142.7
137.1
1947 .
8273
65.2
148.6
138.3
1948 .
8668
65.3
155.9
140.4
*Adjusted to the age distribution of the total population of the U. S. for 1940. Ten-year age groupings
were used between 30-70 with under 30 as one group and 70 and over as another.
P.D. 34
23
Table III — Total Attendance at Individual State-Aided Cancer Clinics
\ 1942
1943
1944
1945
1946
1947
1948
1949
Beth Israel
1159
1285
1469
1384
1485
1321
1388
1590
Beverly
320
314
342
310
391
355
390
353
Boston Dispensary
1693
1465
1441
1402
1919
1987
2098
2348
Brockton
260
325
264
227
332
372
510
556
Fall River
637
607
751
744
938
1063
1318
1194
Fitchburg
210
165
152
113
116
145
193
179
Gardner
93
71
61
53
46
49
39
95
Gloucester
118
81
43
65
Greenfield
34
41
39
68
74
77
79
79
Lawrence
295
249
377
389
369
571
706
901
Lowell .
327
283
336
209
244
238
273
298
Lynn
939
852
982
974
955
943
994
1046
New Bedford
421
375
350
344
409
599
674
881
North Adams
23
33
31
58
53
53
58
35
Salem .
528
487
498
465
500
511
509
480
Springfield
409
511
541
486
510
597
556
507
Worcester
1001
933
1151
1068
990
1149
1240
1346
Pondville
8862
8223
6909
7303
6219
6343
6696
7792
M* estfield
6613
6719
6681
6638
7636
8077
8353
7968
Total
23,824
22,938
22,375
22,235
23,186
24,450
26,074
27,713
Table IV — Number of Social Service Contacts at State-Aided Cancer Clinics
1942
1943
1944
1945
1946
1947
1948
Beth Israel
1764
2476
3266
3013
2993
2834
2635
Beverly
840
702
831
902
1322
1624
1775
Boston Dispensary
3613
3926
3834
4230
5194
5057
6290
Brockton
973
1725
1462
1032
1714
1669
2068
Fall River
732
951
1115
1196
1488
2027
2469
Fitchburg
582
401
479
415
451
383
260
Gardner
721
528
478
512
401
421
427
Greenfield
296
336
419
402
294
326
336
Lawrence
1730
1792
1550
1846
2085
2433
2666
Lowell
684
413
1149
1110
903
867
1135
Lynn
3060
4409
3701
2973
2778
3613
3004
New Bedford
2364
4083
2588
2295
678
1308
1119
Salem
1673
1606
1555
1853
2245
1967
2432
Springfield
1590
2186
2274
2234
2411
2578
2031
Worcester
1937
2465
2710
2551
3043
2726
2624
Table V — Attendance of New Patients at the Massachusetts Cancer Clinics
Total
Year
Individuals
Individuals
Percentage of
With New
With First
Individuals
Conditions
Cancer in Year
With Cancer
1927
1345
296
22.0
1928
2530
530
20.9
1929
2110
529
25.1
1930
2522
649
25.7
1931
3122
744
23.8
1932
3513
880
25.0
1933
3943
1028
26.1
1934
4261
1054
24.7
1935
3744
1089
29.1
1936
3957
1305
33.0
1937
4110
1377
33.5
1938
4993
1773
35.5
1939
5281
1816
34.4
1940
5498
1900
34.6
1941
5010
1790
35.7
1942
4377
1538
35.1
1943
3793
1459
38.5
1944
3863
1498
38.8
1945
3820
1517
39.7
1946
4026
1512
37.6
1947
4516
1504
33.3
1948
4820
1551
32.2
24
P.D. 34
Table VI — Promptness in Seeking Medical Advice Among Individuals
Attending the Massachusetts Cancer Clinics in 194-8
Interval — First Recognized
Symptoms to Physician
Interval — First Recognized
Symptom to Clinic
Site
Individuals
With
Known
Duration
Percentages
of Individuals
Visiting a
Clinic Within
One Month
Median
Interval
in
Months
Individuals
With
Known
Duration
Percentages
or Individuals
Visiting a
Clinic Within
Two Months
Median
Interval
in
Months
Buccal Cavity
Digestive Tract .
Respiratory System
Female Genitals
Breast
Male Genital Organs
Urinary Organs
(male and female)
Skin .
Hodgkins and Leukemi
Others and Unspecified
l
122
140
39
117
126
12
16
316
27
31
18.9
33.6
41.0
35.9
27.0
25.0*
37.5*
9.5
37.1
29.1
3.1
2.4
1.7
2.4
3.4
2.0
2.0
12.3
2.3
2.5
131
171
50
125
130
14
24
340
35
37
25.9
19.3
20.0
27.2
30.8
14.3*
20.8
8.2
20.0
27.1
3.8
3.9
6.0
3.6
5.0
6.0
6.4
12.6
3.7
3.6
Totals .
946
23.3
3.9
1057
19.3
6.2
*Poorly established rate because of the small number of cases.
Table VII — Stage of the Disease — by Site in Individuals
Attending the Massachusetts Cancer Clinics in 1948
Regional
Remote
Site
Localized
Involvement
Metastases
Recurrent
Total
Lip .....
81.9
3.6
0.0
14.5
55
Other Buccal
39.7
51.4
.9
8.0
113
Stomach .
28.3
63.3
6.7
1.7
60
Rectum and Anus
56.4
32.3
3.2
8.1
62
Other Digestive
45.7
41.3
5.4
7.6
92
Respiratory System
57.6
24.2
6.1
12.1
66
Breast
37.6
31.0
8.1
23.3
210
Female Genitals
48.0
28.5
4.0
19.5
200
Male Genitals .
41.2
17.7
23.4
17.7
34
Urinary Organs
37.5
17.5
12.5
32.5
40
Skin
88.5
2.2
.5
8.8
557
Other Organs and Unspecified
25.0
31.6
14.5
28.9
76
Total ....
938
343
68
216
1,565
Leukemia ....
18
Lymphosarcoma
—
—
—
—
12
Multiple Myeloma
—
—
—
—
1
Hodgkin's Disease
—
—
—
21
Other Malignant Lymphomas
—
—
—
16
All Cancer Cases .
1633
P.D. 34
25
Table VIII — Status of Patients at End of 5, 10, and 15 Year Intervals
After Clinic Admission*
Rate per 100
Dead With
Cancer
Dead Without
Cancer
Percent
Alive
Skin (800 cases)
5 years after .......
10 years ........
15 years ........
16.1
23.8
27.1
14.8
33.1
44.6
69.1
43.1
28.3
Lip (183 cases)
5 years after .......
10 years ........
15 years ........
32.2
36.1
37.7
9.3
21.8
36.1
58.5
42.1
26.2
Rest of Buccal Cavity (277 cases)
5 years after .......
10 years ........
15 years ........
68.9
72.2
73.3
5.1
14.1
17.0
26.0
13.7
9.7
Breast (419 cases)
5 years after .......
10 years . . . . . . .
15 years . . . .
70.9
79.7
81.9
3.1
5.5
7.4
26.0
14.8
10.7
Female Genitals (317 cases)
5 years after .......
10 years ........
15 years ........
76.3
81.7
83.3
0.6
3.2
3.5
23.0
15.1
13.2
All Others (481 cases)
5 years after . . .
10 years ........
15 years ........
82.7
85.2
86.3
2.3
3.1
4.4
15.0
11.6
9.3
*In this table the clinic attendance between 1927-1931 was used, omitting all unknowns. In order to
get long-term end results, only the cases attending the clinics in the earlier years have been used.
26 P.D. 34
DIVISION OF MATERNAL AND CHILD HEALTH
CONSOLIDATED REPORT 1942-1949
Florence L. McKay, M.D., Director
During the years covered by this report the Division of Maternal and Child
Health saw many changes.
Although many services were transferred to other divisions, a few new services
were acquired and several special projects were undertaken. Activities in the re-
maining services were intensified. In 1942 the dental staff was organized into a unit
and transferred to the Division of Administration. The Nutrition Service was ele-
vated to the status of a bureau and a Bureau of Medical Social Work was created
in 1944. Both bureaus were transferred to the Division of Administration. The
Annual Census of Handicapped Children and the Services for Crippled Children
were transferred to the Division of Maternal and Child Health in 1945 and 1946
respectively, and a Bureau of Crippled Children's Services created.
Activities op the Various Sections of the Division
1. Maternal, Infant and Preschool Hygiene.
(a) Maternal Mortality Study — A five-year study of maternal mortality was
brought to a close in 1942 and a new five-year program was begun in 1949. The
latter study is being carried on by the Maternal Welfare Committee of the Massa-
chusetts Medical Society, with the Division of Hospitals and the Division of Ma-
ternal and Child Health. Maternal and Child Health Funds were secured from the
United States Children's Bureau. For this study the State has been divided into
two sections — the eastern section including the area east of the City of Worcester,
and the western section including Worcester and the cities and towns west of it. An
obstetrician is in charge of each section. Maternal deaths are reported directly to
the obstetrician serving the area as well as to the Director of the Division of Hos-
pitals. The obstetrician directing the area allocates the cases for investigation and
reports to an obstetrician near the location of the death. These reports are studied
by the Committee as a whole, which recommends whatever action is deemed neces-
sary. For each case investigated physicians are paid a fee of $10.00. The two super-
vising obstetricians are paid $500.00 per year, which includes clerical services.
(b) Prenatal Clinics — A prenatal clinic has been maintained in Westfield through-
out the period. This clinic is held approximately twice a month throughout the
year. Effort has continued in the establishment of more prenatal clinics in hos-
pitals. This activity was hampered during the war by lack of available personnel,
many clinics already established had to be closed during that period. The Morton
Hospital in Taunton reopened its clinic during the past year.
Advisory service was given to prenatal clinics in several service camps during the
war and after the war to clinics held in certain housing projects.
(c) Prenatal and Postnatal Letters — This service, which had grown in volume since
its inception was curtailed abruptly in September 1943 because of the Emergency
Maternity and Infant Care Program which began on September 3, 1943 and re-
quired the use of the entire clerical staff of the division. Only the printed pamphlets
on prenatal and infant care were sent out until the liquidation of the Emergency
Maternity and Infant Care Program in April, 1947. Comparative figures of the
last year before the interruption by war activities and the first year of resumption
of service are given below :
1942 1948
New requests for prenatal letters ..... 8,526 2,513
New requests for postnatal letters ..... 10,675 8,879
(d) The Emergency Maternity and Infant Care Program — The Emergency Ma-
ternity and Infant Care Program was a program to provide maternity care for the
wives of service men in the four lower pay grades, and for the pediatric care of their
P.D. 34 27
infants under one year of age. Ordinarily at least a year is spent in preliminary
preparation for a new health program but because of the emergency nature of this
service, barely six months were spent in this preparation.
Technical committees on obstetrics and pediatrics were set up to pass on the
qualifications of participating physicians. Excellent cooperation was obtained from
the 159 hospitals and 3370 physicians participating in the program. The greatest
volume of cases was processed in the year of 1944 when 10,156 maternity cases re-
ceived care, resulting in 9936 live births — representing 13% of the total infants
born alive in Massachusetts for that year. For the 5-year period 43,771 cases were
authorized for care of which 33,605 were maternity and 10,106 were infant cases.
$4,008,970.19 of the allotted $4,131,677.66 were expended. The Massachusetts
Emergency Maternity and Infant Care Program was rated best in the country by
the Children's Bureau. A special report of this program has been made, which will
be in print in 1950. One of the far reaching effects of the Emergency Maternity and
Infant Care Program was the stimulation of a desire for good prenatal, postnatal,
and infant care among the general population.
(e) Program for the Care of the Prematurely Born — The Massachusetts program
for the care of the prematurely born was the first state program of this kind and was
inaugurated in 1937. A law was passed providing for the reporting of premature
births, the providing of suitable centers for the care of these infants, and the pro-
viding of suitable transportation to these centers. 48 centers were established out-
side the Metropolitan area on a geographic basis in such a way that no infant born
outside one of these centers had far to travel to obtain care. It was also required
that payment of hospital expenses of these infants be made by local welfare boards
in the event the families concerned were unable to meet these costs.
Despite this early progress the public in general, including physicians, was not
familiar with the law concerning the care of prematurely born infants, nor with the
availability of 48 hospital centers established for their care throughout the State.
This appalling state of affairs was brought to our attention in January, 1949, when
the following incident was reported to the Commissioner of Public Health :
Six premature infants born outside of Boston (one of whom was born outside of
the State) were transferred to a Boston hospital. Only two of these infants sur-
vived. An investigation disclosed that a few were improperly cared for during
transportation; also that all the infants could have been cared for in a premature
center nearer the place of delivery. Following this tragedy an immediate spot sur-
vey was made in all health districts to determine: (1) the number of premature in-
fants born; (2) care they received after birth; (3) local boards of health and welfare,
as well as hospitals, were questioned regarding their knowledge and interpretation
of the law for the care of the premature infant. Because of the information received
the following material was assembled and distributed to every physician, hospital
superintendent, local board of health, and local board of welfare :
List of hospitals and their location, which are equipped to care for premature in-
fants
Copy of the law concerning the premature infant
Copy of the leaflet "Your Premature Baby"
Publicity was obtained through the newspapers, medical journals and radio. The
Division program for care of the premature infant was discussed at staff meetings
of the District Health Officers and at the nurses' staff meetings.
The Committee on Fetus and the Newborn of the Massachusetts Academy of
Pediatrics and the Division Director prepared an article which was published in the
June 2, 1949 number of the New England Journal of Medicine, concerning the pre-
mature program and the care of the premature infant before it is sent to the hospital
and during its transfer. Reprints of this article were ordered and a mailing list for
distribution was prepared.
As a result of the survey it was found that many persons responsible for premature
infant care were not familiar with the law; that the law was very confusing, and in
some instances it was not acceptable to parents because of the relationship to wel-
fare. Therefore, after many conferences with the Department staff, the Advisory
Committee on Care of Premature Infants, the Massachusetts Medical Society,
Chiefs of the pediatric staffs of the Massachusetts General Hospital, the Children's
28 P.D. 34
Hospital, the Boston Floating Hospital and the Boston Lying-in Hospital, the Di-
rector of Aid and Relief of the Department of Public Welfare, and the Commis-
sioner of Veterans' Services — a revision and simplification of the premature law
was drafted and submitted to the legislature. The changes in the law are as fol-
lows: (1) Changing from 5 to 53^ pounds birth weight as the definition of a 'prema-
ture infant, to conform to the Federal Government and other state definitions.
This was recommended by the Recess Commission. (2) Changing hospitalization
payment to cover infants weighing 4J^ pounds or less at birth because infants of
lower weight need longer hospitalization than those of more than 4*^ pounds who
are usually in the hospital for shorter periods. (3) Changing to local boards of
health for reporting and for payment for hospitalization to avoid the welfare stigma,
and it is hoped to broaden the interpretation of need.
A generous donor provided premature carrying ambulances wherever the survey
by the Committee on Fetus and the Newborn indicated a need.
Plans were discussed with this Committee for a regional conference for physi-
cians on the care of the premature infant to be conducted during the coming year if
funds became available.
No refresher courses for nursery supervisors in the care of the infant prematurely
born, and no institutes for physicians were given during the war years. Early in
1942 all nursery supervisors in the 48 hospital centers had received special training.
No further specialized training was offered until late in 1945 when a course in pre-
mature nursing was conducted for the New England States by the Children's Bureau
at the Boston Lying-in Hospital. Two nursery supervisors, one fiom Quincy Hos-
pital, the other from Morton Hospital in Taunton attended. Two more supervisors
attended a similar course in 1946. During 1947 two nursery supervisors attended a
three-month course in care of the prematurely born infant at Johns Hopkins Hos-
pital; three more were sent in 1948. As a direct result of this, refresher courses for
nursery supervisors were organized at the Massachusetts Memorial Hospital and
the Burbank Hospital in Fitchburg. These courses were for two-week periods, and
concerned the care of the prematurely born infant. 26 supervisors attended in 1948,
and 19 in 1949. Tuition and stipends were paid for those attending.
Throughout this period a gradual improvement was made in both personnel and
equipment in the 48 hospital centers for the care of the prematurely born infant as
well as in the hospitals located in the Metropolitan areas. A unit system of care is
being adopted in most hospitals, and many are using autoclaving as a means of
terminal sterilization of formulae.
During 1947 several outbreaks of diarrhea occurred in new-born nurseries, in-
cluding nurseries for the prematurely born. Because of the gravity of the situation
an institute on infectious diarrhea was held. Other divisions of the department
were brought into the picture, namely: the Division of Local Health Administra-
tion, Division of Communicable Diseases, and the Hospital Licensing Bureau. Four
regional conferences were held in Springfield, Salem, New Bedford, and Boston.
Many hospital administrators and other members of hospital staffs attended, as
well as from one to thirty members of their staffs. The institutes were considered
to be most successful in stimulating interest in this problem. A report of this in-
stitute was published and sent to a comprehensive mailing list.
"Premature Infants" a Manual for physicians published by the Children's
Bureau of the United States, was sent to all hospitals for the use of their staff, and
to the nursery supervisors who have taken refresher courses. Additional copies may
be obtained on request.
Consultation service was extended to hospitals planning the construction of new
or remodeling of existing nurseries. So many requests for such service came as a re-
sult of the boom in hospital building and remodeling that a committee was formed
consisting of Dr. MacKnight, Dr. Rubenstein and Dr. McKay, to review the con-
struction plans for hospital nurseries. In this way, the points of view of construc-
tion, licensing, and pediatric care could be obtained.
The improvised incubator devised by this division was sent to the Children's
Bureau at their request and was approved by the United States Bureau of Stand-
ards and by the Children's Bureau in 1942.
P.D. 34
29
(/) Well Child Conferences — Prior to 1942 much work had been done throughout
the State in demonstrating the value of well child conferences. Many communities
had begun to set up their own conferences. It was the intention of the division to
reduce its activity in this field as rapidly as possible after sufficient local interest
had been stimulated. With the onset of war, however, and the resultant depletion
of medical personnel, especially in rural areas, it was necessary to continue State
participation in this field at the same, and even a greater rate than previously. De-
spite this a few communities continued to set up locally-sponsored conferences so
that by 1948, 153 cities and towns had established conferences. There were 276
well child conferences in operation throughout the state, 7,283 sessions were held to
which 51,816 patients made 147,640 visits, or an average of 2.8 visits per patient
per year. 19.4 sessions were held per 1,000 children under 5 years of age. Only New
York superseded Massachusetts in amount of service per child population. Al-
though this appears to be a splendid record there are many parts of the state where
little or no health supervision of children is being carried out except by private
physicians. It is in these areas that the physician population is scant, and the State
Well Child Conference Units have had to continue with the State sponsored clinics
in these communities. In eighteen communities 1282 children were examined in
State sponsored conferences in 1948, as compared to 2702 children examined in 59
communities in 1942. The table given below shows a definite improvement in gen-
eral health of the child population. Although much of this can be attributed to the
improvement in the general economic status of the people, the awareness of families
to the importance of health supervision of infants and children is borne out by the
marked increase of the number of children attending the conferences who had had
previous immunization to diphtheria. Much of this effect has been accomplished
by the Well Child Conference program activities through the years.
Well Child Conferences and Nursery School Examinations
1942 and 1948
1942
Number of examinations .
Infant examinations
Preschool examinations
Children with defects
Children with major defects
Children referred to physician
Children referred to dentist
Children refened to both
Children with poor eating habits
Children who need habit training
Children who have not been vaccinated
Children who have not completed TAT
2702
9.6%
90.4%
77.4%
58.7%
26.7%
40.4%
14.0%
26.4%
38.0%
73.1%
44.2%
1948
1282
10.6%
89.4%
63.6%
34.6%
19.3%
23.2%
4.9%
17.0%
17.4%
70.4%
27.7%
Percentage of Children with Specified Defects
Teeth . . . .
41.6%
Nutrition ......
. ■ . . . . 25.8%
Feet
16.4%
Throat
. . . ••.. . 15.7%
Skin
8.8%
21.5%
12.2%
10.4%
11.6%
12.5%
Advisory services have been furnished communities who have or are interested
in setting up their own conferences. Some financial aid continues to be provided to
a few local conferences in the form of fees to the attending physicians. Nutritionists
and dental hygienists are supplied to many conferences from the District Health
Offices. Public Health Nursing supervision and follow-up is available to all com-
munities.
After a lapse of seven years due to war activities a refresher course for Well Child
Conference Physicians was conducted in 1949 at the Harvard School of Public
Health. This consisted of two one-day conferences and was attended by eight
30 P.D. 34
physicians. A letter was prepared for distribution to local well child conferences
advocating the testing of vision and hearing of all children four years or over, in
local well child conferences.
Revision of "Organization and Conduct of Local Well Child Conferences" was
made and copies were sent to the organizations administering local conferences.
In 1946 conferences were held with the Division of Child Guardianship of the
State Department of Public Welfare with the result that examinations of State
wards may be carried out at the State Well Child Conferences.
2. Child Growth and Development.
Work on the Massachusetts Vision Test and the Massachusetts Hearing Test
consumed much of the time and energy of this branch of the Division during the
eight years covered by this report. Need for these tests was first realized through
the preschool readiness conferences where many deficiencies in both sight and hear-
ing were found. To determine the amount of handicapping which such deficiencies
produced, it was necessary to have tests which adequately determined the amount
of deficiency present. To prevent unnecessary loss of learning ability in the early
grades, these tests had to be applicable for use in screening preschool, kindergarten,
first and second grade children. Much time was spent in research in the develop-
ment of both these tests. Once the tests were developed their usefulness had to be
demonstrated through lectures, demonstrations, and practical applications in well
child conferences, school health examinations and before groups of school adminis-
trators, teachers, students in teachers' colleges and other interested personnel.
Training centers had to be set up to instruct those who were to carry on the tests
in their local communities. Instruments had to be calibrated and checked now and
i then in order to assure good results.
Results of all this effort have been gratifying. The Massachusetts Vision Test was
officially approved by the Council on Physical Therapy of the American Medical
Association in 1943. It was adapted for use in the armed forces, and is used to some
extent by 38 other states. Ninety percent of the cities and towns of Massachusetts
are now using this test. Many communities have purchased their own equipment,
others are loaned equipment from their District Health Offices. In September, 1947
in the Oak Ridge Eyesight Conservation Institute it was announced that the State
of Arkansas was about to purchase $7,000.00 worth of equipment so that every
school child in Arkansas could be screened by the Massachusetts Vision Test.
The Massachusetts Vision Test is one by which defects such as myopia, hj^per-
metropia, astigmatism, and muscular imbalance can be detected. The units in the
test are so simple that a preschool child unable to read can still be tested. The uni-
versal^ of its use, and the relative simplicity of the equipment necessary has made
the test widely accepted. About 27% of children tested have defective vision.
In 1946 the audiometer service, assignments, and all functions concerned with
audiometer testing were transferred to the Child Growth and Development Service.
District Health Officers were assigned audiometers for loan to communities within
their districts.
The Massachusetts Hearing Test was devised first with the use of a record for
sound reproduction in group testing. In 1947 an impedance matching device was
adopted for the reproduction of sound from individual pure-tone audiometers
through group earphones. A year later the record for sound reproduction was dis-
carded, as was also an illustrated card heretofor used as an instructing device to the
testee. The test as now devised uses an individual audiometer, group earphones,
and an impedance matching device. The child responds to the presence or absence
of stimulus by underlining words, rather than responding to a picture card. By an
arrangement of equipment components, 10, 20, 30, or 40 children may be tested at
once. This eliminates the necessity of transporting from school to school receiver
trays which would not be used in many instances.
The pure-tone audiometer used in this test reveals high frequency as well as low
frequency losses, thus enlarging the scope of the test. About 9% of children tested
by this method are found to have hearing defects, as compared to 2% found by
other methods.
An effort has been made to stimulate a more thorough follow-up by local nurses,
and to secure reports which will provide necessary statistical information.
P.D. 34 31
Between 200-225 cities and towns in this state and cities in 15 other states as well
as the whole State of Texas are using the test.
A study in stereopsis and the effect of the lack of it on the learning processes, as
well as in athletics, was undertaken but the results were inconclusive, and the study
was abandoned.
A speech study is now in progress. This is a study of speech sounds, and has been
carried out with the aid of Walter F. Dearborn, M.D., Ph.D. The purpose of this
study is to analize speech sounds by electro-mechanical methods so that a feasible
system may be devised for the production of visible speech. This would be of great
importance in educating deaf children. Some progress along these lines has been
made. By using a play-back, amplifier, 12-channel wave analyzer and a constant-
speed film, fairly satisfactory pictures of visible speech have been obtained. These
pictures are unique for a given word and for a given individual, and can be learned.
The pictures are highly reproducible insofar as configuration is concerned. A sec-
ondary purpose of the program is to check on the possibility that "inner speech"
a phenomenon presumably present during silent reading — can be measured and
analyzed. This part of the study is of importance to educators and others in the
field of reading.
The School Health Council requested the Head of Child Growth and Develop-
ment Service to act as consultant to the Council on school lighting for the purpose
of improving lighting conditions in the schools. With the Council, a study of lighting
conditions was made and recommendations for school lighting were developed.
These recommendations were printed in the Spring issue of Contact and in the Feb-
ruary editions of the Massachusetts Educational News in 1946. Both of these pub-
lications reach all school administrators.
In 1949 the Head of Child Growth and Development Service assisted the person-
nel of the Massachusetts Society for the Prevention of Blindness and the U. S.
Children's Bureau in setting up a study of the relative merits of various methods of
screening the vision of school children. This study was carried on in St. Louis at
the invitation of the National Society for the Prevention of Blindness. Personnel
were trained in the proper use of the Massachusetts Vision Test, one of the devices
under investigation.
Otolaryngologists, ophthalmologists, and experts in the fields of light, sonics,
and electronics, who cooperated in the vision and hearing studies, rendered willing,
able, and invaluable help and contributed in large measure to the work. Without
their help much of this work could not have been done.
3. School Health.
(a) Millville School Health Program — School health supervision was carried on
in Millville for a nine-year period until April 20, 1944, at which time the school
health service became free of State aid. This community was used to study the dif-
ferent procedures in a school health program before using them on a State-wide
basis. The improvement in the physical condition of the school children during the
years of this study was appreciated by both parents and teachers. A standard
vitamin-mineral preparation was supplied to the children. Marked gains in general
health were obtained and the rejection rate for those examined for the armed service
was very low.
(6) Haverhill School Health Program — 1948 — In conjunction with the District
Health Officer in the Northeastern Health District, a conference was held in Haver-
hill with the Board of Health late in January, and another a week later with the
Board of Health and five school physicians regarding an evaluation of the school
health program in Haverhill, and specifically in one of the schools (Tilton) where
there had already been established a School Health Council. As a result of these
conferences the District Health Officer was asked to complete the evaluation sched-
ule recommended and provided by the American Public Health Association. In
June, the evaluation schedule was discussed in the Division with the District Health
Officer, the District Health Education Worker, and Dr. Cunningham, the Public
Health Physician of the Bureau of Health Information. At this meeting it was de-
cided that the District Health Officer would contact the Haverhill Board of Health
32 P.D. 34
and the Superintendent of Schools to arrange a meeting for the discussion of the re-
sults of the evaluation.
In connection with this program the Assistant Director of the Division and Miss
Hiller, the Nursing Consultant in School Health, conferred with Father Sherlock,
the Diocesan Director of School Health for parochial schools, relative to the work
under discussion.
Five regional conferences on school health for school nurses were conducted by
the Bureau of Public Health Nursing.
(c) General — Visits of District Health Officers to the schools for the purpose of
discussing health problems with the school supervisors, physicians and nurses have
been carried out with gratifying results.
School Health Council meetings have been held regularly.
One of the most successful projects undertaken was that of a conference for super-
intendents in 1946. 5 one-day conferences on school medical services were held.
95% of the school superintendents in the State attended these conferences. Dr.
George Wheatley, Secretary of the School Health Section of the American Public
Health Association, Advisor in School Health to the Children's Bureau, and Assist-
ant Director of Metropolitan Life Insurance Company, conducted the conferences.
The morning session was devoted to the topic "Present Trends in School Medical
Services", with special attention to four topics previously chosen by the superin-
tendents for discussion, as follows:
1 . How may the work of the school physician be improved?
2. How may the role of the classroom teacher be strengthened?
3. How may relationships to public health and community agencies be im-
proved?
4. What methods will bring about closer coordination of the school medical ex-
aminations with the total school health program within the school adminis-
tration?
During the afternoon session the superintendents were assigned to committees to
plan and recommend action on the four topics listed, and worked well in group par-
ticipation. Their recommendations were excellent and were published in a succeed-
ing number of Contact.
Results from these conferences were requests for advisory service in school health
programs and for Well Child Conferences from superintendents and from District
Health Officers to this Division. One of the results of these conferences was the re-
quest from the superintendents' group that school health services be given a place in
the activities of the Massachusetts Medical Society. Consequently the Massachusetts
Medical Society appointed a subcommittee of the Public Health Committee to con-
sider school health services.
Two courses for school physicians were organized and conducted by the Bureau
of Health Information and the Harvard School of Public Health. 39 physicians
from 30 towns attended.
Contact, the bulletin for superintendents of schools and school physicians was
prepared in this Division and published regularly until 1948 when all activities of
this service were taken over by the Bureau of Health Information.
A one-week Workshop for School Nurses was conducted through Maternal and
Child Health funds, by the Bureau of Public Health Nursing, at Simmons College
in 1949.
Guide to School Health was twice revised by the Division of Maternal and Child
Health and was transferred with the school health program to the Bureau of Health
Information for publication.
Workshops for Teachers, in Health Education, with credit, were given at the
Harvard Graduate School in 1945; in Pittsfield in 1946; and in Hyannis in 1947.
A six-week Workshop for Teachers of Health Education was given at Amherst
Summer School in 1946.
P.D. 34 33
4. Health Education.
A course for credit at the Harvard University Summer School on "Youth Stand-
ards in War-Time" given in 1943 was unusually successful.
A 3-year training program for parent education was organized. The work was to
be done in (1) small parent groups studying the needs of children of each age group
in regard to physical and emotional health; (2) institutes conducted for three or
more years in major cities. 20 to 40 leaders from as many different communities in
each of the 3-year training groups illustrated considerable local interest in this
field. In 1943 this program was discontinued by the Commissioner, after the resig-
nation of the Teacher-Training Coordinator in Parent Education.
Classes for mothers and fathers in maternal and infant care formerly carried on
by this Division are now conducted entirely by local nursing organizations.
A three-year Study of Health Education in Secondary Schools was conducted,
sponsored by the State Departments of Education and Public Health, the Massa-
chusetts School Superintendents' Association, the High School Principals' Associa-
tion, the Massachusetts Medical Society, the Massachusetts Dental Society, the
Academy of Pediatrics, Boston University, Harvard Universitj^, and the Massa-
chusetts Institute of Technology. Work on the Study was done in the Maternal
and Child Health Division; reports were prepared in this Division and published
in the Journal of School Health.
A Committee on the "Guide to Health Teaching in High Schools" resulting from
this Study was appointed by the Commissioner of Education with the Teacher-
Training Coordinator of this Division as Chairman. They have produced several
units, the organization, editing and clerical work being done in the Division of Ma-
ternal and Child Health until March, 1948, when the Teacher-Training Coordinator
was transferred to the Bureau of Health Information.
Medical consultations and many workshops for teachers in individual communi-
ties were conducted, on request.
On July 1, 1944, a Bureau of Health Information was formed and incorporated
into the Division of Administration. Much of the activities of health education was
carried on by this bureau.
In July, 1948, all school health services were transferred to the Bureau of Health
Information and a coordinator of health education serves as a liaison agent for the
Department, including this Division.
5. Nutrition.
Each year an annual one-day conference for New England nutritionists was con-
ducted by the Division of Child Hygiene, the programs varying from year to year.
Nutrition demonstrations were conducted in Barnstable County, Bristol County,
Plymouth County and the towns of Cohasset and Hanover. In 1942-43 the nu-
tritionists were placed in some of the health districts. By 1944 there was a nutri-
tionist in each of the 8 District Health Offices and 4 nutritionists on the Boston
staff.
During the war years a great deal of stimulus was given to nutrition activities
and the nutritionists of the Division gave courses for training home economics per-
sonnel, for Red Cross courses in nutrition, and for canteen workers. One nutrition-
ist was assigned part time to the Committee on Public Safety for the coordination
of their activities in nutrition with those of the Division and other organizations.
Nutritionists gave intensive service to school lunches throughout the State. They
visited prenatal clinics and assisted in arranging nutrition exhibits for clinics. They
cooperated with the State Teachers College at Ficthburg in courses in nutrition;
gave consultation service to the State Sanatoria for Tuberculosis; held group meet-
ings for professional and lay groups; participated in local as well as State Well Child
Conferences; conducted kitchen parties for home makers; gave service to Day Care
Centers and to industries; conducted newspaper publicity on nutrition for various
local newspapers.
The year 1944 marked the twentieth year for nutrition service in the Department
of Public Health and in this year the nutrition group was transferred to the Division
of Administration.
34 P.D. 34
6. Medical Social Work.
Monthly discussion groups for nurses were conducted in medical social work.
Studies were made of economic and social factors involved in behavior problems of
cases referred by the Well Child Confeiences. A syllabus on child care for use in
training volunteers for Day Care Centers was written with the cooperation of the
Massachusetts Committee on Public Safety. Social problems in school children in
the Town of Millville were given special attention.
After the beginning of the Emergency Maternity and Infant Care program in
1943 much time was given to social problems arising in this field.
In 1944 a Bureau of Medical Social Work was established in the Division of Ad-
ministration and since then the Medical Social Work Supervisor has become a con-
sultant to the Division of Maternal and Child Health and acts as liaison between
this Division and the Bureau of Medical Social Work; also the District Medical
Social Work Supervisors and other social agencies.
In 1945 a special study was made of rejected cases under the Emergency Mater-
nity and Infant Care Program to determine the needs for their social service follow-
up.
In 1945 a special study of medical social service needs of infants who have passed
their first birthday was started but has not yet been completed.
Consideration of what the social worker is offering and should offer in relation to
the Maternal and Child Health Program, exclusive of Crippled Children's Services,
led to plans for a social work staff meeting on this subject. Workers from the dis-
tricts discussed the sources of referrals, kinds of services offered, and further op-
portunities. It was clear that many requests were for the same kind of help that is
offered to orthopedic and plastic cases, on behalf of children with other diagnoses.
Other referrals came from Well Child Conferences and from the Census of the
Physically Handicapped. Services offered for these patients varied from simple
information regarding resources to extended study and evaluation as a basis for
advice to local workers. It was agreed that further effort was needed to interpret
the social services of the Department to prenatal clinics and to hospitals with pre-
mature nurseries.
The function of the Medical Social Consultant in Maternal and Child Health
would seem to be that of continued study of the problem in this field and their social
and emotional implication. She is aware of new developments in the program and
can assist in planning for the welfare of the patient. She interprets new develop-
ments to the district workers, as in the working out of the revised law on the care
of infants prematurely born. She correlates the social work in the districts with the
activities of the Maternal and Child Health Division staff as in stimulating the
follow-up of vision and hearing tests. She is the link between the Division and the
Bureau of Medical Social Work.
7. Dental Health.
In 1941-1942 the Dental Unit was included in the Division of Child Hygiene.
During that time dental education in schools and in hospital training schools was
promoted. Dental services were stimulated on a local basis. Dental surveys were
made in the schools. The services of the dental hygienists were given to the Division
Well Child Conferences and an attempt was made to promote dental service in pre-
natal clinics. Refresher courses in children's dentistry were conducted in several
communities of the State in cooperation with Forsyth Dental Infirmary, so that
they were made available to all students of the State. In some summ.Fr camps dental
examinations were made of the children upon request of the camp officials. The
dental staff participated in courses given at Harvard and Tufts Dental Schools, at
Boston University and at Forsyth Dental Infirmary.
Working with the State Department of Public Welfare, rates weie established
for the payment of dental care for welfare cases.
The promotion of community dental programs as a part of general community
health organization was carried out through this group.
P.D. 34 35
8. Crippled Children's Services.
Analysis of the statistics for the seven-year period covered by this report shows
a steadily increasing service to crippled children in Massachusetts. During this
period a total of 16,923 clinic visits were made in the eleven monthly orthopedic
clinics and the two clinics for plastic surgery, in contrast to 9,394 visits in the pre-
vious six years. During the six-year period previous to this report, the average
clinic attendance was 16. During the seven-year period covered by this report, at-
tendance averaged 20 children per clinic session.
The number of new cases admitted to Services for Crippled Children increased
from 244 in 1942 to 732 in 1948. The number of active cases increased from 924 on
January 1, 1942 to 1988 on December 31, 1948. This great increase is due to the
fact that almost all of the children admitted to service required treatment over a
period of years. About one-quarter of the cases admitted in 1942 were still under
active care as of December 31, 1948.
By legislative action during 1945 the Census of Handicapped Children was trans-
ferred from the State Department of Public Welfare to the State Department of
Public Health, and in September of that year this activity and the register of such
children were centered in this Division.
On January 1, 1946 the Service for Crippled Children, formerly administered
through the Division of Administration, was transferred to the Division of Maternal
and Child Health.
In December 1947, the Massachusetts Rheumatic Fever Program was started
with the opening of a Rheumatic Fever Clinic at North Reading State Sanatorium.
The clinic serves children under twenty-one years of age living in the Northeastern
Public Health District, having or suspected of having rheumatic fever. By the end
of 1948, 103 children made 252 visits to this clinic. A second Rheumatic Fever
Clinic was opened in the North Central Health District in March 1949. Intensive
public health education in the needs of the rheumatic fever patient was carried on
in both districts.
North Reading Rheumatic Fever Clinic 1948
Total cases
With Rheumatic fever
Active rheumatic fever
Inactive rheumatic fever
Rheumatic heart disease
Family history of rheumatic fever*
No rheumatic fever ....
♦Parents and siblings
103
41
21
20
20
15
62
The cost of hospital care has increased to such an extent over the past seven
years that the average family is no longer able financially to meet the expenses of
hospital care, which averages three months in the rheumatic fever patient. Hos-
pitalization for the child with rheumatic fever under twenty-one years of age has
been available at the North Reading State Sanatorium on a state-wide basis since
April 1949.
In 1948, Lakeville State Sanatorium was authorized to admit any crippled child,
as defined by the State, who had been living in Massachusetts for twelve months
preceding the date of the admission application.
In 1949, State funds were made available to Services for Crippled Children for
the first time. Prior to this period, the service had been provided by Federal funds,
with matching funds allotted to Lakeville State Sanatorium.
Services for Crippled Children is deeply indebted to all the clinic consultants for
the excellent quality of the service they have given, and to the physicians in the
Commonwealth for their cooperation with and support of the efforts of the service
to rehabilitate crippled children to active lives so that they may be self-supporting
and not a burden to the Commonwealth.
36 P.D. 43
9. General.
The Division of Maternal and Child Health cooperated with the State Depart-
ments of Agriculture, Education, Extension Services, Mental Health, Public Wel-
fare, and similar state organizations interested in maternal and child health by act-
ing on advisory committees, and coordinating effort in the handling of problems
presented. Conferences were held with lay and professional groups requesting ad-
vice concerning local problems in maternal and child health activities. Lectures on
pediatrics and obstetrics were given each year in the post-graduate courses for
physicians conducted by the Massachusetts Medical Society.
Conferences were held with students from Harvard School of Public Health and
with visitors from many states and foreign lands each year. Time spent with these
visitors is more than compensated for by the new points of view obtained from such
contacts.
Members of the Division attended regular sessions of the Clinico-pathological
Conferences at the Children's Medical Center, the Floating Hospital, and Mount
Auburn Hospital; Meetings of the New England Pediatric Society, Massachusetts
Medical Society, the Massachusetts and National Public Health Associations, and
many others. Several members of the staff attended courses in Maternal and Child
Health both within the state and in other parts of the country.
Motion picture films have been in constant demand by various lay, professional,
and official groups. The most popular films are those on nutrition, care of the teeth,
tuberculosis, posture, and the "cleanliness series" for children. Several radio talks
and lectures have been presented.
The Director of Maternal and Child Health served as chairman of the library
committee and as editor of The Commonhealth as long as it was printed. Due to war
shortages the last printing was in 1942 covering the activities of the Division for
1941. In 1944 the library was transferred to the Division of Administration under
the Bureau of Health Information.
10. Legislation.
Much time was spent by members of the staff on proposed legislation, especially
on recommended changes in the law concerning school medical examinations from
an annual examination to spaced examinations ; on laws relating to employment of
pregnant women in industry ; and on the changes in the premature law. A committee
containing the Director and Assistant Director, and the Director of the Division of
Local Health Administration laid plans for the administration of the Federal Health
Bill when, and if, it is passed.
11. Personnel Changes.
During the illness and after the death of Dr. M. Luise Diez the duties of Director
were taken over by Dr. Florence L. McKay, who, in November, 1942, became Act-
ting Director of the Division. In January, 1943, Dr. McKay was made Director,
and the position of Assistant Director was filled in August, 1942, by the appoint-
ment of Dr. Sallie Saunders.
Vital Statistics
Massachusetts
Birth Rate
Death Rate Infant Mortality Rate
Maternal Mortality Rate
per 1,000
per 1,000
per 1,000
per 1,000
Year
Population
Population
i Live Births
Live Births
(Under 1 Yr.
Under 1 Mo.)
1942
19.2
11.7
31.8
23
2.1
1943
19.8
12.5
34.3
22
2.0
1944
18.0
11.8
33.0
22
1.8
1945
16.9
11.3
31.8
22
1.9
1946
21.3
11.3
30.9
23
1.3
1947
23.3
11.2
28.3
21
1.0
1948
21.4
11.3
26.4
20
0.7
Special Projects
Under Federal Reserve Fund B, through the Children's Bureau, nine projects
have been organized through the Division of Maternal and Child Health.
1. Pediatric Nursing Course — A special course in pediatric nursing was or-
ganized by the Children's Bureau, Boston University, and this Division in the Fall
P.D. 34 37
of 1944. Nurses from all parts of this state and many other states have attended.
The course has affiliation with the Children's Medical Center.
2. Maternity Nursing Course — The course in Maternity Nuising at Boston
University was begun in the Fall of 1947. It is conducted on the same basis as the
Pediatric Nursing Course, and has affiliation with the Boston Lying-in Hospital.
3. Harvard School of Public Health Course in Maternal and Child Health —
Through a special grant of $69,072.00 the program for teaching and research into
public health problems of maternity, infancy, and childhood was expended to such
an extent that a complete training unit for specialists in maternal and child health
and crippled children's services was obtained. On January 1, 1948 a major improve-
ment in teaching facilities took place when the new Child Health Division of the
Children's Medical Center was opened with the head of the Department of Ma-
ternal and Child Health as its Director. A variety of clinics are conducted in this
unit which provide small numbers of children under conditions permitting thorough
basic training and detailed demonstration of health services. Of a total of 122 full-
time and part-time students enrolled in the 1948 class, 42 took the basic lecture
course in the Department, 29 the course in administration of maternal and child
health services and 26 took one or more of the seminars.
4. Study of Pediatric Care of Children of Harvard Veterans — This project is
sponsored by the Massachucetts General Hospital under funds from the Children's
Bureau, and is to serve as a pilot study in a nation-wide investigation of cost of
pediatric care. The Director of the Division of Maternal and Child Health is di-
rectly responsible for administrative supervision of the project. Services are ex-
tended through child health conferences, domiciliary pediatric and consultation
service, out- and in-patient hospital services. Consultation service is given by
practicing physicians who are licentiates of the American Board of Pediatrics. Hos-
pitals which are participating in the project are the Massachusetts General Hospital,
the Mount Auburn Hospital, the Floating Hospital and the Children's Medical
Center. The staff includes a part-time medical director, a full-time assistant di-
rector, two pediatricians, two public health nurses, and statistical and clerical help.
The children eligible for care were those of Harvard veterans whose fathers were
attending the university in Cambridge and the unit at Harvardevens in Ayer. In
September, 1948, children of all Harvard students, veteran or non-veteran, were
made eligible. In June, 1949, Fort Devens was closed and the Devens portion of
the study was brought to a close. In June, 1950, the entire project will be termin-
ated. During the first nine months of the study the services rendered were as fol-
lows: total 8358, office 3740, domiciliary 752, hospital 264, telephone advice 3529,
unspecified 73.
5. Medical Social Work Training Project — This project was organized in the
Spring of 1948 and provides for the training of medical social workers through co-
operation of the Bureau of Medical Social Work of the Department of Public Health
with the three schools of social work in Boston — Simmons College, Boston Uni-
versity, and Boston College. The deans of the three schools, the Commissioner of
Public Health, the Chief of the Department's Bureau of Social Service, and the
Director of Maternal and Child Health form a Technical Committee to assist in the
development of the project, and the selection of professional personnel. The di-
rector of the project is the Chief of the Bureau of Social Service. Administrative
supervision is given by the Division of Maternal and Child Health.
6. Fellowship in Rheumatic Disease — Following conferences held between Dr.
Getting, Dr. Curtis, Dr. Massell, Dr. Rafuse, and Dr. McKay in May, 1947, two
fellowships in rheumatic disease were established. The fellowships are given through
the Harvard Medical School, the Children's Medical Center, and The House of the
Good Samaritan, the Pediatric Department of Harvard Medical School, and the
State Department of Public Health. Only candidates who plan to go into the public
health or teaching fields are eligible. Two fellowships were granted in each of the
years 1948, and 1949.
7. Scholarships in Pediatric Nursing — Plans with the Boston University School
of Nursing and the Children's Hospital for this scholarship, to begin late in the
fiscal year 1948-1949, came to fruition with the selection of a graduate nurse who
completed special training in June, 1949.
38 P.D. 34
8. Dental Health Projects — Two new dental health projects were approved by
the Children's Bureau late in the fiscal year 1948-1949. One is a cooperative pro-
ject with Tufts Dental College in the training of dentists in oral pediatrics. The
second is a cooperative project with Forsyth Dental Infirmary for the training of
ancillary personnel in certain phases of dentistry for children. This is the first
project of its kind to be developed in the United States and is, therefore, experi-
mental in nature. The training period will start in September, 1949, and will be of
two years duration. A three-year evaluation period is planned to follow the train-
ing period.
9. A Study of Emotional Aspects of Pediatric Hospital Care and the Value of
Parental Participation — This project, involving primarily the nursing aspects, was
set up for an experimental six-months' period by the Children's Hospital and the
Boston University School of Nursing, and this Division. It was approved by the
Children's Bureau as of January 1, 1949, and was carried through the remainder of
the fiscal year.
10. Survey of Child Health Services — Another project was the Survey of Child
Health Services in Massachusetts, sponsored by the American Academy of Pedia-
trics, and comprising a part of a nation-wide investigation of the status of child care
in the United States. This project was begun in May, 1946 and was completed by
the publication of its report in June, 1949, entitled Health Services for Massachusetts
Children. The Division of Maternal and Child Health participated in planning, in
submitting material on child health services, and in furnishing funds to cover rental
of office space, telephone service and other services and supplies.
P.D. 34 39
DIVISION OF COMMUNICABLE DISEASES
CONSOLIDATED REPORT 1942-1949
Roy F. Feemster, M.D., Dr. P.H., Director
General Statement
The large fluctuations in the total number of cases of communicable diseases re-
ported to the Department are usually due to the prevalence or lack of prevalence
of some of the more highly contagious diseases of childhood . The period was ushered
in by an increase in prevalence of several of these diseases reaching a high for the
period in 1943 (137, 9S6 cases) due primarily to an epidemic of German measles ac-
companied by some increase in measles and scarlet fever. During the next four
years, the general tendency was downward due to a fall in these highly infectious
diseases broken only by an epidemic of measles in 1946. After a low of 76,247 cases
in 1947, there was an increase to 105,216 in 1948 due largely to increases in measles
and mumps and, to a less extent, scarlet fever. The following year there was an-
other drop due primarily to a recession in the diseases which had been high the year
before.
The period was also characterized by a marked increase in meningococcal menin-
gitis early in the period, a rise in malaria in the middle of the period, and a rise in
diphtheria at the end of the period. The explanation for these will be found later
in this report. Typhoid fever was held at a very low level and smallpox did not in-
vade the State even in these troublous times.
Prevalence of Certain Diseases
Chicken pox. This disease is either being better reported by physicians or is be-
coming more highly prevalent. The total number of cases did not drop below
10,000 during the period and twice exceeded all previous records, first in 1944 with
19,489 cases and second in 1949 with 22,132 cases.
Diphtheria. After reaching 123 cases, the lowest figure on record, in 1941, diph-
theria tended to increase and remained high to the end of the period. While various
parts of the State contributed irregularly to the high totals, particularly the larger
cities of the Merrimack Valley and for a time New Bedford and other more popu-
lous areas, the bulk of the cases for the period occurred in the Boston Metropolitan
area. During the last two years, Boston has had a disproportionate share of the num-
ber of cases with Somerville, Cambridge, Chelsea, Revere and other nearby com-
munities contiibuting to the total.
Renewed efforts in broadening the immunization program appear to have been
more effective in reducing the prevalence in the remainder of the State than in the
Boston Metropolitan area. One reason for the continued high figures has been a
shift in the proportion of cases to adolescents and adults, who are not being affected
by current immunization programs.
Dysentery, Bacillary. The annual fluctuations in the number of cases of bacillary
dysentery are due primarily to outbreaks in State institutions. Usually 50 to 100
cases are discovered in the general population, the remainder coming from institu-
tions. The high figures for the early years of the period were followed by a decline
to a low level of only 55 cases in 1949.
Encephalitis. Infectious. Although a varied number of cases are reported to the
Department each year, nothing has occurred during the period to indicate that any
of the epidemic viruses have been active in the State. A proportion of the cases re-
ported are apparently post infection encephalitis. Some of them may be primary
infections due to Coxsackie viruses, which also cause confusion in the diagnosis of
other conditions such as poliomyelitis, meningitis of undertermined origin, etc.
German Measles. This disease which tends to be quiescent for long periods of
time reached epidemic proportions in 1943 for the first time since 1935. Two minor
waves were observed in 1946 and in 1949.
A study carried out among adult females who had the disease in 1943 uncovered
congenital defects in several infants whose mothers had the disease early in preg-
nancy. The study was begun more than a year after the outbreak occurred.
40 P.D. 34
Hepatitis, Infectious. This disease was not made reportable until 1949. No large
outbreaks apparently occurred during this year.
Gastroenteritis. Most of the outbreaks of diarrhea which occur are usually in-
cluded under this classification or under that of food poisoning. Many outbreaks
are due to staphylococcus enterotoxin but many are also due to unrecognized etio-
logic agents. A list of the outbreaks which have been brought to the attention of
the Department will be found in the tabulation of outbreaks later in this report.
Malaria. The number of cases of malaria reported annually rose from the level
of approximately 10 a year to a high of 1031 in 1945. Very few of these cases were
primary infections. Most of them were relapses in military personnel or in civilians
returning from service in areas where malaria is prevalent. So far as we could de-
termine, none of the cases were contracted in Massachusetts. With the cessation
of the war, the prevalence again declined to approximately 10 cases a year.
Measles. This disease reached high levels in three of the eight years of the period
with either one or two lower years intervening. Deaths attributable to the disease
remained under 20 per year except in 1943 when there were 21 deaths.
During the period, immune globulin from the Red Cross and other blood pro-
grams has largely replaced the use of placental extract.
Meningitis, Meningococcal. This disease rose suddenly at the onset of the war
not only in Massachusetts but throughout the country. It reached its highest level
with 736 cases reported in 1943, thereafter subsiding gradually. Since an attempt
was made to investigate every case reported, cases were not classified finally as
meningococcal infections unless there was good laboratory evidence. Questionable
cases were classified as meningitis of undertermined origin. In spite of this close
scrutiny of cases, the 1943 prevalence is the highest that has ever been repoited in
the State.
During the period, sulfonamides have replaced all other methods of treatment of
meningococcal infections except that some of the antibiotics are now beuig tried.
This has tremendously lowered the fatality rate. Among robust individuals in the
armed services, the rate fell as low as 1%. However, because many cases are not
recognized early, the fatality rate in the general population ranges up to 30%.
Meningitis, Other Forms. The year 1942 was the first full year in which all forms
of meningitis were reportable. In addition to meningitis due to the Pfeiffer bacillus,
records were kept in regard to infections due to the pneumococcus, streptococcus,
staphylococcus, and other causative agents. Since meningococcal meningitis has
returned to normal levels, the number of cases due to the Pfeiffer bacillus and pneu-
mococcus sometimes almost equals the number due to the meningococcus.
Mumps. Formerly, this disease showed a higher prevalence every four or five
years. During this period, however, the waves have come every three years. In
1948, the total number of cases reached 17,037, the highest ever reported. During
the latter part of the period, Enders' work on serological and skin tests to determine
supposed immunity to the disease has made it possible to recognize infections with-
out the usual swelling of the salivary glands.
Ophthalmia Neonatorum. Formerly, reported cases of suppurative conjuncti-
vitis were tabulated with ophthalmia neonatorum. The experience gathered over
the years indicated that no useful purpose was being attained by the reporting of
this condition, and it was removed from the list of reportable diseases in 1948. This
leaves only infections of the eyes of infants under two weeks of age in the reportable
list. Already the number of eye infections reported had dropped from nearly 1,000
per year in 1940 to under 200.
Poliomyelitis. Since this disease became reportable, a rise to a high level had
been observed every four to seven years. During this period, however, the time be-
tween years of high prevalence was not only prolonged to nine years but the peak
in 1945 was not as high as expected. This was followed, however, four years later
by a rise to the second highest level ever reported.
In interpreting this trend, however, it must be emphasized that there has been a
marked increase in the proportion of non-paralytic cases reported, reaching in 1949
almost 50%.
P.D. 34 41
Each year the organization of the agencies caring for persons with the disease is
being better coordinated, the public is being educated in regard to which measures
are reasonable so that the outbreak of 1949 was handled with much less panic
among the public than previous outbreaks.
An explanation for some of the confusing conditions which have been called polio-
myelitis may have been discovered in the isolation of the viruses of the Coxsackie
group in one-day old mice. Epidemiological observations indicate that this group
of viruses may have been unusually prevalent duiing the 1948 season.
Rabies. No human cases or deaths from rabies have occurred during the eight-
year period. This is due to the disappearance of animal rabies from the State. Only
20 rabid animals were discovered in 1942, five in 1943, and since that date the only
animals found with the disease in the State have been those which were infected
beyond our borders, except for one dog in Longmeadow in 1949.
There is increasing evidence that the disease was eliminated by the program of
inoculating dogs with rabies vaccine.
Rocky Mountain Spotted Fever. Eight cases of this disease have occurred during
the eight-year period, all of them in the area infested with the wood tick. Three of
the cases have occurred in Chatham, two in Dennis, one in Barnstable, and two in
Oak Bluffs. This marked localization indicates that the infection of the wood tick
in Massachusetts is limited to these areas.
Salmonellosis. The number of cases of infection with Salmonella organisms re-
ported does not include all of the cases which have occurred. Only those cases
which have been bacteriologically proved are included in the figures. Numerous
cases which epidemiologically appear to be caused by the same agent were not of-
ficially reported. This is particularly true of some of the cases which occurred in
food-borne outbreaks.
Many of the cases continue to be single sporadic cases or small family outbreaks.
An accompanying table gives the distribution of the cases by the species of Sal-
monella. S. typhimurium continues to be the most frequent organism found.
Scarlet Fever. The beginning of the eight-year period was characterized by a high
prevalence of scarlet fever, the peak being reached in 1943 with 15,400 cases. The
disease declined, however, to 4,424 cases in 1947 and has risen only slightly above
that level in the last two years. Deaths continue to decline due largely to the use
of the sulfa drugs and antibiotics in the treatment of complications.
Smallpox. No cases of the disease occurred in the State during the period in
spite of the rapid movement of civilians and military personnel. No cases of small-
pox have occurred in the State since 1932.
Tularemia. Eighteen cases of this disease have been reported during the period,
all of them from the area of high wood tick prevalence except two, one of which was
probably not tularemia. This concentration in the wood tick area indicates that the
tick probably plays an important role in the spread of the disease. The Department
continues to oppose the importation of cottontail rabbits from western states.
Typhoid Fever. Typhoid fever dropped to 50 cases for the first time in 1942, the
first year of the period, and fell immediately below this level thereafter. In 1945,
only 18 cases were discovered.
These cases are certainly due to contact with permanent typhoid carriers who
have had the disease sometime in the past. Approximately one-fourth of the cases
are explained by discovery of the carrier. The comparative record for the discovery
of the carriers is shown in the following table :
Carriers
Per Cent_
Cases
Carriers
Rate
Found on
Rate
Epidem-
of Units in
of
Added to
per 100
Investigation
per 100
iological
Which Carrier
Year
Typhoid
List
Cases
of Cases
Cases
Units
Was Found
1940
86
19
22.1
12
13.9
59
20.3
1941
68
22
32.4
18
26.4
63
28.6
1942
50
20
40.0
14
28.0
42
33.3
1943
34
17
50.0
8
23.5
33
24.2
1944
32
9
28.1
7
21.9
31
22.6
1945
18
7
38.9
4
22.2
16
25.0
1946
33
11
33.3
6
18.2
31
19.4
1947
23
9
39.1
4
17.4
20
20.0
1948
33
12
36.4
9
27.3
28
32.1
1949
30
6
20.0
-
0.
25
0.
42 P.D. 34
For the years 1942 through 1949, 91 carriers were added to the carrier list: 53
were found on investigation of typhoid cases; 13 were convalescents who had con-
tinued to show positive stools for more than a year; 6 moved into Massachusetts
from other states. There were 19 discovered accidentally by laboratory examina-
tions.
The manner of discovery of the last 19 carriers was: 5 in routine examinations of
patients hospitalized for other conditions; 5 in routine examinations of patients in
mental hospitals ; 2 in routine examinations of contacts of a newly discovered car-
rier; 3 in routine examinations of hospital employees; 2 at the time of gall-bladder
operations ; 1 at the time of a community outbreak of bacillary dysentery ; 1 at post
mortem — (examination because son-in-law suspected case was a typhoid carrier).
During the period, 95 carriers were removed from the list: 60 carriers died; 16
moved away; 2 disappeared; 12 were removed following 12 monthly negative stool
examinations and a negative bile; 5 were removed by special arrangements varying
slightly from the usual policy.
There were 169 carriers on the list on January 1, 1942 and 165 on the list January
1, 1950.
It has been calculated that there are less than 700 carriers in the State at the
present time. It is expected that the number will drop to 200 by 1960 since most of
the carriers are over 60 years of age and only one replacement per year is being
furnished by current cases.
Undulant Fever. The number of cases of this disease reported annually has
been stabilized at 40 to 50. Most of these continue to occur in rural areas in the
State. A few result from the handling of carcasses of dead animals in meat packing
plants. The high percentage of milk which is pasteurized in the State keeps down
the number of cases particularly in urban areas where regulations requiring pasteuri-
zation are in force.
Whooping Cough. The period was ushered in with a high prevalence of this
disease but there was a decline during the last of the period, dropping almost to
4,000 cases in both 1944 and 1 949. It is suspected that the increasing use of immuni-
zation against pertussis is having some influence upon the prevalence of the disease.
Reorganization
At the beginning of the period, the District Health Officers were a part of the Di-
vision and their activities were supervised by the Director. Early in the period,
steps were taken to transfer the District Health Officers to a newly created Division
of Local Health Administration, along with the transfer of other field personnel
from other divisions. This resulted in a broadening of the field of activities of the
District Health Officers and many new programs were placed upon their shoulders.
Even with a competent subsidiary staff, these programs could not be shouldered
without neglecting some of the activities in connection with communicable diseases
which they formerly carried, when most of their time was available for this purpose.
During the period, the Wassermann Laboratory was also transferred to the Di-
vision from the Division of Biologic Laboratories. This Laboratory and the Bac-
teriological Laboratory were moved from their former locations at the Harvard
Medical School and in the State House to a building at Forest Hills owned by
Harvard University. This move gave the laboratories more satisfactory quarters
and allowed them to take on new activities, such as the Rh typing of blood speci-
mens from pregnant women financed at first by private funds, later bjr funds au-
thorized by the Legislature.
With the passage of the Hospital Licensing bill early in the period, the licensing of
dispensaries was transferred to the unit handling the licensing. It is no longer neces-
sary to license dispensaries in authorized hospitals so that the number of dispen-
saries was greatly decreased.
Epidemiology
During most of the period, the shortage of physicians in the epidemiological posi-
tions aggravated the situation caused by diverting the activities of the District
Health Officers to a wider field so that it has not been possible to give as much as-
sistance to local boards of health as formerly in making epidemiological investiga-
tions. Preparation of scientific papers has also been difficult because of this shortage
P.D. 34 43
of personnel. It was not until July 1, 1949 that all of the positions were filled on a
full-time basis. Since that time, much of the unfinished work which had been ac-
cumulated has been taken care of.
Special Projects and Studies
Scarlet Fever Immunization. The scarlet fever immunization program carried
on since 1932 was halted early in the period, due first to lack of personnel in the
Biologic Laboratories to continue the search for a more efficient immunizing agent,
and later by a shortage of personnel resulting from the demands of war activities.
Pneumonia Studies. The studies of the value of serums for pneumococcal pnue-
monia which had been rendered less important by the introduction of the sulfona-
mides were discontinued when the antibiotics in combination with the sulfonamides
replaced serum treatment.
German Measles Study. Beginning in 1944, a study of congenital defects which
resulted from pregnancies in women who had german measles in 1943 was under-
taken. The study was completed and a paper prepared in the fall of 1946.
Diarrhea of the Newborn. The Division worked in cooperation with the Division
of Hospital Licensing in 1946 and 1947 in investigating outbreaks of epidemics of
infectious diarrhea of the newborn and in setting up the procedures in maternity
wards to prevent the occurrence of such outbreaks. Excellent results in informing
hospitals in regard to the problem were obtained in a series of four one-day con-
ferences held in different portions of the State culminating in a large meeting in
Boston. The Division took the responsibility of seeing that the manuscripts of these
conferences were duplicated for distribution to hospitals within the State as well as
out-of-state health departments. It is more than a coincidence that no maternity
wards had to be closed during the two and one-half years following these confer-
ences and the continued check on the procedures carried out in the hospitals.
Poliomyelitis. In 1946, a study of poliomyelitis authorized by Chapter 93 in the
Resolves of that year was carried out. It consisted largely of a thorough epidemio-
logical study of an outbreak in a summer camp and an analysis of the records of the
Division regarding poliomyelitis. The work was made the subject of a report to the
Legislature and two papers were published in scientific journals.
In 1947, $5,000.00 was placed in the budget of the Division to continue laboratory
studies on poliomyelitis, and the succeeding year a position of Assistant Bacteriolo-
gist was authorized with some expense funds. These studies have been carried out
during the remainder of the period mainly at the Virus Laboratory at Harvard
Medical School on specimens collected in the field by our own epidemiologists.
Diphtheria Studies. In 1947, a series of studies on the practicability of immuniz-
ing high school students without preliminary Schick tests was undertaken. It has
been demonstrated that the plan is practicable with reduced doses which do not
produce undue reactions. It is expected that within another year the recommenda-
tions for the immunization of high school students can be made.
Milk Regulations. During the years immediately prior to the war, numerous
communities had been encouraged to pass regulations requiring the pasteurization
of milk. By 1942, 85 communities had adopted regulations that all milk sold be
pasteurized or certified. In this year inability to obtain pasteurization equipment
due to war priorities stopped the activities in this line and they were not renewed
until 1946. During the remainder of the period, 26 other communities took action
bringing the total to 111 by the end of 1949. Preparations are being made to urge
all communities of over 5,000 and all suburban communities of over 1,000 popula-
tion to pass similar regulations.
Wood Tick Study. In 1948, the Legislature authorized a study to discover
methods of controlling wood ticks in the State. By the time the funds became avail-
able, observations could be made only at the end of the season. A renewal of the
study was authorized in 1949 to be carried out in 1950.
Communicable Disease Information. As a part of the program of keeping boards
of health and health workers in general informed in regard to communicable dis-
ease problems, a weekly publication was begun in 1944 carrying not only a statistical
summary of the communicable diseases for the previous week but also brief dis-
44 P.D. 34
cussions of current problems. This publication has become quite popular and other
state health departments have asked for permission to reprint articles appearing
in it.
Cooperation of Military Authorities. During the war, the Division spent much
of its time cooperating with military authorities in dealing with communicable
diseases of various kinds both inside of military reservations and in the areas im-
mediately surrounding them.
Revision of Regulations
The isolation and quarantine requirements for communicable diseases were re-
vised both in 1944 and in 1948. In each instance proposed revisions were submitted
to an Advisory Committee of well-informed physicians who suggested a number of
changes in the proposals. Although local boards of health may require more string-
ent regulations, the majority of them have followed our regulations quite closely.
Bacteriological Laboratory
During the early part of the period, this Laboratory continued to operate in
cramped quarters in the State House. In 1946, when the Chief of Laboratory who
had been in charge since 1914 retired, this Laboratory was placed under the super-
vision of a physician with the title of Assistant Director. Early in 1947, the Labora-
tory was moved to quarters formerly occupied by the First Service Command
Laboratory of the Army, and thereafter it was possible to take on new programs.
The work of this Laboratory increased considerably during the period. The
number of specimens examined annually increased from just under 40,000 in the
first half of the period to over 90,000 in 1949. The bulk of this increase was due to
blood grouping and Rh typing on blood bank bloods begun in 1946 and of the same
tests on prenatal specimens begun in 1947. The cost of carrying out the tests on
blood bank specimens was assumed by the American Red Cross in 1949 and the
burden is to be removed from the Laboratory in 1950. There was also a 50% in-
crease in the number of specimens for tuberculosis within the last four years, and a
slightly less increase in the number of specimens for diphtheria. The increase in the
tuberculosis specimens was due to the accelerated program for discovering cases of
the disease, and the increase in diphtheria specimens was due to an increased preva-
lence following the war.
The number of specimens does not give a complete picture of the increase of
work, however, since the number of examinations increased from approximately
65,000 in the early years of the period to 185,000 tests in 1949. This increased bur-
den has been assumed with only minor increases in personnel. We must face the
prospect of either eliminating some of these very necessary services or of obtaining
additional positions so that the burden can be carried. The above figures also do
not include the work involved in preparing and sending out check specimens to the
laboratories in the Approval Program.
New Tests Offered. As continued research makes new tests available for the diag-
nosis of communicable diseases, physicians and boards of health expect the De-
partment to make these tests available through our Laboratory. It has been im-
possible to offer all of the tests which would contribute to the health of the people
of the State but certain ones appear to be unusually important.
The heterophile antibody tests for the diagnosis of infectious mononucleosis was
offered beginning in 1944 because this disease is so frequently confused with undu-
lant fever.
Examinations of shipped specimens from patients with gonorrhea by culturing
methods was begun on an experimental basis in 1944, but was discontinued in 1946
because it was felt that the service was unreliable on shipped specimens.
In 1946, after repeated requests that the Department perform Rh testing and
blood grouping tests on pregnant women, private funds were found to begin this
work. In 1947 one position was put into the State budget to assist in carrying this
burden, and in 1949 a second position was added. One of the reasons why the
Laboratory is heavily overburdened is that these two positions do not quite take
care of this load.
The diagnosis of virus diseases assumes greater importance every year. In 1946,
the Laboratory began paying for virus examinations carried out in the Virus Lab-
P.D. 34 45
oratory at the Harvard Medical School from a few specimens sent in by physicians.
In 1948, routine testing for influenza and mumps was transferred to the Bacterio-
logical Laboratory but virus tests for other diseases continued to be carried out at
the Harvard Medical School and the cost assumed by the Laboratory.
Salmonella Typing. Throughout the period, typing of all Salmonella organisms
isolated from human illness has been available through the courtesy of the Typing
Center of the Beth Israel Hospital in New York City. This service has been per-
formed by that hospital without any cost to the State. This information has been
very valuable in planning the control of this disease in Massachusetts.
Laboratory Approval. The program for approving laboratories meeting proper
standards was well under way by the beginning of this period. Because many
laboratories were having difficulty in obtaining approval for all of the tests for which
they applied, no list of approved laboratories was issued until 1946. Since that time
a new list of current laboratories has been issued annually. In 1946, the law was
changed to add blood grouping and Rh typing to the tests for which approval could
be granted, as well as certain sanitary procedures such as the examination of eating
and drinking utensils, milk samples, and water and sewage samples. The Divisions
of Food and Drugs and Sanitary Engineering have cooperated in granting approvals
on the last three tests.
Wassermann Laboratory
This Laboratory has carried a heavy burden of routine tests throughout the
period. The number of specimens was highest in 1942 when the Laboratory was
carrying out tests for the draft boards. The number of specimens declined from the
peak of over 760,000 in 1942 to about 530,000 in the last three years. This is ap-
parently the level at which requests for serological tests for syphilis will be requested
on a continuing basis.
This Laboratory was moved from the Harvard Medical School to the Bussey
Building at Forest Hills in 1947 where it has more adequate quarters. The heavy
burden of routine tests makes research work difficult but the Laboratory has con-
tinued to carry on investigations aimed toward improving its technique. The
Laboratory has been evaluated annually by the Public Health Service and rates
high among state laboratories in efficiency and accuracy.
Publications
During this period, the Division was responsible for the publication of twenty
articles on Communicable Diseases.
46
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Table II — Diphtheria
Case Rate
Death Rate
Fatality Rate
Year Cases
per 100,000
Deaths
per 100,000
(Per Cent)
1940 ... 144
3.3
8
.2
5.6
1941
123
2.8
12
.3
9.8
1942
154
3.6
7
.2
4.5
1943
140
3.2
11
.3
7.8
1944
229
5.3
10
.2
4.4
1945
. . 194
4.3
10
.2
5.2
1946
439
9.6
36
.8
8.2
1947
433
9.4
12
.3
2.8
1948
290
6.3
27
.6
9.3
1949
333
7.1
44
.9
13.2
Table III — Measles
1940 . . . 21,698
502.6
11
.3
.05
1941
22,338
516.5
4
.1
.02
1942
25,590
590.7
16
.4
.06
1943
35,098
809.0
21
.5
.05
1944
19,837
456.5
20
.5
.10
1945
7,486
166.0
10
.2
.13
1946
38,400
844.1
14
.3
.03
1947
12,065
263.1
12
.3
.09
1948
37,081
802.0
18
.4
.04
1949
26,394
566.3
12
.3
.05
Table IV —
Meningitis,
Meningococcal
1940 ... 47
1.1
15
.3
31.9
1941
98
2.3
25
.6
25.5
1942
191
4.4
34
.8
17.8
1943
736
16.9
119
2.7
16.2
1944
456
10.5
81
1.9
17.8
1945
161
3.6
20
.4
12.4
1946
116
2.5
21
.5
21.6
1947
47
1.0
15
.3
31.9
1948
66
1.4
20
.4
30.3
1949
50
1.1
9
.2
18.0
Table V
— Poliomyelitis
1940 ... 45
1.0
2
.04
4.4
1941
182
4.2
6
.1
3.3
1942
36
.8
3
.06
8.3
1943
252
5.8
18
.4
7.1
1944
436
10.0
17
.4
3.9
1945
527
11.7
22
.5
4.2
1946
378
8.3
19
.4
5.0
1947
345
7.5
12
.3
3.5
1948
175
3.8
5
.1
2.8
1949
1,782
38.2
51
1.1
2.9
Table VI — Scarlet Fever
1940 . . . 5,277
122.2
19
.4
.4
1941
7,141
165.1
13
.3
.2
1942
. 11,526
266.1
10
.2
.1
1943
. 15,400
354.9
19
.4
.1
1944
. 11,956
275.2
14
.3
.1
P.D. 34
75
Table VI —
Scarlet Fever — Continued
Case Rate
Death Rate
Fatality Rate
Cases
per 100,000
Deaths
per 100,000
(Per Cent)
. 10,373
229.9
7
.2
.1
6,079
133.6
2
.04
.03
4,424
96.5
4
.1
.1
6,033
130.5
1
.02
.01
6,052
129.8
1
.02
.01
Table VII
— Tuberculosis ,Pulmonary
. 2,816
65.2
1,484
34.4
52.7
2,987
69.1
1,521
35.2
50.9
3,075
71.0
1,501
34.7
48.8
2,739
63.1
1,697
39.1
61.9
2,679
61.6
1,612
37.1
60.2
2,675
59.3
1,557
34.5
58.2
2,858
62.8
1,592
35.0
55.7
2,608
56.9
1,495
32.6
57.3
2,656
57.4
1,279
27.7
48.2
2,451
52.6
1,064
22.8
43.4
Table VIII
— Tuberculosis, Other Forms
294
6.8
114
2.6
38.8
295
6.8
112
2.6
38.0
199
4.6
118
2.7
59.3
221
5.1
109
2.5
49.3
193
4.4
84
1.9
43.5
164
3.6
79
1.8
48.2
179
3.9
82
1.8
45.8
187
4.1
89
1.9
47.6
166
3.6
82
1.8
49.4
139
3.0
59
1.3
42.8
Table IX — Typhoid Fever
. 86
2.0
8
.18
9.3
68
1.6
3
.07
4.4
50
1.2
1
.02
2.0
34
.8
5
.11
14.7
32
.7
1
.02
3.1
18
.4
2
.04
11.1
33
.7
2
.04
6.1
23
.5
2
.04
8.6
33
.7
2
.04
6.1
30
.6
3
.06
10.0
Table X — Whoopi
ng Cough
. 7,959
184.4
22
.5
.3
9,790
226.4
40
.9
.4
10,932
252.4
27
.6
.2
5,990
138.1
38
.9
.6
4,051
93.2
15
.3
.4
7,445
165.0
22
.5
.3
6,514
143.2
16
.4
.2
7,121
155.3
15
.3
.2
2,778
60.1
11
.2
.4
4,638
99.5
7
.2
.2
76
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Actinomycosis
Anthrax ....
Chicken Pox .
Diphtheria
Dog Bite . _ .
Dysentery, Amebic .
Dysentery, Bacillary
Encephalitis, Infectious
German Measles
Gonorrhea
Hepatitis, Infectious
Lymphocytic Choriomeningitis
Malaria ....
Measles ....
Meningitis, Meningococcal
Meningitis, Pfeiffer Bacillus
Meningitis, Pneumococcal
Meningitis, Other Forms* .
Meningitis, Undetermined
Mumps ....
Ophthalmia, Neonatorum**
Poliomyelitis .
Rocky Mountain Spotted Fever
Salmonellosis .
Scarlet Fever .
Septic Sore Throat .
Syphilis ....
Tetanus ....
Trachoma
Trichinosis
Tuberculosis, Pulmonary .
Tuberculosis, Other Forms
Tularemia
Typhoid Fever .
Typhus Fever .
Undulant Fever
Whooping Cough
3 a
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P.D. 34
Bacteriological, Laboratory
Table XIV — Number and Kind of Specimens
1940 1941 1942
Total
1943
1944
Blood Typing Tests
Pre-natal .....
—
-
—
_
_
Blood Typing Tests
Bank Bloods ....
-
-
-
_
_
Diphtheria .....
6,614
5,463
5,521
4,922
6,578
Gonorrhea .....
13,070
12,590
10,753
8,964
10,386
Malaria .....
50
48
42
67
119
Miscellaneous
1,368
1,699
1,188
1,125
1,530
Pneumonia .....
3,608
3,247
2,347
2,072
1,337
Tuberculosis .....
7,565
6,937
6,319
5,807
5,903
Typhoid Fever
Widal
3,037
2,730
2,674
1,804
1,642
Culture .....
12,814
11,019
9,455
9,304
7,992
Undulant Fever ....
1,966
2,686
1,958
1,988
1,848
Viral Serological Tests
Influenzal and B .
-
-
-
_
_
Mumps Complement Fixation Tests
.
-
-
-
-
Total
50,092
46,379
40,357
36,053
37,335
1945
1946
1947
1948
1949
Agglutinations ....
3,838
8,439
9,722
9,594
5,825
Blood Typing Tests
Pre-natal .....
-
—
7,785
17,825
20,197
Blood Typing Tests
Bank Bloods ....
-
1,376
24,917
28,549
31,470
Diphtheria .....
5,436
8,046
9,335
8,146
8,891
Enteric Pathogens
8,412
9,003
9,345
7,523
7,294
Gonorrhea .....
11,015
12,196
9,190
7,280
6,071
Malaria .....
196
725
449
254
161
Miscellaneous ....
1,359
2,821
1,207
1,097
893
Pneumonia .....
980
991
680
295
152
Tuberculosis ......
5,715
8,153
8,153
8,825
9,416
Viral Serological Tests
Cold Agglutinins . . . .
-
-
-
-
18
Influenza A & B & FM . . .
-
-
-
18
77
Lymphocytic Choriomeningitis 1 .
-
-
-
-
12
Lymphogranuloma and Psittacosis
-
—
-
-
8
Mumps Complement — Fixation Tests
•
-
-
180
185
36,951
49,415
80,783
89,586
90,670
Table XV — Specimens and Examinations for 19^-2
Positive
Negative
Total
Number of
Specimens
Total
Number of
Examinations
Diphtheria:
Diagnosis
Release
Gonorrhea
Malaria ....
Meningitis, Spinal fluid for
Pneumonia:
Pneumococci found and typed
Pneumococci not found .
Tuberculosis:
Sputum .....
Urine, spinal fluid, etc. (Culture and
animal inoculations)
Typhoid fever:
Widal
Culture (brood, feces, urine, etc.)
Undulant fever .....
Miscellaneous:
Diphtheria virulence tests
Dysentery agglutination tests .
Dysentery, amoebic ....
Vincent's angina (sent by dentists)
Weil-Felix reaction for Rickettsial
diseases .....
Unclassified .....
Total
82
87
946
0
15
835
613
48
64
312
73
22
0
0
501
14
4,875
477
9,907
42
39
1,579
5,016
642
2,610 *
9,143
1,885
9
101
17
193
68
4,957
564
10,853
42
54
768
1,579
5,629
690
2,674
9,455
1,958
31
101
17
694
82
209
ll,526i
564
21,706 2
42
132 «
835
1,579
5,629
690
5,736 s
16,606 «
5,874 '
31
101
17
694
82
7448
40,357
72,588
1 Includes examinations for hemolytic streptococci and the organisms of Vincent's angina.
2 Includes examinations for average number of leucocytes per field.
s Includes examinations for influenza bacilli and other organisms.
* Includes 173 partial reactions.
* Includes 388 agglutination tests for paratyphoid A and 2,674 tests for paratyphoid B.
6 Includes examinations for paratyphoid and dysentery bacilli.
7 Includes examinations for agglutinins for typhoid a.nd paratyphoid B.
8 Includes miscellaneous examinations for identification of organisms.
P.D. 34
101
Bacteriological Laboratory
Table XV — Specimens and Examinations in 1948
Total
Total
Number of
Number of
Positive
Negative
Specimens
Examinations
Diphtheria:
Diagnosis: ....
114
4,249
4,363
10,092 1
Release ....
252
307
559
559
Gonorrhea ....
1,130
7,834
8,964
17,928 2
Malaria . . . .
10
57
67
67
Meningococci, Spinal fluid for
47
55
102
212 3
Pneumonia:
Pneumococci found and typed .
871
-
795
871
Pneumococci not found .
-
1,277
1,277
1,364
Tuberculosis :
Sputum ....
560
4,465
5,025
5,025
Urine, spinal fluid, etc. (Culture anc
animal inoculations)
111
671
782
782
Typhoid fever:
Widal
50
1,754*
1,804
3,835 s
Culture (blood, feces, urine, etc.)
205
9,099
9,304
17,155 «
Undulant fever ....
121
1,867
1,988
7,112?
Miscellaneous:
Diphtheria virulence tests
39
19
58
58
Dysentery agglutination tests .
0
103
103
103
Dysentery, Amoebic
0
53
53
53
Vincent's angina (sent by dentists)
293
93
386
386
Weil-Felix reaction for Rickettsia
I
diseases . . . . .
8
68
76
76
Unclassified ....
-
-
347
1,335 8
Total
36,053
67,013
1 Includes examinations for hemolytic streptococci and the organisms of Vincent's angina.
2 Includes examinations for average number of leucocytes per field.
8 Includes examinations for influenza bacilli and other organisms.
* Includes 142 partial reactions.
6 Includes 227 agglutination tests for paratyphoid A and 1804 tests for paratyphoid B.
6 Includes examinations for paratyphoid and dysentery bacilli.
' Includes examinations for agglutinins for typhoid and paratyphoid B and heterophile antibody.
8 Includes miscellaneous examinations for identification of organisms.
102
P.D. 34
Bacteriological Laboratory
Table XV — Specimens and Examinations in 1944
Total
Total
Number of
Number of
Positive
Negative
Specimens
Examinations
Diphtheria:
Diagnosis .....
122
5,640
5,762
ll,402i
Release .....
346
470
816
816
Gonorrhea
Smear ......
1,372
7,889
9,261
18,522 2
Culture . . . . .
37
1,088
1,125
2,587
Malaria . . .
21
98
119
119
Meningococci, Spinal fluid for .
24
62
86
210 3
Pneumonia:
Pneumococci found and typed .
647
-
593
647
Pneumococci not found .
-
744
744
828
Tuberculosis:
Sputum .....
547
4,503
5,050
5,050
Urine, Spinal fluid, etc. (Culture and
animal inoculations)
52
801
853
853
Typhoid fever:
Widal . ...
31
1,611
1,642*
5,054 s
Culture (blood, feces, urine, etc.)
146
7,840
7,992
11,193 =
Undulant fever: ....
95
1,753
1,848
5,544"
Miscellaneous:
Diphtheria virulence tests
44
2
46
46
Dysentery agglutination tests .
0
100
100
100
Dysentery, Amoebic
0
55
55
55
Vincent's angina (sent by dentists) _ .
359
122
481
481
Weil-Felix reaction for Rickettsial
diseases .....
11
53
64
64
Unclassified .....
-
-
698
2,180 8
Total
37,335
65,751
1 Includes examinations for hemolytic streptococci and the organisms of Vincent's angina.
2 Includes examinations for average number of leucocytes per field.
3 Includes examinations for influenza bacilli and other organisms.
4 Includes 112 partial reactions.
5 Includes 128 agglutination tests for paratyphoid A and 3284 tests for Salmonella B and C groups.
6 Includes examinations for Salmonella and dysentery bacilli.
' Includes examinations for agglutinins for typhoid and Salmonella bacilli.
8 Includes miscellaneous examinations for identification of organisms.
P.D. 34
103
Bacteriological Laboratory
Table XV — Specimens and Examinations in 19J+5
Positive
Negative
Total
Number of
Specimens
Total
Number of
Examinations
Diphtheria:
Diagnosis .....
Release .....
114
281
4,649
392
4,763
673
10,7841
673
Gonorrhea
Smear ......
Culture .....
1,148
65
8,243
1,559
9,391
1,624
18,782 2
3,149
Malaria ......
36
160
196
196
Meningococci, Spinal fluid for
11
18
29
473
Pneumonia:
Pneumococci found and typed .
Pneumococci not found .
403
603
377
603
403
725
Tuberculosis:
Sputum .....
Urine, Spinal fluid, etc. (Culture and
animal inoculations)
586
60
4,184
885
4,770
945
4,770
945
Typhoid fever:
Widal ......
Culture (blood, feces, uring, etc.)
Undulant fever .....
19
104
118
1,578*
8,308
2,123
1,597
8,412
2,241
4,208 5
11,702 s
8,964 ^
Miscellaneous:
Diphtheria virulence tests
Dysentery agglutination tests .
Dysentery, Amoebic
Vincent's Angina (sent by dentists)
Weil-Felix reaction for Rickettsial
diseases .....
64
0
1
582
3
2
73
64
269
58
66
73
65
851
61
66
73
65
851
61
Unclassified . .
-
-
214
565»
Total . . . . - .
36,951
67,029
1 Includes examinations for hemolytic streptococci and the organisms of Vincent's angina.
2 Includes examinations for average number of leucocytes per field.
3 Includes examinations for influenza bacilli and other organisms.
4 Includes 94 partial reactions.
5 Includes 156 agglutination tests for paratyphoid A, 3, 194 agglutination tests for Salmonella B and
C groups and 206 tests for heterophile antibody.
6 Includes examinations for Salmonella and dysentery bacilli.
7 Includes examinations for agglutinins for typhoid and Salmonella bacilli.
8 Includes miscellaneous examinations for identification of organisms.
104
P.D. 34
Bacteriological Laboratory
Table XV — Specimens and Examinations in 194-6
Positive
Negative
Total
Number of
Specimens
Total
Number of
Examinations
Blood Grouping and Rh Typing Tests
Diphtheria:
Diagnosis ....
Release ....
Gonorrhea:
Smears .....
Cultures ....
Malaria .....
Meningococci, Spinal fluid for
Pneumonia:
Pneumococci found and typed
Pneumococci not found .
Tuberculosis:
Sputum
Cultures and animal inoculations
Typhoid fever:
Widal . . . ...
Culture (blood, feces, and urine)
Undulant Fever
Diphtheria Virulence Tests
Dysentery, Amoebic .
Vincent's Angina (sent by Dentists)
Weil-Felix reaction for Rickettsial
diseases
Unclassified
Total
1,376
2,752
221
411
6,708
706
6,929
1,117
15,064 1
1,117
1,086
58
9,648
1,404
10,734
1,462
21,468 2
2,846
227
498
725
725
24
69
93
120 3
320
678
313
678
313
1,114
748
58
5,070
1,257
5,818
1,315
5,818
1,315
34
182
4,974 *
8,821
5,160
9,003
10,320 °
13,139 6
217
3.062
3,279
3,955'
57
8
65
65
3
203
206
206
395
320
715
715
1
77
77
77
-
-
350
545 3
4,041
43,503
49,415
81,674
1 Includes examinations for hemolytic streptococci and the organisms of Vincent's Angina.
2 Includes examinations for average number of leucocytes per field.
3 Includes examinations for influenza bacilli and other organisms.
* Includes 152 partial reactions.
6 Includes 5,160 tests for paratyphoid B.
« Includes examinations for Salmonella and dysentery bacilli.
' Includes 632 tests for heterophile antibodies and 44 tests for dysentery agglutination.
• Includes tests (miscellaneous) for identification of organisms.
P.D. 34
105
Bacteriological Laboratory
Table XV — Specimens and Examinations in 194-7
Total
Total
Number of
Number of
Positive
Negative
Specimens
Examinations
Pre-natal Blood Typing Tests:
Blood Grouping
-
-
7,785
7,785
Rh Typing ....
—
—
Bank Blood Typing Tests :
Blood Grouping
-
-
24,917
24,917
Ry Typing ....
—
-
24,917
28,521
Diphtheria:
Diagnosis ....
329
7,850
8,179
17,664 i
Release ....
357
799
1,156
1,156
Gonorrhea — Smears
747
8,443
9,190
18.3S0 2
Malaria . . .
69
380
449
449
Meningococci, Spinal fluid for
4
46
50
50 »
Pneumonia:
Pneumococci found and typed
133
-
133
133
Pneumococci not found .
—
547
547
547
Tuberculosis:
Sputum ....
820
5,768
6,588
6,588
Urine, spinal fluid, etc. (culture anc
1
animal inoculations)
111
1,454
1,565
1,565
Typhoid Fever:
Widal . . . ...
8
5,708^
5,716
11,432 5
Culture (blood, feces, and urine)
135
9,210
9,345
13,830 6
Undulant Fever
168
3,838
4,006
5,055 ■>
Diphtheria Virulence Tests
25
11
36
36
Dysentery, Amoebic .
1
329
330
330
Vincent's Angina (sent by Dentists)
167
132
299
299
Weil-Felix reaction for Rickettsia
1
diseases ....
-
103
103
103
Unclassified
-
-
389
1,3718
Total ....
3,074
44,618
80,783
149,057
1 Includes examinations for hemolytic streptococci and the organisms of Vincent's Angina.
2 Includes examinations for average number of leucocytes per field.
3 Includes examinations for influenza bacilli and other organisms.
4 Includes 63 partial reactions.
6 Includes 5,716 tests for paratyphoid B.
• Includes examinations for Salmonella and dysentery bacilli.
7 Includes 1,049 tests for heterophile antibodies.
8 Includes tests (miscellaneous) for identification of organisms.
106
P.D. 34
Bacteriological Laboratory
Table XV — Specimens and Examinations in 1948
Positive
Negative
Total
Number of
Specimens
Total
Number of
Examinations
Prenatal Blood Typing Tests:
Blood Grouping
Rh Typing
-
:)
17,825
/ 17,825
119,000
Bank Blood Typing Tests:
Blood Grouping ...
Rh Typing ....
_
:}
28,549
/28,549
130,411
Diphtheria:
Diagnosis ....
Release ....
Gonorrhea — Smears
Malaria . . .
Meningococci, Spinal fluid for
203
143
537
9
9
6,691
1,109
6,743
245
33
6,984
1,252
7,280
254
42
15,886 1
1,252
14,560 2
254
73'
Pneumonia:
Pneumococci found and typed
Pneumococci not found .
54
241
54
241
54
241
Tuberculosis:
Sputum — Smears .
Urine, spinal fluid, etc. (Culture anc
animal inoculations)
859
1
221
6,119
1,626
6,978
1,847
6,978
1,847
Typhoid Fever:
Widal
Culture ....
Undulant Fever
Diphtheria Virulence Tests
11
140
141
31
5,598 4
7,383
3,844
19
5,609
7,523
3,985
50
11,2186
15,717 6
5,389 »
50
Viral Serological Tests:
Influenza A and B . .
Mumps Complement Fixation Tests
Dysentery Amoebic . . .
Vincent's Angina (sent by Dentists)
Weil-Felix reaction for Rickettsia
diseases ....
100
1
366
106
107
18
180
366
206
107
36
180
732 8
206
107
Unclassified ....
-
-
326
540 9
Total ....
2,458
40,230
89,586
171,105
i Includes examinations for hemolytic streptococci and the organisms of Vincent's Angina.
2 Includes examinations for average number of leucocytes per field.
3 Includes examinations for influenza bacilli and other organisms.
4 Includes 86 partial reactions.
6 Includes 5,609 tests for paratyphoid B.
• Includes examinations for Salmonella and dysentery bacilli.
' Includes 1,404 tests for heterophile antibodies.
8 Includes examinations for ova.
' Includes tests (miscellaneous) for identification of organisms.
P.D. 34
107
Bacteriological Laboratory
Table XV — Specimens and Examinations in 1949
Total
Total
Number of
Number of
Positive
Negative Specimens
Examinations
Agglutinations :
Typhoid ....
18
5,8071
Paratyphoid B
. ' 2
5,789
Undulant Fever
156
4,086
5,825
18,114
Heterophile Antibodies
257
1,739 f
Weil-Felix ....
1
134
Additional Tests . .
- 124
"J
Blood Grouping and Rh Typing:
Bank Blood Typing Tests
31,470
62,940
Prenatal ....
20,197
40,394
Enteric Pathogens:
Typhoid ....
103
7,191]
Other Salmonellas
392
6,891 1
7,294
17,870
Flexner
55 \
f
Sonne .
23/
3,2131
Amoebae
2
354 1
Ova
4
365/
371
725
Gonorrhea
440
5,631
6,071
12,164
Malaria: .
8
153
161
161
*Throat Cultures:
Diphtheria Diagnosis
150
6,6981
Diphtheria Release
106
1,9381
Diphtheria Virulence
23
13 1
8,891
19,355
Hemolytic Streptococci .
1,065
2,809 f
Vincent's Angina .
72
6,156
Others ....
- 325
-J
Tuberculosis:
Microscopic Direct
929
5,9571
273/
Microscopic Concentrates
55
7,214
7,214
Isolations Reported on Direct Sme
ar 106
2,168
2,202
4,602
Isolations Reported on Culture
266
1,936
Isolations Reported on Guinea Pig
51
75
Vincent's Gingivitis .
77
90
167
167
Virus Serology:
Mumps ....
—
-
185
185
Influenza A, B, and FM,
—
-
77
231
Lymphocytic Choriomeningitis
-
-
12
12
Lymphogranuloma and Psittacosis
-
—
8
8
Cold Agglutinins
.
-
18
18
Miscellaneous:
Blood Cultures
—
-
64
109
Spinal Fluids
'. 5
20
25
52
Others (urine, pus, etc.) .
—
—
266
589
^Pneumonia ....
20
132
152
152
Total
•
4,386 449
69,618
90,670
185,062
108 P.D. 34
Table XVI — Salmonella Types Found During the Years 194-0 Through 1949
Type
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
Total
Percent
S. typhimurium
96
12
66
106
70
43
80
69
27
85
654
35.2
S. newport
4
1
18
31
48
16
367
19
26
5
535
28.8
S. oranienburg
4
6
9
7
14
8
9
89
13
7
166
8.9
S. montevideo
10
10
4
7
13
14
11
28
6
5
108
5.8
S. paratyphi B
11
20
1
4
7
6
7
7
4
3
70
3.8
S. anatum
2
5
2
2
2
43
-
4
-
1
61
3.3
S. tennessee .
-
-
-
3
2
6
2
2
-
15
30
1.6
S. derby
-
2
5
4
8
2
1
5
1
-
28
1.5
S. bareilly
1
5
-
8
5
2
1
3
1
1
27
1.4
S. choleraesuis
5
5
2
5
3
1
-
1
1
-
23
1.2
S. enteritidis .
-
-
-
8
-
-
4
6
1
4
23
1.2
S. panama
2 •
4
2
2
6
2
1
2
-
-
21
1.1
S. thompson .
-
-
-
-
—
—
2
10
-
1
13
.7
S. newington .
-
-
2
2
-
—
1
3
1
-
9
.5
S. senftenburg
-
2
6
-
-
-
1
—
-
1
10
.5
S. manhattan
-
1
-
1
1
-
1
3
-
1
8
.4
S. minnesota .
-
-
-
-
—
1
6
1
-
-
8
.4
S. urbana
-
3
3
-
-
-
-
1
-
-
7
.4
S. litchfield .
-
-
-
-
1
-
4
-
-
-
5
.3
S. meleagridis .
-
-
-
-
5
-
-
-
1
-
6
.3
S. berta
-
-
-
-
-
-
-
3
-
-
3
.2
S. bredeney .
-
-
-
1
-
-
1
2
-
-
4
.2
S. give
1
1
—
—
—
1
—
—
—
—
3
.2
S. muenchen .
-
-
3
-
-
-
-
1
-
-
4
.2
S. oregon
-
-
-
-
-
1
-
-
1
2
4
.2
S. st. paul
-
-
—
-
-
—
3
-
—
—
3
.2
S. worthington
-
1
1
-
-
1
-
-
-
-
3
.2
S. Chester
1
-
-
-
-
—
-
-
-
-
1
S. hartford
-
-
-
-
-
-
—
1
-
-
1
S. kentucky .
-
-
-
1
-
-
-
-
1
-
2
S. morbificans bo vis
-
-
-
-
1
-
-
—
-
1
S. paratyphi A
-
-
-
-
-
-
-
1
-
-
1
S. poona
-
-
-
—
-
-
-
-
1
-
1
S. san diego .
-
—
-
-
1
-
—
—
-
1
2
S. Stanley
-
-
-
1
-
-
—
-
-
-
1
Untyped
7
. 144
78
124
193
186
148
502
261
1
86
2
134
10
1856
.5
Total
100.0
P.D. 34
109
Wassermann Laboratory
Table XVII — Tests and Examinations
Kind of Specimen
1940
1942
1944
Blood
Number of Specimens
Tests
Hinton ....
Rapid Hinton
Hinton Titr. — Penicillin
Kahn Titr. — Penicillin
Davies — Hinton Micro
G. C. Compl. Fixation
♦Bacillus Abortus Agglutination
♦Glanders ....
**Blood Grouping
♦*Rh Typing ....
**Hinton ....
Spinal Fluid
Number of Specimens
Tests
Wassermann . . .
Davies-Hinton
Rabies Diagnosis*
Number of Specimens
Tests
Impressions
Sections ....
Animal Inoculations
Path, and Bact. Examinations*
Number of Specimens
Tests
Animal Inoculations
Cultures ....
Smears ....
Total Tests ....
Total Specimens
360,401
425,581
755,700
652,286
493,531
322,797
388,723
721,753
616,164
462,607
-
628
12,451
11,073
6,986
-
—
-
-
70
-
-
—
-
70
4,662
4,620
5,605
6,006
6,743
9,146
679
-
-
—
30,380
31,431
28,327
30,082
24,101
22
25
15
34
10
11,784
10,934
10,139
9,790
1
4
2
385,796
372,496
2
2
1
446,575
436,787
6
6
3
788,442
766,046
682,010
662,258
Wassermann Laboratory
Table XVII — Tests and Examinations
10,018
1,784
6,154
10,934
8,774
9,573
10,139
8,330
9,790
8,642
10,018
306
269
201
174
152
306
298
240
269
255
232
201
187
176
174
172
166
152
145
145
519,704
503,708
♦Diagnostic Examinations for Division of Livestock Disease Control.
**Tests for State Blood Bank.
Kind of Specimen
1945
1946
1947
1948
1949
Blood
Number of Specimens
Tests
Hinton ....
Rapid Hinton
Hinton Titr. — Penicillin
Kahn Titr. — Penicillin
Davies — Hinton Micro .
♦Bacillus Abortus Agglutination
♦Glanders ....
**Blood Grouping
**Rh Typing
**Hinton ....
Spinal Fluid
Number of Specimens
Tests
Wassermann
Davies~Hinton
Rabies Diagnosis*
Number of Specimens
Tests
Impressions
Sections ....
Animal Inoculations
Path, and Bact. Examinations*
Number of Specimens
Tests
Animal Inoculations
Cultures ....
Smears ....
Sections ....
Total Tests ....
Total Specimens
519,296
541,108
524,765
517,683
519,668
485,864
10,495
2,950
2,950
6,953
23,147
7
375
375
346
486,954
3,704
12,033
12,033
9,130
23,829
15
4,156
4,156
8,608
457,747
9,086
9,086
10,091
26,956
9
20,876
446,727
9,820
9,683
11,398
24,424
33
25,281
438,820
13,247
13,247
14,693
34,330
10
28,568
11,022
12,409
13,908
12,732
13,068
9,447
11,022
10,142
12,409
11,729
13,908
9,883
12,732
9,950
13,068
159
186
213 ■
194
192
159
148
143
186
179
177
213
201
191
194
184
184
192
186
172
2
2
-
10
2
2
2
2
1
—
4
5
3
5
1
554,385
530,479
587,714
553,705
560,093
538,886
550,560
530,619
542,915
532,93 0
♦Diagnostic Examinations for Division of Livestock Disease Control.
♦♦Tests for State Blood Bank.
110
P.D. 34
Wassermann Laboratory
Table XVIII — Laboratory Examinations for Rabies
Positive
Total Animals
Year
Dogs
Other
Animals
Negative
Examined
1940
52
4
244
309
1941
20
1
240
274
1942
18
1
171
202
1943
4
-
169
177
1944
1
-
145
152
1945
0
-
148
160
1946
1
-
178
185
1947
0
—
204
214
1948
0
-
184
193
1949
1
-
186
191
Index to Line Numbers in the Table of Cases and Deaths from Diseases Dangerous
to the Public Health
Abington
. 114
Clarksburg
. 256
Hanover .
. 175
Acton
. 185
Clinton .
71
Hanson .
. 195
Acushnet
. 147
Cohasset
. 156
Hardwick
. 225
Adams
72
Colrain .
. 255
Harvard .
. 279
Agawam .
93
Concord .
94
Harwich .
. 226
Alford .
. 341
Conway .
292
Hatfield .
. 218
Amesbury
79
Cummington .
. 309
Haverhill
24
Amherst .
106
Hawley .
. 342
Andover .
74
Dalton
. 140
Heath
. 329
Arlington
23
Danvers .
63
Hingham
77
Ashburnham
. 210
Dartmouth
81
Hinsdale .
. 261
Ashby
. 273
Dedham .
55
Holbrook
. 154
Ashfield .
. 285
Deerfield
170
Holden
. 130
Ashland .
. 172
Dennis
232
Holland .
. 333
Athol
76
Dighton .
181
Holliston
. 161
Attleboro
43
Douglas .
192
Holyoke .
19
Auburn .
91
Dover
236
Hopedale
. 163
Avon
193
Dracut .
110
Hopkinton
. 187
Ayer
149
Dudley .
139
Hubbardston .
. 282
Dunstable
312
Hudson .
. 102
Barnstable
92
Duxbury
200
Hull
. 143
Barre
166
Huntington
. 268
Becket
300
East Bridgewater
153
Bedford .
141
East Brookfield
275
Ipswich .
. 117
Belchertown
155
East Longmeadow
152
Bellingham
157
Eastham
304
Kingston
. 183
Belmont
32
Easthampton .
78
Berkley .
269
Easton
125
Lakeville
. 249
Berlin
272
Edgartown
264
Lancaster
. 180
Bernards ton
278
Egremont
301
Lanesboro
. 234
Beverly .
34
Erving
262
Lawrence
12
Billerica .
90
Essex
239
Lee
. 142
Blacks tone
148
Everett .
20
Leicester
. 134
Blandford
307
Lenox
. 186
Bolton
289
Fairhaven
70
Leominster
38
Boston
2
Fall River
5
Leverett .
. 305
Bourne
160
Falmouth
97
Lexington
61
Boxboro .
323
Fitchburg
25
Leyden .
. 334
Boxford .
293
Florida .
316
Lincoln .
. 219
Boylston
263
Foxboro . . . .
120
Littleton
. 241
Braintree
41
Framingham
35
Longmeadow .
. 115
Brewster
296
Franklin . . . • .
105
Lowell
10
Bridgewater
96
Freetown
228
Ludlow .
. 103
Brimfield
286
Lunenburg
. 182
Brockton
15
Gardner .
49
Lynn
7
Brookfield
258
Gay Head
348
Lynnfield
. 167
Brookline
16
Georgetown
224
Buckland
251
Gill . . . .
288
Maiden .
17
Burlington
184
Gloucester
36
Manchester
. 199
Goshen .
328
Mansfield
. Ill
Cambridge
6
Gosnold . . . .
350
Marblehead
65
Canton .
113
Grafton . . . .
98
Marion .
. 217
Carlisle .
299
Granby .
271
Marlboro
. 60
Carver
259
Granville
302
Marshfield
. 208
Charlemont
295
Great Barrington
121
Mashpee
. 327
Charlton
164
Greenfield
54
Mattapoisett .
. 212
Chatham
216
Groton .
178
Maynard
. 112
Chelmsford
86
Groveland
222
Medfield
. 151
Chelsea .
27
Medford
14
Cheshire .
238
Hadley . . . .
196
Medway .
. 171
Chester .
267
Halifax . . . .
277
Melrose .
33.
Chesterfield
319
Hamilton
194
Mendon .
. 244
Chicopee
21
Hampden
265
Merrimac
. 205
Chilmark
337
Hancock .
325
Methuen
. 40
P.D. 34
111
Middleboro
Middlefield
Middleton
Milford .
Millbury
Millis
Millville
Milton
Monroe
Monson
Montague
Monterey
Montgomery
Mt. Washington
Nahant
Nantucket
Natick
Needham
New Ashford
New Bedford
New Braintree
New Marlboro
New Salem
Newbury
Newburyport
iNewton
Norfolk .
North Adams
North Andover
North Attleboro
North Brookfield
North Reading
Northampton
Northboro
Northbridge
Northfield
Norton
Norwell .
Norwood
Oak Bluffs
Oakham
Orange
Orleans
Otis
Oxford
Palmer
Paxton
Peabody
Pelham
Pembroke
Pepperell
Peru
Petersham
Phillipston
Pittsfield
Plainfield
Plain ville
Plymouth
84
338
204
59
101
211
247
39
345
129
108
330
346
352
188
190
56
58
351
8
315
291
321
240
64
13
229
44
100
75
176
174
37
168
82
220
179
209
57
260
313
128
245
318
135
83
290
42
310
231
177
347
298
311
18
339
214
66
Plympton
Princeton
Provincetown
Quincy .
Randolph
Raynham
Reading
Rehoboth
Revere
Richmond
Rochester
Rockland
Rockport
Rowe
Rowley .
Royalston
Russell
Rutland .
Salem
Salisbury
Sandisfield
Sandwich
Saugus
Savoy
Scituate
Seekonk
Sharon
Sheffield
Shelburne
Sherborn
Shirley .
Shrewsbury
Shutesbury
Somerset
Somerville
South Hadley
Southampton
Southboro
Southbridge
South wick
Spencer .
Springfield
Sterling .
Stockbridge
Stoneham
Stoughton
Stow
Sturbridge
Sudbury
Sunderland
Sutton
Swampscott
Swansea .
Taunton
Templeton
Tewksbury
308
284
162
215
68
173
30
303
276
89
145
344
246
297
270
248
26
191
320
242
52
331
132
131
146
233
243
281
203
80
343
107
9
104
266
206
53
223
118
4
227
235
69
85
257
207
213
283
197
73
124
28
144
127
Tewksbury State Infirmary
353
Tisbury .
237
Tolland .
349
Topsfield
274
Townsend
201
Truro
306
Tyngsboro
254
Tyringham
340
Upton
202
Uxbridge
119
Wakefield
47
Wales
324
Walpole .
87
Waltham
22
Ware
109
Wareham
99
Warren .
165
Warwick
317
Washington
335
Watertown
29
Wayland
150
Webster .
67
Wellesley
51
Wellfleet .
294
Wendell .
326
Wenham
250
West Boylston
189
West Bridgewater
158
West Brookfield
252
West Newbury
253
West Springfield
45
West Stockbridge
280
West Tisbury .
336
Westborough
116
Westfield
. 46
Westford
. 159
Westhampton
. 314
Westminster
. 221
Weston .
. 137
Westpbrt
. 136
Westwood
. 126
Weymouth
31
Whately .
. 287
Whitman
. 95
Wilbraham
. 169
Williamsburg
. 230
Williams town
138
Wilmington
. 123
Winchendon
. 122
Winchester
62
Windsor .
. 332
Winthrop
. 48
Woburn .
50
Worcester
3
Worthington
. 322
Wrentham
. 133
Yarmouth
. 198
112
P.D. 34
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I I I I I IO I I I I I I I I I I I rH I I I I I I I I I I I I I I I I | | | | | | | |
I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I
I | I I I I I I I I I I I <N I I I I I I ] I I I I I I I I I I iH I I I I I I I I I T*
■*'^'*<w-t(C0COC0C0C0C0C0C0COMrac0MC<IC^Oq(N(NC^(M(M(N(MCJ-lC-).
S ^ •>■ ° "5 l2 >S *rl 9 -Z >S 03 £ -
CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO COCO CO CO CO 00 CO COCO CO cocococococococococococococococo
200
Actinomycosis
P.D. 34
1942 1943 1944 1945 1946 1947 1948 1949
CDCDCDCDCDCDCDCD
Avon
Boston
Brockton
Burlington
Everett
Fall River
Falmouth
Holyoke
Lak.ville
Lawrence
Medford
Military Est.
New Bedford
Norfolk .
Palmer
Somerset .
Springfield
Waltham .
West Springfield
Total .
1 1
1111
1 1
11 22 53 23 3 2 1
Anthrax
1942
1943 1944
1945
1946
1947
1948
1949
C
D
C
D C
D
C
D
C
D
C
D
C
D
C D
Boston
1
1
1
Chelsea
1
1
- -
Franklin
-
-
-
1
1
2
1
-
-
1
-
-
-
-
Haverhill .
2
1
3
Lowell
1
Lynn
1
1
Mid .leboro
1
Milton
1
Newton
1
Peabody
-
-
-
1
-
1
-
1
-
-
-
-
-
1
Salem
1
—
—
—
— —
—
—
—
—
—
—
-
2
—
— —
Somerville
1
1
Woburn .
1
Total
5
1
5
4
1
4
1
2
1
2
-
3
1
3
Dysentery,
Amebic
1942
1943 1944
1945
1946
1947
1948
1949
C
D
C
D C
D
C
D
C
D
C
D
C
D
C D
1
1
4
1
Brookline .
1
Cambridge
-
-
-
-
-
-
-
1
-
1
-
-
-
-
Danvers .
1
Fall River
1
Fitchburg
1
Gt. arrington .
1
Lawrence .
1
Marblehead
1
Melrose
1
Military Est.
-
-
-
2
-
17
-
4
-
-
-
-
-
-
New Bedford
1
Newton
1
2
No. Andover
1
Quincy
-
- .
-
-
-
-
-
1
-
1
-
-
-
-
Revere
-
-
-
- -
-
-
-
1
-
-
-
1
-
-
Seekonk .
1
Somerville
-
1
Stoneham
1
Worcester .
1
Total
3
1
1
2
-
18
7
2
10
-
5
1
3
P.D. 34
Dysentery, Bacillary
201
1942
C D
1943
C D
1944
C D
1945
C D
1946
C D
1947
C D
1948
C D
1949
C D
Adams
Amesbury
Amherst
Andover
Arlington
Auburn
Ayer
Beoket
Belmont
Beverly
Billerica
Boston
Braintree
Brimfield
Brockton
Brookline
Brookfield
Cambridge
Canton
Chelsea
Chicopee
Clinton
Danvers
Dedham
E. Bridgewater
Easthampton
Everett
Fall River
Fitehburg .
Foxboro .
Framingham
Gloucester
Grafton
Greenfield
Groton
Haverhill
Hingham
Holyoke
Hopkinton
Ipswich
Lawrence
Lexington
Lincoln
Lowell
Lynn
Maiden
Marblehead
Medford
Melrose
Military Est.
Milton
New Bedford
Newburyport
Newton
No. Andover
Northampton
Norwood
Palmer
Peabody
Pittsfield
Plainville
Quincy
Rehoboth
Revere
Rockland
Salem
Saugus
Scituate
Shrewsbury
Somerville
Springfield
Stoneham
Swampscott
T ewksbury State
Wakefield .
Walpole
Waltham .
Wellesley .
W. Boylston
Westport .
Whitman .
Wilbraham
Winchester
Winthrop
Woburn
Worcester .
Wrentham
Total .
Hosp.
4
1
22
385
1 218
- 113
21
239
104
4
6 245 8
68
57
17 121 18
23
1
96 7 8
2-6
202
Encephalitis, Infectious
P.D. 34
Amherst
Andover
Arlington
Attleboro
Auburn
Ayer
Barnstable
Barre
Belmont
Billerica
Boston
Braintree
Bridgewater
Brimfield
Brockton
Brookline
Cambridge
Chatham
Chelsea
Chelmsford
Clinton
Dover
E. Longmeadow
Easton
Everett
Fall River
Fitchburg
Framingha:
Gardner
Greenfield
Halifax
Haverhill
Hingham
Holyoke
Hudson
Lawrence
Leicester
Lexington
Longmeado
Lowell
Lunenburg
Lynn
Maiden
Manchester
Mansfield
Marlboro
Marshfield
Medford
Melrose
Methuen
Middleboro
Milford
Military Est.
Millbury
Milton
Needham
New Bedford
Newburyport
Newton
No. Adams
Northampton
No. Attleboro
No. Brookfield
Palmer
Pittsfield
Princeton
Quincy
Rehoboth
Salem
Salisbury
Saugus
Somerville
Southbridge
Springfield
Sterling
Stoneham .
Taunton .
Waltham
Wareham .
Warren
Watertown
1942
C D
1
1 3
1
1 1
1
1 1
1943 1944 1945 1946 1947 1948 1949
CDCDCDCDCDCDC D
1 1
1
1
1 1
1 1
1 1
2 1
1
1 1
1 1
1
2 1
1
1
1
P.D. 34
203
Encephalitis, Infectious — Continued
1942 1943 1944 1945 1946 1947 1948 1949
CDCDCDCDCDCDCDCD
21 -- -- -- -- -- -- --
__ __ __ __ __ __ i- -_
1 - 1- -- -- -- -- -- --
!_ __ __ 1- -- _- -- -_
__ i- _- -- -- -- -_
__ __ __ __ -1 __ __ __
-1 41 12 -- 2- -- 8- 1 ■■-
__ __ i- __ __ __ __
25 13 34 9 23 8 18 10 8 8 8 2 34 4 26
6
Leprosy
1942 1943 1944 1945 1946 1947 1948 1949
CDCDCDCDCDCDCDC D
__ !_ __ __ __ __ __ __
__ __ __ __ _- -- i- __
Lymphocytic Choriomeningitis
1942 1943 1944 1945 1946 1947 1948 1949
CDCDCDCDCDCDCDCD
__ __ __ _ ' - 2- -- -- --
_ _ __ __ __ __ -_ i- __
1- -- 3- -- -- -- 1 -
-- 1- -- -- -- -- -- --
__ __ __ __ l- 2- 4- 1 -
__ __ __ __ __ _ _ i_ __
__ i_ __ __ _- _- __ __
__ __ _- _ __ -- -- 2-
__ __ __ l- _- __ii_ 2-
__ __ _- -- _- -- -- l-
__ __ _- -- -- _- l- -_
__ __ __ __ -_ _- i- __
__ __ __ _ 1- -- -- __
__ __ __ __ _- _- 1- __
1- 1- -- -- -- -- -- --
_ _ -- 1- __ __
__ __ __ _ ' _ __ -- __ 1
__ __ i- _- -- -_ -- 1
__ __ __ i- -- __ -- -_
__ __ __ i- __ -- -- __
__ __ __ __ __ _- i_ __
__ __ __ __ -- 1- -- -
1- -- -- -- -- -- -- --
__ __ __ __ -_ -- 1- --
!_ __ __ i- - - 1- 1- -_
3- 4- 1- 8- 4- 6-23- 9
Malaria
1942 1943 1944 1945 1946 1947 1948 1949
CDCDCDCDCDCDCDCD
— Z Z __ __ -- 2- -- -- - -
__ __ __ -- -- 1- -- -_
__ __ __ -- 1- _- -- --
1 I Z _ __ _- 2- -- -- --
__ _- __ __ l- _ - _- -_
_ _ __ __ -- 3- -- -- --
__ __ __ __ l- -- _ - -_
__ __ __ __ -_ l- -_ -_
__ __ __ -- l- -- -- - _
2 1 1 - 11 1 1 125 - 19 - 2 1 11
Wellesley .
Westfield .
Weston
Weymouth
Winchendon
Woburn .
Worcester .
Yarmouth
Total .
New Bedford
Ware .
Total
Agawam .
Barnstable
Boston
Brockton .
Cambridge
Dianvers ._
E. Longmeadow
Fall River .
Fitchburg .
Framingham
Lakeville .
Maiden
Medford .
Middleboro
Military Est.
Pittsfield .
Quincy
Somerville
Springfield
Swampscott
Townsend .
Waltham .
Weymouth
Winchester
Winthrop .
Worcester .
Total .
Abington
Acton
Amesbury
Amherst
Arlington
Athol
Attleboro
Barnstable
Bedford
Belmont
Berkeley
Beverly
Boston
204
P.D. 34
Malaria — Continued
Bourne
Braintree .
Bridgewater
Brockton .
Brookfield .
Brookline .
Cambridge
Chelsea
Chicopee .
Clinton
Concord
Dartmouth
Dedham .
Douglas .
Easthampton
Easton
Everett .
Fall River .
Falmouth .
Fitchburg
Foxboro
Framingham
Franklin .
Gardner
Georgetown
Gloucester
Grafton
Gt. Barrington
Greenfield .
Haverhill .
Heath
Hingham .
Holbrook .
Holliston .
Hudson
Lanesboro .
Lawrence .
Leicester .
Leominster
Longmeadow
Lowell
Ludlow
Lunenburg
Lynn
Lynnfield .
Maiden
Manchester
Marblehead
Marion
Marlboro .
Medford
Melrose
Merrimac .
Methuen .
Middleboro
Middleton
Milford
Military Est.
Millbury .
Milton
Monson
Montague .
Nantucket
Natick
New Bedford
Newton
Northampton
No. Andover
Norwood
Orleans
Oxford
Peabody
Pittsfield
Plymouth
Quincy
Raynham
Reading
Revere
Rockport
Rowley
Salem
Salisbury
Saugus
1942
C D
1943
C D
1944
C D
1945
C D
1946
C D
1947
C D
1948
C D
1949
C D
3 1
1
565 - 1026
1
36
1 1
1
1 1
1
P.D. 34
Malaria — Continued
205
Seekonk .
Shrewsbury
Somerset .
Somerville
Southboro .
Southbridge
Springfield
Stoneham .
StoughtoD .
Stow
Swampscott
Taunton .
Templeton
Townsend .
Tyngsboro
Uxbridge .
Wakefield .
Waltham .
Walpole
Warren
Watertown
Webster
Wellesley .
Westfield .
W. Springfield
Westwood
Weymouth
Whately .
Williamstown
Wilmington
Winchendon
Winchester
Winthrop .
Woburn .
Worcester .
Total .
1942
C D
1943
C D
1944
C D
1945
C D
1946
C D
1947
C D
1948
C D
1949
C D
2
116
1
-
2
_
6
-
1
_
35
-
8
-
572
7 1031
91
23 2
10 1
Meningitis, Meningococcus
1942
C D
1943
C D
1944
C D
1945
C D
1946
C D
1947
C D
1948
C D
1949
C D
Abington
Acton
Acushnet
Adams
Agawam
Amesbury
Amherst
Arlington
Ashby
Ashfield
Ashland
Athol
Attleboro
Auburn
Ayer
Barnstable
Bedford
Bellingham
Belmont
Beverly
Billerica
Boston
Bourne
Boxboro
Braintree
Bridgewater
Brimfield
Brockton
Brookfield
Brookline
Cambridge
Canton
Carver
-- 11 -- -- - — - __ __
-- 1- 2- 1- 11 - - -- -_
1- 1- 21 -- -- -- -- 1
2- -- -- 1- -- -- -_ __
-- 2- 52 1- 1- -- - - --
1_ -- _ _ _ __ __ __ __
__ -- l- __ -_ __ __ __
__ 3- 3- 1- - - -- -- --
-- 3- 11 1- -- -- -- --
11 -- 1- - - -- -- -_ __
1- 81 71 -- -- -- -- --
__ l- _ -- -_ _ __ __
__ i_ __ __ __ __ __ __
32 -- -- -- -- - - --
1- 1- - - 11 - - -- -- --
_ 21 -- - - -- -- -- --
36 13 168 43 137 25 48 5 23 3 13 9 15 5 6 1
__ _- _- __ i_ __ __ __
2- 1- 51 - ■ .- 1- -- -- - -
2- 2- -- -- -- -- - -
__ __ -_ _. _ i_ _ _ __ __
42 91 3- 11 2- -- -1 2 -
2- 52 21 11 1- 1- 32 --
10 -23 4 72 2- 2- 11 41 3
-- 21 21 -- 1- -- -- --
1_ __ i_ __ __ __ __ __
206
Meningitis, Meningococcus — Continued
P.D. 34
1942
C D
1943
C D
1944
C D
1945
C D
1946
C D
1947
C D
1948
C D
1949
C D
Charlton .
Chelmsford
Chelsea
Chicopee
Clarksburg
Clinton
Cohasset
Danvers
Dartmouth
Dedham
Dennis
Draeut
Dudley
E. Bridgewater
Easthampton
Easton
Edgartown
Erving
Everett
Fairhaven
Fall River .
Falmouth
Fitehburg
Foxboro
Framingham
Franklin
Gardner
Gloucester
Grafton
Gt. Barrington
Greenfield
Groveland
Hamilton
Hanover
Hanson
Hardwiek
Harwich
Haverhill
Hingham
Holbrook
Holden
Holyoke
Hopedale
Hopkinton
Hudson
Hull.
Ipswich
Kingston
Lakeville
.Lawrence
Lee .
Leominster
Lenox
Lexington
Longmeadow
Lowell
Ludlow
Lunenburg
Lynn
Lynnfield
Maiden
Manchester
Mansfield
Marblehead
Marluoro
Marshfield
Maynard
Medford
Medway
Melrose
Methuen
Middleboro
Milford
Military Est.
Millbury
Millville
Milton
Montague
Nahant
Natick
Needham
New Bedford
New Braintree
2
21
4
7
2
4
2
2
135
1
1
1
3
1
2
1
4
1
21
1
4
1
1
1 1
2 2
P.D. 34
Meningitis, Meningococcus — Continued
207
Newbury .
Newburyport
Newton
No. Adams
No. Attleboro
No. Brookfield
No. Andover
No. Reading
Norfolk .
Northampton
Northbridge
Norton
Norwood
Oxford
Palmer
Peabody
Pittsfield
Plymouth
Quincy
Randolph
Reading
Rehoboth
Revere
Rockland
Rookport
Rowley
Rutland
Salem
Salisbury
Saugus
Scituate
Seekonk
Sharon
Sheffield
Shrewsbury
Somerset .
Somerville
South Hadley
Southboro .
Southbridge
Spencer
Springfield
Stoneham .
Stoughton
Sturbridge
Sudbury
Sutton
Swampscott
Swansea
Taunton
Templeton
Topsfield
Townsend
Uxbridge
Wakefield
Walpole
Waltham
Ware
Wareham
Washington
Watertown
Wavland .
Webster .
Wellesley .
Wenham .
Westboro .
West Bridgewater
West Springfield
Westfield .
Westport .
Weston
Westwood
Weymouth
Whately .
Wilbraham
Williamstown
Wilmington
Winchester
Winchendon
Winthrop .
Woburn
Worcester .
Wrentham
Total .
1942
C D
1943
C D
1944
C D
1945
C D
1946
C D
1947
C D
1948
C D
1949
C D
4 1
-
-
7
1
1
-
-
-
-
1
1
5
1
15
1
10
3
8
-
3
-
_
_
1
1
3
_
1
-
3
1
-
-
2
-
1
1
1
-
1
1
-
-
-
-
-
-
-
-
-
1
-
-
2
-
2
1
-
-
-
-
-
1
-
-
-
-
-
-
1
4
1
1
-
1
-
-
-
_
_
_
1
_
_
-
-
1
1
1
-
1
1
—
-
2
-
1
-
1
-
-
-
-
-
1
-
-
-
1
—
1
—
—
—
1
—
—
—
-
—
_
—
_
_
1
-
9
2
3
1
-
-
-
2
1
2
-
1
-
1
-
3
1
-
-
5
-
3
-
1
-
2
-
-
1
_
-
1
_
2
_
4
1
-
-
-
_
2
~
-
-
1
-
1
-
-
-
1
-
1
1
1
-
2
-
1
2
-
1
-
-
-
-
-
-
-
-
-
-
-
1
6
2
-
-
-
-
1
-
_
-
_
_
_
1
_
_
1
_
1
-
2
1
2
2
1
1
-
2
-
-
-
-
-
1
.-
3
2
1
1
1
_
-
1
2
1
1
1
1
_
_
1
_
-
1
1
9
2
37
4
13
1
4
2
5
3
1
-
3
-
1
1
191 34 736 119 456 81 161 20 116 21 47 15 66 20
50
208
Meningitis, Pfeiffer Bacillus
P.D. 34
1942
C D
1943
C D
1944 1945 1946 1947 1948
CDCDCDCDCD
1949
C D
Acton .
Adams .
Amesbury
Arlington
Attleboro
Auburn
Barnstable
Belmont
Beverly
Billerica
Bolton .
Boston
Brockton
Cambridge
Canton
Carlisle
Charlton
Chelsea
Cheshire
Chicopee
Cohasset
Concord
Dalton
Dartmouth
East Bridgewater
E. Longmeadow
Easthampton
Everett
Fairhaven
Fall River
Falmouth
Fitchburg
Framingham
Franklin
Gardner
Gloucester
Greenfield
Hadley
Hampden
Hanson
Hardwick
Harvard
Hatfield
Haverhill
Hinsdale
Holyoke
Hull .
Huntington
Lawrence
Lee
Leominster
Lowell
Lynn
Lynnfield
Maiden
Mansfield
Marlboro
Marshfield
Maynard
Medford
Medway
Methuen
Melrose
Middleboro
Milford
Millbury
Milton .
Monson
Natick
Needham
New Bedford
Newburyport
Newton
North Adams
North Attleboro
Northampton
Northbridge .
Oxford .
Palmer
Paxton
Peabody
Petersham .
4 2
1
1 1
2 2
1
1 1
1
6 5
2 1
1
7 4 5
2 1 2
1 - 3
1
7 3
1
1
1111
1
1 1
1 1
2 2
1 1
1 1
1
1 1
1
1 1
1
3 1
1-11
11--
2 1
1
1 1
2 1
1
1 1
1 1
1
1
1 1
1 2
4
1
P.D. 34
Pittsfield
Quincy
Randolph
Reading
Rehoboth
Revere
Rockland
Rockport
Royalston
Salem
Saugus .
Seekonk
Sharon
Somerville
South Hadley
Southboro
Southbridge
Spencer
Springfield
Stoneham
Stow .
Sudbury
Taunton
Templeton
Tisbury
Tyngsboro
Wakefield
Wareham
Watertown
Wellesley
West Boylston
West Brookfield
West Springfield
Westfield
Westwood
Weymouth
Wilbraham
Wilmington
Winchester
Winthrop
Woburn
Worcester
Total
209
Meningitis, Pfeiffer Bacillus — Continued
1942 1943 1944 1945 1946 1947 1948 1949
CDCDCDCDCDCDCDC D
_ _ 11 1- -- -- -- 1- 1 -
1- -- -- -1 -- 2 - 2- --
J : : : : : 1 : I : : : I r : :
__ __ -_ -- l- -- -- --
_ _ _- -- -- -- 11 1- --
__ __ i- -- -- -- -- --
__ __ -_ -- -- -- 11 --
____ -i -- -- -- -- --
1- 2- 22 1- 1- -- 1- 1 -
I ' _ __ _ - -- -- 1- -- --
__ __ __ _ -- -- - - 1-
31 -- -1 1- -- 11 11 --
__ __ _- - -- -- 1- --
-- 1- -- -- -- -- -- --
3132 1-31211-4111
__ __ __ _ ■_ -_ __ i _
__ _- -- -- -- -- 1 -
__ _- -- -- -- 1- -- --
__ __ - - -- -- -- 2-
__ _ i __ _ -- -- -- --
_ _ _ _ 1- 11 -- -- -- --
__ _• •_ -- - - -- -- -- 11
__ i- - - -- -- -- -- --
__ __ -- -- 1- - - -- --
_ _ ! ; _ x _ !1 __ -- _- - -
_ _ - - 1- -- -- 1- -- 1 -
__ _- - - -- -- - . - -- 1 -
__ __ _- - -- -- -- 1 -
__ _- -- -- - j - 2- -- 1 -
__ _- , -- -- -- 1- 21
__ __ - _ -- -- - • - -1 --
__ __ 31 __ __ __ -_ __
_ _ 1X _ i __ __ __ - _ _-
__ -- -- -1 -- -- --
11 -- -- -- -- -- --
_ _ i- -- -- -- -- - .- 1 -
__ 2- -- -- 3- 53 2- 41
~29 12 36 20 38 22 32 15 38 15 49 15 44 12 43 12
Abington
Agawam
Amherst
Andover
Ashland
Athol .
Attleboro
Avon .
Barnstable
Barre .
Belchertown
Belmont
Beverly
Billerica
Boston
Bourne
Braintree
Bridgewater
Brockton
Brookline
Cambridge
Canton
Chelsea
Chesterfield
Chicopee
Cohasset
C'olrain
Meningitis, Pneumococcal
1942 1943* 1944 1945 1946 1947 1948 1949
CDCDCDCDCDCDCDC
--- !____-__---
___ _!_____-___
_ _ _ 1- 11 -- -- -- -
1__ ____-_-----
1 -- -- ___I II I
i : : i 1----1----
- - ...... ii -- -- ii -- - •
5 5 6 49 8 15 7 12 7 9 1
1 _■_•_•__.__----.
Ill -- -- -- -1 -- -
321 21 --12 ------
2-2 1 - 1 - - - - 1 1 - - ■
523 44 42 43 54 --2-
lii i i i i i i : : : : I :
43- 1---11--11--
11- 1 - - - 1 ~ . " - - -• - "
*Deaths not available.
210
P.D. 34
Meningitis, Pneumococcal — Continued
1942 1943* 1944 1945 1946 1947 1948 1949
CDCDCDCDCDCDCDCD
--- __.__■___■___!_
___ i •___-••__•_._■■__■_ _
__- i_ __________
__1 -_ - _ ______ _. _
11- -_----______
2 - - 1 1 2 ------ -
--2 --1121----1-
1__ ____!_____ 1 Z
_ - 1 -- --11 ______
- - - 1- -- 1- 1- 1- --
___ ii.__ ________
211 -1-11--- 11 -~ _
1__ ____________
1__ -------_____
_ _ 1 ______!___!_
2-1 11 -- -- -- 1- --
__1 ____________
- - - 22 11 -- 11 -- 1-
11 -- -- l- __ __
1-- 21---- 11----
111 ________i_i_
-11 22--22--1121
--3 1- -- 11 -- -- --
___ ----11 ______
___ 1- ----_-____
- ~- 1 1- -I----11- --
- -- 1- -- -- 11 -- --
___ 1- ______ ____
111 _______ _2_ _-
_ _ i ___________!
"_- --111- ______
_-2 -- 22--1 ______
I I - 1 2 ------- Z -
1 _______
II- __ _-ii ______
II- 1 -1-.-- ______
_ __ ___________i
_ _ i ____________
III _1 _-__.'___•___
- - - 11 -1 1- 11 12 1 -
- - 1 _-_---______
I _ _ _________!_!
11- 3 _____ 2 - - - 1 -
II- ii---_______
1 2 1-1 ---12 1-1
21 -- -- -- -- --
__1 ____________
224 3 411 ----22--
1
1 - - _----_-_____
I__ ____________
- 1 - _------_____
I__ __________!!
- - 1 ____________
___ i---________
11 -- -- -- -- __
Conway
Danvers
Dartmouth
Dracut
Duxbury
Easthampton
East Bridgewater
Easton
Everett
Fall River
Falmouth
Fitchburg
Foxboro
Framingham
Franklin
Gill
Gloucester
Grafton
Greenfield
Hampden
Haverhill
Hingham
Holliston
Holyoke
Hudson
Ipswich
Lawrence
Leominster
Lexington
Lowell .
Lunenburg
Lynn .
Maiden
Manchester
Mansfield
Marblehead
Marion
Mattapoisett
Medford
Melrose
Merrimac
Methuen
Milford
Millbury
Natick .
Needham
New Bedford
Newburyport
Newton
Norfolk
North Reading
Northampton
Northboro
Northbridge
Norwood
Oak Bluffs
Oxford .
Palmer
Pittsfield
Quincy
Randolph
Reading
Revere
Salem .
Sandwich
Sharon
Shrewsbury
Somerville
Southbridge
Spencer
Springfield
Stoneham
Sturbridge
Sunderland
Swampscott
Sutton .
Taunton
Tewksbury
Wakefield
Walpole
Waltham
Ware .
*Deaths not available.
P.D. 34
211
Meningitis, Pneumococcal — Continued
1942 1943* 1944 1945 1946 1947 1948 1949
CDCDCDCDCDCDCDC D
__________!_
---------- 1-
1 ____________
22 -------- --
________ 21 --
-------- 11--
_ _ _ _ ii _ _ _ _ _
1 ii___i ______
9 1151422-1-31
46 27 58 51 71 45 42 24 48 26 30 24 30 17 23 8
Warren
Watertown .
1
-
Webster
-
1
Wellesley
1
Westfield
1
1
Westport
-
_
Weston
_
_
West Springfield
-
-
Weymouth .
1
1
Winchester .
_
_
Winthrop
-
-
Wobarn
—
—
Worcester
2
1
Total
Meningitis, Other Forms
Adams
Arlington
Ashland
Athol .
Attleboro
Barnstable
Beverly
Blackstone
Boston
Braintree
Brockton
Brookline
Cambridge
Carver
Chelsea
Chicopee
Dedham
Dracut
Easton
Everett
Fairhaven
Fall River
Foxboro
Gardner
Greenfield
Groton
Groveland
Haverhill
Hingham
Holbrook
Hudson
Lawrence
Lowell
Ludlow
Lynn .
Maiden
Medfield
Milford
Milton
Montague
Needham
New Bedford
Northampton
Norwood
Orleans
Palmer
Phillipston
Pittsfield
Plymouth
Quincy
Randolph
Revere
Salem .
Saugus
1942
1943*
1944
1945
1946
1947
1948
1949
C
D
C
D
C
D
C
D
C
D
C
D
C
D
C D
-
-
-
1
-
1
2
-
-
-
-
-
1
-
-
1
1
1
—
-
1
1
2
1
8
1
17
9
-
5
1
1
1
1
2
1
1
2
1
1
1
1
1
-
2
1
1
-
1
1
1
2
1
- -
1
1
1
-
-
1
-
-
-
-
-
1
-
-
- -
1
-
1
1
-
-
2
1
1
-
1
1
-
-
-
1
2
1
_
_
_
_
_
_
_
_
_
_
1
_
_
_
1
-
-
-
-
1
-
-
1
-
1
:
-
-
1 1
1
1
-
1
1
1
1
:
1
1
-
=
1
1
-
2
1
1
2
_
1
-
1
-
-
-
-
-
-
-
-
-
-
-
1
-
3
1
-
1
-
-
-
1
-
-
-
-
1
1
1
_
—
-
—
1
-
-
1
1
1
1
1
2
1
1
-
-
-
1
2
1
-
-
-
-
1
-
-
1
-
2
-
-
-
-
-
-
-
-
-
-
-
1
_
*Deaths not available.
212
P.D. 34
Meningitis, Other Forms — Continued
1942 1943* 1944 1945 1946 1947 1948 1949
CDCDCDCDCDCDCDCD
1-2 -1 1- 1- 1- -- --
__1 ____________
11- _-__i_i_____
1__ ____________
1- ________i_i_
1__ ____________
__1 ____________
2 1 - 1 - - - 1 -
29 11 28 11 20 6 25 7 10 5 10 5 11 3 15 5
Scituate
Somerville
Springfield
Swampsoott
Taunton
TJxbridge
Wakefield
Walpole
Waltham
Wareham
Webster
West Bridgewater
West Springfield
Weymouth .
Winthrop
Worcester
Wrentham .
Total .
Meningitis, Undetermined
1942 1943* 1944 1945 1946 1947 1948 1949
CDCDCDCDCDCDCDCD
Adams
0
1
Agawam
-
-
-
-
_
_
_
_
_
1
_
_
-
-
-
Amesbury
_
-
_
_
_
_
_
1
_
1
_
_
-
_
-
Amherst
1
Andover
_
_
_
1
_
_
_
_
_
_
_
i
_
_
-
Arlington
-
_
3
-
-
_
-
_
-
_
-
2
-
1
_
Ashburnham
-
-
_
_
_
_
—
_
_
_
_
1
_
-
_
Ashland
_
_
1
1
Attleboto
_
_
_
1
_
_
1
_
_
_
_
_
_
_
-
Auburn
_
_
-
1
1
_
_
-
_
-
1
-
_
-
Avon
_
_
_
_
_
_
_
_
_
_
_
1
_
_
Bedford
1
-
Belmont
_
_
1
_
_
_
_
1
_
_
_
_
_
_
-
Beverly
-
-
-
_
1
_
_
-
_
_
1
_
-
1
Boston
1
_
31
15
8
11
7
3
<>
1
in
?,
6
>
4
Bourne
_
_
2
Braintree
_
_
1
_
_
?,
_
_
_
_
_
_
_
1
-
Bridgewater
-
-
1
_
_
1
_
_
_
_
_
_
-
_
_
Brockton
1
_
1
4
_
_
1
_
_
?,
i
3
1
1
_
Brookline
_
_
_
1
2
_
_
_
-
Buckland
_
_
_
_
_
_
1
_
_
_
-
-
_
Cambridge
_
_
6
5
_
3
2
2
7
6
?,
4
1
1
1
Canton
_
_
1
_
_
_
1
_
_
_
_
-
_
Carlisle
_
_
_
2
Charlton
_
_
1
Chelsea
_
_
1
1
_
1
1
Chelmsford
2
_
Chicopee
_
_
_
_
_
_
_
1
_
1
_
1
_
_
_
Clinton
_
_
_
_
_
_
1
_
_
_
_
_
_
_
-
Dalton
_
_
_
_
_
_
1
_
_
_
_
_
_
-
Dracut
1
_
_
_
_
_
_
_
_
l
_
_
-
_
Dudlev
_
_
_
_
_
_
_
_
_
1
_
_
_
East Brookfield
_
_
_
_
_
_
_
_
_
_
_
1
_
_
-
Easthampton
_
_
_
_
_
1
_
_
_
_
_
_
-
_
-
Easton
_
_
_
2
Everett
_
_
1
1
_
_
1
_
_
.
_
1
1
-
-
Fall River .
_
_
4
2
1
_
1
_
_
3
_
_
_
9
-
Falmouth
_
_
1
_
1
Fitchburg
_
_
2
1
_
_
1
_
_
_
_
_
_
-
Foxborough .
-
Framingham
_
_
1
1
_
_
_
0
_
_
_
_
_
—
Gloucester .
_
_
1
_
_
_
_
1
_
_
_
1
_
Grafton
1
Great Barrington .
_
_
_
_
_
_
_
_
_
1
_
_
_
-
Greenfield
-
Hanover
_
_
1
-
Hanson
_
_
_
_
_
_
1
_
_
_
_
_
-
-
Haverhill
_
_
2
_
_
3
_
2
_
3
l
1
_
2
_
Hingham
_
_
_
2
Holden
_
_
_
_
_
_
_
_
_
1
_
_
_
-
-
Holbrook
_
_
1
Holyoke
-
-
1
1
1
-
-
-
-
1
l
-
-
-
-
*Deaths not available by communities.
P.D. 34
Meningitis, Undetermined — Continued
213
Hopedale
Lawrence
Lenox .
Leominster
Lexington
Longmeadow
Lowell
Ladlow
Lynn
Maiden
Marblehead
Marlboro
Medford
Melrose
Methuen
Middleboro
Milford
Military Est.
Millbury
Milton
Monson
Montague
Nantucket
Needham
New Bedford
Newburyport
Newton
Norfolk
North Adams
Northampton
North Attleboro
Northbridge
Norton
Northampton
Norwood
Palmer
Paxton
Peabody
Pembroke
Pittsfield
Plainfield
Plainville
Plymouth
Quincy
Randolph
Rehoboth
Revere
Rockport
Rowley
Salem
Salisbury
Saugus
Scituate
Sheffield
Shirley
Shrewsbury
Somerville
South Hadley
Southbridge
Spencer
Springfield
Sterling
Stockbridge
Stoughton
Swampscott
Taunton
Tempi eton
Uxbridge
Wakefield
Waltham
Ware .
Wareham
Watertown
Webster
Wellesley
West Boylston
West Bridgewater
West Springfield
Westboro
Westfield .
Westwood
1942
C D
1943*
C D
1944 1945 1946 1947 1948
CDCDCDCDCD
1 1
1
2
1 1
2
1
1
1
2 2
1 - 2
1
1
1 1
2
1 1
1 1
1-11
-21-
3 1 1
1
- - - 1
-11-
11--
-721
4 3 3
1 1
1 1
1 1
1
1
1
1 1
1
1
1949
C D
1 1
1 1
*Deaths not available.
214
P.D. 34
Meningitis, Undetermined — Continued
1942
1943*
1944
1945
1946
1947
1948
1949
C
D
C
D
C
D
C
D
C
D
C
D
C
D
C D
Weymouth .
_
_
1
1
_
_
9
1
_
_
_
1
_
1
Williamstown
-
-
1
-
-
-
-
-
-
1
-
1
-
- -
Winchendon .
-
-
-
-
-
-
-
-
-
-
-
1
-
-
Winthrop
-
-
-
-
-
-
1
-
-
-
-
-
-
-
Woburn
-
-
2
Worcester
-
-
10
10
1
2
-
3
2
7
-
5
_
2 2
Wrentham .
-
-
1
2
-
-
-
-
-
2
-
-
-
-
Total .
10
-
130
46
108
24
41
36
44
25
57
26
58
18
43 19
*Deaths not available.
Rocky Mountain Spotted Fever
1942 1943 1944 1945 1946 1947 1948 1949
CD CDCDCDCDCDCDCD
__ __ __ __ __ __ __ i_
_ _ _ _ i_ ii __ __ __ __
__ __ __ __ __ i_ __ __
- - 2 - 11 1- 3- -- 1 -
Barnstable
Chatham
Dennis
Oak Bluffs
Worcester
Total
Salmonellosis
Adams .
Amesbury
Amherst
Andover
Arlington
Athol .
Attleboro
Auburn
Ayer .
Barnstable
Becket
Bedford
Belmont
Bernardston
Beverly
Billerica
Boston
Boylston
Braintree
Brewster
Bridgewater
Brockton
Brookline
Cambridge
Canton
Chatham
Chelsea
Chicopee
Dalton
Danvers
Dartmouth
Dedham
East Bridgewater
Erving
Everett
Fall River
Falmouth
Fitchburg
Framingham
Gardner
Gloucester
Grafton
Granby
Greenfield
Hatfield
Haverhill
Hingham
Holden
1942
1943
1944
1945
1946
1947
1948
1949
C D
C
D
C
D
C D
C
D
C 'D
C D
C D
4
1
1
1
1
1
2
2
1
1
-
-
1
5
2
1
2
1
- -
-
-
-
- -
-
-
1
1
1
- -
21 1
1
P.D. 34
215
Salmonellosis — Continued
1942 1943 1944 1945 1946 1947 1948 1949
CDCDCDCDCDCDCDC D
-- 1- -- -- 2 - 6- 2- 11
-- -- 1- -- -- -- -- --
3- 4- 6 - 3- 5- 4- 11 1 -
1_ i __ __ __ __ __ i
__ i_ __ __!_ __ __ 2-
3- 2- -- 1- 3- 6- 2- 4 -
2- -- l- l- -- 1- -- - -
-- 2- 31 21 32- 4- 1- --
2- -- 7 - 8- 6- 1- 4- 2 -
- - 5- -- -- -- -- --
1_ __ __ __ __ __ __ __
- - 5- 1- 6- 5- 1- -- 1 -
__ __ __ __ __ i_ __ __
1- 2- 4- -- -- 3- 4- --
3- 1- 5- 1- 4- 3- 1- --
1- 1- 1- 1- 3- -- 2- --
__ __ __ __ __ __ i_ __
__ __ i_ __ __ __ __ __
__ __ __ __ __ i_ __ __
- - 1- _- 3- __ i_ 2- --
__ __ i_ __ __ __ __ __
__ __ __ __ __ 3_ i_ i-
2- --13- 4- 8- 2- 1- 1 -
- - - - -- -- -- -- 6- --
- - - - - - -- -- -1 -- --
1_ __ __ __ __ __ __ __
1- i_ __ __ __ i_ __ i_
__ __ __ __ __ _ ,_ i_ -_
__ __ __ __ __ i __ __
-- 3- -- -- 3- 3- 1- 1 -
__ __ __ __ __ __ i_
12 1 -- --36- 2- 2- -- --
1- -_ __ __ __ __ __ _-
__ __ i_ __ __ __ __ __
-- -- 1- 3- 2- 2- -- --
6-10- 4- 4- 6- 6- 3- 2-
__ __ __ i_ __ __ __ __
__ i_ __ __ __ __ __ __
5- 2- 2- -- -- 3- 3- 1 -
__ __ __ __ i_ __ __ _-
__ __ _ _ __ 2- -- -- --
1- -_ i_ __ __ 2- -- --
1_ __ __ __ __ __ __ __
1_ i_ __ __ __ __ __ _-
1- -- 3- -- 3- 1- -- --
__ __ __ __ __ i_ __ __
__ __ __ __ __ i_ __ _-
- - 11- -- _- 1- l- -- --
__ __ __ __ 2- -- -- --
1_ __ __ __ __ __ __ --
__ __ __ __ __ i_ __ _-
__ 2- - • 1 -- -- 2- --
1- __ 2- -- -- -- -- --
4- 1- 2- -- 1- 4- -- 1 -
_- __ __ i_ __ __ __ --
2- -- 1- -- 1- 2- -- --
1- 2- 6- 1- 1- 2- -- 2 -
5- __ __ __ __ __ __ __
__ __ __ __ __ 3_ __ --
__ __ i_ __ __ __ __ --
__ i_ __ __ __ __ __ --
-- 2- -- -- -- -- -- --
-- i- __ i_ __ i_ __ --
__ -_ __ __ __ 2- -- --
2- 2- -- -- 1- 2- 1- --
2- -- -- -_ -_ -- -- --
2- 4-11- -- 5-15 1 81 1-
-- -_ __ __ i_ __ _- --
109 2 158 2 120 1 124 2 180 1 156 2 72 2 130 2
Holyoke
Hopedale
Hull .
Ipswich
Lawrence
Leominster
Lexington
Lowell
Ludlow
Lynn
Maiden
Manchester
Mansfield
Marblehead
Marshfield
Medford
Melrose
Methuen
Millbury
Milton
Montague
Monterey
Natick .
Needham
New Bedford
Newburyport
Newton
Norfolk
North Adams
North Andover
Northampton
Northfield
Norton
Norwood
Otis .
Palmer
Peabody
Pittsfield
Plymouth
Quincy
Reading
Rehoboth
Revere
, Salem
Salisbury
Sandwich
Saugus
Sheffield
Somerville
South Hadley
Southampton
Southbridge .
Southwick .
Spencer
Springfield .
Stoneham
Sutton
Swampscott .
Taunton
Templeton .
Topsfield
Tyringham .
Uxbridge
Wakefield .
Walpole
Waltham
Ware
Watertown .
Wellesley
West Boylston
West Bridgewater
West Stockbridge
Westboro
Westminster .
Weymouth .
Winchendon .
Winchester .
Winthrop
Woburn
Worcester
Yarmouth
Total .
216
P.D. 34
Septic Sore Throat
Acton .
Acushnet
Adams
Amesbury
Amherst
Arlington
Athol .
Attleboro
Avon
Barnstable
Barre .
Bedford
Belmont
Beverly
Billeric a
Boston
Bourne
Braintree
Bridgewater
Brockton
Brookfield
Brookline
Burlington
Cambridge
Canton
Carver .
Chelmsford
Chelsea
Chicopee
Clinton
Colrain
Dartmouth
Dedham
Easthampton
Easton
East Bridgewater
Everett
Fall River
Falmouth
Fitchburg
Foxboro
Framingham
Freetown
Gardner
Georgetown
Gloucester
Grafton
Greenfield
Groton
Hanover
Haverhill
Hinsrham
Holbrook
Holliston
Hoi yoke
Hudson
Hull .
Ipswich
Lancaster
Lawrence
Leominster
Lowell
Ludlow
Lynn
Maiden
Mansfield
Marion
Marlboro
Maynard
Medford
Melrose
Merrimac
Methuen
Millbury
Military Est.
Milton
Montague
Natick
New Bedford
Newburyport
Newton
Norfolk
1942
C D
1 2
4 1
46 2
1
4 1
1943 1944 1945 1946 1947 IB48 1949
CDCDCDCDCDCDCD
26
77 1 87 2
- - 1 -
96
74
48
10
1
1
1
2
1
1
-
1
-
-
1
-
20
7
2 1
1 1
P.D. 34
217
Septic Sore Throat — Continued
1942 1943 1944 1945 1946 1947 1948 1949
CDCDCDCDCDCDCDC D
_- _- 2- 12 2- -- 1- --
__ -_ __ __ _ _ 2- -- --
2- -- -- -- -- -- __ -
1- __ __ __ __ __ __ __
__ __ __ 2- -- -- -- --
__ __ __ __ __ __ __ 2-
41 -- 3- 3- 2- 21 -- 1 -
__ __ __ __ __ __ __ i_
__ __ __ -_ __ i_ __ __
__ __ 2- -- -- -- -- --
__ _i __ _,■_.__ __ __ __
-- -- -- -■-■__ -- 1- __
1- __ _- i_ 2- 1- -- --
__ i- __ __ __ __ __ __
__ __ i_ _ _ __ __ __ __
__ __ __ i_ __ __ __ __
-1 1- -- 3- 3- -1 -- --
-- 13 -1 -1 12 -1 -- --
1- __ - - __ __ __ i_ __
_1 _- __ __ __ __ __ __
_ _ 31 __ __ _ _ __ __ i_
-- -- -- -- -- - - -- 1 -
-- -- -- -- -- -- 1- --
1_ __ i_ __ __ __ i_ _ _
-- -- -- -- -- -- -1 --
__ 6- - -- -- -- -- -
5_ __ __ -i __ __ __ __
__ __ __ __ __ i_ __ __
__ __ i_ i_ __ __ __ _i
_ _ __ __ _i __ _ ._ __ __
-_ -- 1- 1- -— 2- 1- -1
1- 1- -- -- -- -- -- --
1_ i_ __ __ 4_ __ __ 3_
__ __ __ __ i_ __ __ _
1_ __ __ i_ __ _ ._ __ __
1- 3- 4-10-10- -- -- --
4- -- -- -- -- -- -- --
5_ 3_ 4_ __ __ __ _ _ __
2- -_ 1- __ __ -- -- _-
6- 2- 2- 2- -- -- --12-
171 18 160 15 188 8 200 15 179 9 113 7 85 6 96 6
North Adams
North Brookfield
Northampton
Northbridge
Norwood
Orleans
Orange
Pittsfield
Quincy
Randolph
Reading
Revere
Rockland
Rutland
Salem
Salisbury
Scituate
Sharon
Somerville
Springfield
Stoneham
Sutton .
Swampscott
Taunton
Templeton
Tewksbury
Topsfield
Upton
Uxbridge
Wakefield
Waltham
Warren
Watertown
Webster
West Newbury
West Springfield
Westford
Weston
Weymouth .
Whitman
Williamstown
Winchendon
Winchester .
Winthrop
Worcester
Total .
Tetanus
1942 1943 1944 1945 1946 1947 1948 1949
CDCDCDCDCDCDCDC D
Acton
Ashburnham
Attleboro
Beverly
Billerica
Blackstone .
Boston
Boxboro
Bridgewater .
Brockton
Brookline
Burlington .
Cambridge .
Chelsea
Chicopee
Dartmouth .
Deerfield
Duxbury
East Bridgewater
Fall River .
Falmouth
Framingham
Gloucester .
Grafton
1 1
1 1
1-212
1 1
2 1
1 1
1 1
111-
--11
1 1
2
218
P.D. 34
Tetanus — Continued
1942 1943 1944 1945 1946 1947 1948 1949
CDCDCDCDCDCDCDCD
-- -- -- -- -- 1- -- _ _
-- -- 1- -- -- -- __ __
11 11 -- -- -- -- -- __
1- -- -- -- -- -- __ __
-- -- -- -- -- i- __ __
- - -- -- 1- -- -_ __ __
-- -- -- -- -- -_ i- _ _
-- 11 -- 1- -- -- __ __
- i -- -_ _- II I Z II II
- - - - 21 -- -I -I II II
-- -- -- -- 1- __ __ __
-- -- -- -- -- -- -- 1 -
1- -- - - -- -_ __ __ __
- - -- 11 - - -_ _- -_ __
-- -- -1 -- -_ _ _- __
1- -- -- -- -- -- 1- __
1- -- -- _- __ __ __ __
-- -- 1- _- __ __ __ __
-- -- 1- -_ __ - - __ __
-- 11 -- -_ __ _ - __ __
-- -_ -- -1 __ __ __ __
-- 1- -_ __ __ __ __ __
- - - - 1- -- 3- 1- 1- 1 -
11 ----11 ________
-- -- 21 -- 2- -- -- 1 -
__ 1_ __ __ __ __ __ __
__ __ __ __ __ __ __ i_
__ _- _- __ __ __ i_ __
__ __ -i __ __ __ __ __
2- 1- 11 -- -- 11 -- --
__ __ __ __ __ __ __ i_
__ __ __ __ __ __ __ i-
__ _i __ __ __ __ __
__ __ __ __ i_ __ __ __
__ __ __ __ __ i_ __ __
__ __ __ __ __ __ __ 1
__ _- __ i_ __ __ 21 --
11 4 14 8 18 8 12 4 13 3 10 1 9 2 11 -
Great Barrington
Hanover
Haverhill
Holyoke
Hopkinton
Kingston
Lawrence
Lexington
Lowell
Lynn .
Maiden
Medford
Medway
Methuen
Milford
Natick
New Bedford
Newbury
Newton
Norfolk
North Attleboro
North Reading
Northbridge
Oakham
Orange
Peabody
Pittsfield
Plymouth
Quincy
Raynham
Rockport
Shrewsbury
Somerville
South wick
Springfield
Taunton
Wakefield
Wareham
West Springfield
Weymouth
Whitman
Worcester
Total .
Trachoma
1942
1943 1944 1945 1946 1947 1948 1949
C C C C C C C
Acton .
1
_
_
Arlington
_
_
1
_
_
-
-
-
Beverly
-
-
1
-
-
-
-
-
Boston
3
7
2
-
-
3
-
1
Brookline
_
_
_
-
1
-
-
Cambridge
1
_
1
-
-
-
-
1
Chicopee
_
_
-
-
1
-
-
-
OummingtriTi
—
_
-
—
—
1
—
—
Fall River
_
1
_
_
-
-
1
-
Foxboro
_
_
_
-
-
-
-
3
Hudson
-
1
-
_
-
-
-
-
Lee
_
_
1
_
—
—
—
—
Lynn .
_
-
_
-
-
-
1
-
Maiden
_
_
_
-
-
-
1
-
Medford
_
1
_
_
-
-
-
-
Medway
_
1
-
-
-
-
-
-
Milton .
_
_
_
_
-
1
-
-
Norwood
1
_
-
-
-
-
-
-
Quincy
1
1
-
-
-
-
-
-
Salem .
_
_
_
1
-
-
-
-
Wakefield
_
_
-
-
-
1
-
-
Watertown
_
_
1
-
-
-
-
-
West Boylston
1
-
-
-
-
-
-
-
West Tisbury
-
-
1
-
-
-
-
-
Weymouth .
_
1
-
-
-
-
-
-
Whitman
_
-
-
-
-
-
-
1
Worcester
1
-
-
-
-
1
1
_
Total
9
13
8
1
2
7
4
6
P.D. 34
219
Trichinosis
1942 1943 1944 1945 1946 1947 1948 1949
CDCDC DCDCDCDCDCD
1_ _ _ __ __ __ __ __ __
-_ -_ -_ __ __ i_ __ __
__ __ __ i- __ __ __ __
1- __ __ __ __ __ __ __
4- 7- 12- 13 -14- 19 1 4- 9 -
__ -_ -_ __ i_ __ __ __
-- -- -- -- -- - -- 1 -
__ __ i- _ _ _ _ __ __ __
1- -- -- 1- 3- 4- 4- 6 -
__ __ i- __ __ __ __ _ _
__ __ 3_ __ __ __ __ __
_ _ _ _ __ __ i_ __ __
__ __ __ i- -_ _. _ __ __
__ i_ __ __ __ __ __ __
2- _- -- -- -- -- 1- __
-- -- -- 1- 1- 4-11- 1 -
__ __ i i_ i- i_ __ __
_ _ _ _ _ _ _ _ _ _ 3 _ _ _ !
__ __ __ __ i_ __ __ __
__ __ __ __ __ __ 2- --
__ __ i_ __ __ __ __ __
- - - - - - - 1
__ __ __ __ __ __ 3_ __
__ __ i_ __ __ __ __
__ __ __ __ -_ __ i_ __
1- __ __ __ __ i- __ __
__ __ __ __ __ __ i- __
1- -- -- -- 1- 1- 2- 2 . -
__ i_ __ __ i_
__ __ i_ __ -_ __ __ __
_ _ _ _ i ■_ __ 2- -- 1- --
-- -- 1- -- -- -- -- --
__ __ __ -_ -_ 1- __
__ __ __ __ __ 2- -- --
__ __ __ i_ __ __ __ _ ■ _
3- -- -- -- -- -- -- --
__ __ __ __ -_ __ __ i-
!_ __ i_ -_ i- _- __ --
__ i_ __ __ __ _- -_ -_
__ __ __ __ -- -- -- 1-
__ __ __ i_ __ -_ -- --
__ __ __ __ __ -- i_ _-
__ __ __ _ - -- 3- -- --
__ __ __ _- _- i_ -- l -
__ __ __ __ __ l- -- l-
__ __ __ __ __ i- i- l-
__ __ __ i- -- -- -- --
_ _ _ _ _ _ i _ i - - - 1 - - -
__ __ __ __ __ i- -- --
!_ __ __ __ __ 2- -- --
__ 2- -- -- -- -- -- --
__ __ __ -- 3- - -
1- -- -- -- -- -- -- - -
1 _ __ _- __ -- -- -- --
__ __ i_ __ __ __ -- --
__ __ __ __ __ -- 1- --
__ __ __ _- 1- -- -- 1-
__ __ __ __ _- 2- -- --
__ _ _ __ 2- -- -- -- --
:: i : :: __ __ -- -- 1-
__ _- -_ _- -- -- i-
i- -- -- -- -- -- -- --
__ -_ _- l- 2- -- -- 3-
19 - 13 - 31 - 28 - 38 - 59 1 42 - 32 1
Adams .
Amherst
Andover
Arlington
Attleboro
Becket .
Belchertown
Boston
Bridgewater
Brockton
Brookline
Cambridge
Chelsea
Chesterfield
Concord
Danvers
Dighton
Douglas
Dover .
Everett
Fall River
Falmouth
Fitchburg
Framingham
Gloucester
Hadley
Hancock
Hanover
Haverhill
Hingham
Lakeville
Lawrence
Lenox .
Lexington
Lowell .
Maiden
Mansfield
Marblehead
Medford
Melrose
Methuen
Middleboro
Millbury
Military Est.
Natick .
New Bedford
Newton
Northampton
Norton
Norwood
Pembroke
Pittsfield
Plymouth
Quincy
Salem .
Shirley
Somerville
Springfield
Stoneham
Sutton .
Swansea
Taunton
Wakefield
Walpole
Waltham
Watertown
Wellesley
Wenham
West Stockbridge
Westport
Westwood
Williamstown
Winchendon
Worcester
Total
220
P.D. 34
Tuberculosis, Other Forms
1942
1943
1944
1945
1946
1947
1948
1949
C
D
C
D
C
D
C
D
C
D
C
D
C
D
C
D
Abington
1
1
Acton
Adams .
-
1
-
-
1
1
-
-
-
-
-
-
1
-
-
-
Agawam
1
1
Amesbury
1
-
-
1
-
-
1
1
-
1
-
1
-
1
-
1
Amherst
—
Andover
-
-
1
-
-
-
-
-
1
-
-
-
1
-
-
-
Arlington
2
-
-
-
-
1
4
-
1
1
-
-
2
-
2
-
Ashburnham
Athol . . . .
1
-
-
1
-
-
-
1
-
-
-
-
1
-
-
-
Attleboro
2
-
1
-
-
-
-
-
1
-
-
-
2
-
1
1
Auburn
Avon .
-
-
1
1
Ayer .
1
Barnstable .
-
-
-
-
1
-
-
-
-
-
-
-
1
-
-
-
Barre .
1
-
Becket . .
1
1
-
-
-
-
Bedford
1
Belohertown .
1
-
-
-
-
-
-
-
-
-
-
-
2
-
1
-
Belmont
1
1
2
3
-
-
-
-
3
-
-
-
1
2
1
-
Beverly
-
-
4
-
1
-
-
-
1
-
-
2
1
1
1
1
Boston
48
28
56
21
52
24
41
22
64
28
66
23
45
23
45
IV
Bourne
-
-
-
1
-
-
-
-
-
-
1
-
-
-
-
-
Braintree
-
1
-
-
-
1
1
1
-
-
2
-
1
-
1
-
Bridgewater
-
-
-
-
2
1
1
-
1
Brockton
2
2
2
1
3
-
2
2
2
-
3
2
1
2
4
-
Brookline
-
1
2
1
2
-
1
1
1
2
Burlington .
Cambridge .
17
5
9
4
12
3
6
-
8
1
13
2
5
1
3
1
Canton
-
-
-
1
-
-
-
-
1
-
-
-
-
-
-
-
Chelmsford .
1
1
Chelsea
4
-
3
-
2
2
2
-
1
2
2
3
-
-
-
-
Chicopee
-
1
-
-
1
-
-
1
4
3
2
1
2
-
-
2
Clinton
1
-
C oncord
-
-
-
-
1
1
-
-
-
1
2
Dalton
_
1
_
-
-
1
-
-
-
-
-
1
-
-
-
-
Danvers
-
-
-
_
1
2
-
-
-
1
-
1
2
1
-
-
Dartmouth .
1
-
-
-
-
-
1
-
1
-
1
-
-
-
-
-
Dedham
-
_
1
2
1
1
1
3
2
-
-
Deerfield
1
Dennis
1
1
Dighton
-
-
-
-
-
-
1
-
-'
-
-
-
-
-
1
-
Douglas
Dracut
-
1
East Bridgewater .
East Longmeadow
-
-
1
1
1
Eastham
Easton
Everett
-
3
5
1
4
1
5
2
1
-
-
1
1
-
1
1
Fairhaven
_
-
_
-
-
-
-
-
1
-
1
-
-
-
-
-
Fall River .
4
2
3
-
5
2
11
4
4
4
12
3
11
4
12
y
Falmouth
Fitchburg
4
-
2
1
-
4
1
1
1
1
3
1
1
1
1
-
Foxboro
1
-
-
-
-
-
-
-
-
-
-
-
1
-
1
-
Framingham
2
1
-
-
2
1
3
1
-
-
1
-
2
-
l
Franklin
-
-
-
1
-
-
-
-
-
-
-
-
1
-
-
-
Gardner
1
-
-
1
-
-
1
1
1
-
1
-
-
-
1
-
Gloucester .
2
2
-
-
5
-
1
-
1
-
-
1
-
-
1
-
Great Barrington .
-
-
1
-
-
-
-
-
-
-
-
1
-
-
-
-
Greenfield
-
2
1
-
-
-
1
1
1
-
Groton
Hadley
2
1
-
-
Hanover
-
-
-
-
1
1
Harwich
Hatfield
Haverhill
. 1
-
3
1
2
-
1
1
5
2
1
3
3
-
3
i
Hingham
-
1
-
-
-
-
1
1
-
1
1
Holbrook
1
1
Holden
-
1
1
1
_
-
Holyoke
3
3
3
2
3
2
3
-
7
2
3
-
1
-
-
-
Hopedale
1
Hudson
-
-
-
1
-
-
-
-
1
1
Ipswich
1
1
1
—
Lawrence
. 4
2
5
6
2
. 1
2
2
4
1
5
1
1
2
2
i
Leicester
. 1
Leominster .
.
-
1
-
-
-
-
-
-
-
1
2
-
_
_
-
Lenox .
Lexington
. 2
Longmeadow
. 1
1
Lowell
. 6
-
13
V
4
2
4
-
6
3
3
1
2
1
4
i
Ludlow
~~
—
2
1
2
1
1
P.D. 34
Tuberculosis, Other Forms — Continued
1942
c D
Lynn
Maiden
Manchester
Mansfield
Marblehead
Marion
Marlboro
Mattapoisett
Medford
Melrose
Merrimac
Methuen
Middleboro
Milford
Millbury
Millville
Military Est.
Milton
Monson
Montague
Nahant
Nantucket
Natick .
Needham
New Bedford
Newburyport
Newton
Norfolk
North Adams
North Andover
North Attleboro
Northampton
Northbridge
Norwood
Oak Bluffs
Orange
Palmer
Peabody
Pepperell
Pittsfield
Plymouth
Provincetown
Quincy
Randolph
Reading
Revere
Rockland
Rockport
Russell
Salem .
Saugus
Scituate
Seekonk
Sharon
Shrewsbury
Somerset
Somerville
South Hadley
Southampton
Southbridge
South wick
Spencer
Springfield
Stockbridge
Stoneham
Stoughton
Swampscott
Swansea
Taunton
Tewksbury
Tewksbury State Hospital
Tisbury
Townsend
Tyngsboro
Uxbridge
Wakefield
Walpole
Waltham
Ware .
Wareham
Warren
Watertown
1943
C D
1944
C D
1945
C D
1946
C D
1947
C D
1948
C D
221
1949
C D
222
P.D. 34
Tuberculosis, Other Forms — Continued
1942
1943
1944
1945
1946
1947
1948
1949
C
D
C
D
C
D
C
D
C
D
C
D
C
D
C D
Wayland
_
1
_
1
_
_
1
_
_
_
_
_
_
Webster
- -
1
1
1
1
1
-
_
_ _
Wellesley
-
-
3
-
-
-
-
-
1
1
-
1
_
-
_ _
West Boylston
1
West Springfield
1
1
Westboro
-
-
1
-
-
-
1
1
Westfield
1
3
1
-
-
-
-
1
-
-
1
_
-
_
_ _
Weston
1
1
Westport
1
Weymouth .
-
-
1
1
1
-
-
-
1
-
-
1
-
1
_ _
Whately
1
Whitman
1
Wilmington .
I
1
Winchendon .
1
Winchester .
-
_
1
2
1
-
-
1
-
-
_
_
1
_
1
Winthrop
2
1
1
1
2
1
-
-
1
Woburn
2
-
2
-
-
1
-
2
2
2
1
Worcester
9
5
18
7
6
1
9
F
6
3
3
5
7
2
2 1
Worthington . „
-
1
Wrentham .
-
2
1
Total .
199
118
221
109
193
84
164
79
179
82
187
89
166
82
138 59
Tularemia
1942
1943
1944
1945
1946
1947
1948
1949
C
D
C
D
C
D
C
D
C
D
C
D
C
D
C D
Boston
_
_
_
_
1
_
_
1
_
_
_ _
Bourne
2
Chilmark
1
Duxbury
1
Falmouth
-
-
2
-
-
-
-
-
-
-
-
-
-
-
- —
Grafton
1
1
-
-
- -
Holyoke
2
Lakeville
1
Sandwich
1
Scituate
1
Tisbury
1
.-
2
Waltham
1
Wareham
1
Total
-
-
3
-
1
-
-
-
2
-
7
2
1
-
4
Typhoid Fever
1942 1943 1944 1945 1946 1947 1948 1949
CDCDCDCDCDCDCD CD
__ __ _- 2- -- -- -- - -
_ •_ _ -- -- 1- -- -- --
2- -- -- -- 1- -- -- - -
__ __ __ l- -- -- -- --
5_ __ _- -- -- -- -- --
1- -- -- -- -- - - - ' - --
1- -- -- 21 1- --
13 1 32 7- 41 5- 5112 1 31
_ _ i- l- -- - • - -- 1- --
__ _- -- -- -- -- - - 1 -
_ _ i- -1 -- - - - - -- - -
2- -- -- -- -- -- -- 1 -
__ __ l- -- -- -- -- --
II 1 ~- 1- -- 2- -- -- - -
_- _- 1- 4- 31 -- -- --
__ _ _ -- -- -- 4- -- --
__ i_ -- -- -- -- -- --
I ::::::::::::: i :
i : i ::::::: r : : : i :
Adams .
Andover
Arlington
Attleboro
Becket .
Bellingham
Beverly
Boston
Brockton
Brookline
Brookfield
Cambridge
Charlton
Chelmsford
Chelsea
Chicopee
Clinton
Dalton
Dartmouth
Dunstable
East Longmeadow
Easton
Everett
P.D. 34
Typhoid Fever — Continued
223
1942
C D
1943
C D
1944
C D
1945
C D
1946
C D
1947
C D
1948
C D
Fairhaven
Fall River
Framingham
Gardner
Gloucester
Grafton
Haverhill
Holyoke
Ipswich
Lawrence
Leominster
Lowell .
Ludlow
Lynn
Lynnfield
Maiden
Marblehead
Medford
Melrose
Methuen
Middleboro
Milton .
Natick .
New Bedford
Newton
North Adams
North Attleboro
Norwood
Orange
Peabody
Pittsfield
Plymouth
Quincy
Randolph
Rehoboth
Rockland
Salem .
Shrewsbury .
Saugus
Shirley
Somerset
Somerville
South Hadley
Springfield .
Stoughton
Tewksbury .
Tewksbury State Infirmary
Waltham
Warren
Watertown .
Wellesley
West Brookfield
Westfield
Winthrop
Woburn
Worcester
Total
50
32
33
1
1
2 I
30
Arlington
Boston
Chelsea
Maiden
Military Est.
Williamstown
Total .
Typhus Fever
1942 1943 1944 1945 1946 1947 1948 1949
CDCDCDCDCDCDCDCD
1: : : 2 - - - 2 - - - - - 11
__ 1- -- -- -- -- -- --
__ _- - - - - 1- -- -- --
1- 1- 1- - - -- - - - - --
__ 1- -- -- -- -- -- -
2- 3- 3- -- 3- -- -- 11
224
P.D. 34
Undulant Fever
1942 1943 1944 1945 1946 1947 1948 1949
CDCDCDCDCDCDCDC D
-- -- __ -_ __ __ ii __
-- 61 -- 2 - 5- 1- -- --
- - -- -- -- -- -- -- 1 -
-_ -_ __ __ __ __ 21 --
1- _ _ -_ __ _ _ 2- -- --
_- __ __ i- __ __ __ __
__ __ __ __ i_ __ _._ __
__ -_ _- __ i_ __ __
-- -- -_ __ __ 2- -- --
-_ -_ __ __ __ i_ __ __
-_ -_ _- -_ __ i_ __ __
__ _ _ __ __ __ i_ __ __
_ _ -- i_ __ __ __ __ __
1_ __ __ __ __ __ __ __
-_ -_ -_ __ __ i_ __ __
-- 1- 7 - 1- 2- 3- 2- 1 -
-_ __ i- __ __ __ __ __
-- -- -- -- -- -- -- 1 -
__ __ __ __ __ i_ __ __
1- - - 1- -- 1- -- 3- 1 • -
__ __ __ __ __ i_ __ __
__ __ i_ __ __ __ __ __
1- __ _ i_ __ __ __ __
-_ 1- __ 2- -- 1- -- --
__ __ i- __ __ __ _ . _ __
2- -- 1- _- -- -- l- __
_ _ __ __ __ i_ __ __ __
__ _i __ __ __ __ __
1_ __ __ __ __ __ __ __
__ i_ __ __ __ __ __■_•_
__ __ __ __ __ __ i_ __
__ __ _ __ __ i_ __ __
1_ __ __ __ __ __ __ __
__ __ __ __ __ i_ __ __
__ i_ ii __ __ __ __ __
1- - - 1- -- -- 1- -- 1 -
__ 2- -- -- -- 1- 1- 1 -
__ __ __ __ __ __ __ i_
__ __ __ i- __ __ __ __
1_ __ __ __ i_ __ __ __
__ __ i_ __ __ __ __ __
__ __ i_ __ __ __ __ __
1_ __ i_ __ __ i_ __ __
__ __ __ __ __ i_ __ __
1_ i_ __ __ __ __ __ __
__ __ __ i_ __ __ __ __
2- 2- -- 2- - - -- 1 - --
1_ i_ __ _i _ _ i_ 1
1_ __ __ __ __ i_ __ _
__ __ __ __ i_ __ _ _ __
__ __ __ i_ __ __ __ _ _
-- -- -- -- 1- -- -- --
__ __ __ i_ __ __ __ __
1- 1- 1- -- -- -- --
__ __ __ _i i_ i- _ ■ _ _ _
__ i_ __ __ __ __ __ __
_ _ __ __ __ i_ __ __ __
__ __ __ __ __ i- -_ __
__ __ i_ i_ __ 3- i_ _
_ _ 3- __ - - - - -- 2- --
-- 1- -- -- -- -- -- - -
__ _ _ __ __ _- 2- -- --
1_ __ __ __ __ _- -_ __
__ __ __ __ i_ __ _ _ i-
__ __ __ __ __ i __ __
1_ __ __ __ __ i_ __ _ _
__ __ __ __ __ __ __ i_
-- 1- -- -- -- -- -- --
__ __ __ __ __ i_ __ -_
Acton .
Adams
Aga am
Alford .
Amesbury
Ashburnham
Ashfield
Ashland
Attleboro
Auburn
Avon .
Bedford
Belchertown
Belmont
Beverly
Billerica
Blandford
Bolton .
Boston
Bourne
Boxboro
Boxford
Bridgewater
Brimfield
Brockton
Brookfield
Brookline
Burlington
Cambridge
Carlisle
Charlemont
Chatham
Chelsea
Chesterfield
Chicopee
Clarksburg
Clinton
Conway
Dalton
Danvers
Dartmouth
Deerfield
Dighton
Douglas
Dudley
Kast Bridgewater
East Brookfield
East Longmeadow
Easton
Egremont
Falmouth
Fitchburg
Foxboro
Framingham
Franklin
Freetown
Gardner
Gloucester
Grafton
Great Barrington
Greenfield
Groveland
Hampden
Hanson
Hard wick
Hatfield
Haverhill
Ha ley
Hinsdale
Holbrook
Holyoke
Hopedale
Hopkinton
Ipswich
Lancaster
Lee
Lenox .
Leominster
Lexington
Lincoln
Lowell .
Ludlow
P.D. 34
225
Undulant Fever — Continued
1942
C D
1943
C D
1944 1945 1946 1947 1948 1949
CDCDCDCDCDCD
Lunenburg
Maiden
Mansfield
Marblehead
Mattapoisett
Maynard
Medford
Medway
Melrose
Merrimac
Methuen
Middleboro
Milford
Millbury
Military Est.
Millville
Nantucket
Natick .
New Ashford
New Bedford
New Marlboro
Newton
Norfolk
North Adams
North Andover
North Brookfield
Northampton
Northboro
Northbridge
Northfield
Norton
Norwood
Oxford .
Palmer
Paxton
Pembroke
Pepperell
Plymouth
Quincy
Raynham
Rehoboth
Revere
Rockport
Rutland
Sandwich
Saugus
Sheffield
Shelburne
Somerset
Somerville
Southampton
Southboro
Southbridge
South wick
Spencer
Springfield
Sudbury
Swansea
Taunton
Templeton
Tewksbury
Townsend
Uxbridge
Waltham
Ware .
Wareham
Warren
Watertown
Webster
Wellesley
West Bridgewater
West Brookfield
West Springfield
Westboro
Westfield
Westminster .
Weston
Weymouth
Whately
Whitman
Wilbraham
Williamstown
1
1 1
226
P.D. 34
Undulant Fever — Continued
1942 1943 1944 1945 1946 1947 1948 1949
CDCDCDCDCDCDCDC D
__ __ __ __ __ __ __ i
__ __ i_ __ __ __ __ __
__ __ __ __ i_ __ __
1- -- -- 2- 2-23- -- --
__ __ __ __ i_ __ __ __
35 - 43 1 46 1 49 3 52 3 76 - 39 2 31 -
Weils Disease
1942 1943 1944 1945 1946 1947 1948 1949
CDCDCDCDCDCDCDC D
11 -- 11 -1 -- -- -- --
__!____ ________
!1 __ __ __ __•_._
__ __ __ i _ __ ____ __
__ __ __ 2- -- -- -- --
1- -- -- -- -- -- - --
11 2- 22 31 -- -- -- --
Wilmington
Winchester
Woburn
Worcester
Yarmouth
Total
Boston
Gloucester
Medford
Monson
Ware
Watertown
Total
P.D. 34
227
DIVISION OF VENEREAL DISEASES
CONSOLIDATED REPORT 1942-1949
Nicholas J. Fiumara, M.D., M.P.H., Director
The period between 1942 and 1949 saw the development of the antibiotic era in
venereal disease control. These antibiotics revolutionized the treatment of all the
venereal diseases, syphilis in particular. This period too was marked with discoveries
in the diagnostic field rivaling in importance even the antibiotics. However, before
going into the discussion of the utilization of these monumental tools in our venereal
disease program, it may be well to review very briefly the highlights of the work of
the Venereal Disease Division.
Administration
The Division of Venereal Diseases moved from the State House in 1945 and has
since occupied a suite of offices on the second floor of the Ford Building, 15 Ashbur-
ton Place, Boston. It has had, and still continues to have, an authorized comple-
ment of a Director, Assistant Director, three Public Health Nursing Supervisors,
and a stenographic and clerical force of eleven, up to June 1949, when, because of
budgetary limitations, the stenographic force was reduced by one. In addition to
the three Public Health Nursing Supervisors, the Division also employed a full
time epidemiologist up to 1942 when this position was abolished. Throughout this
period the Division also saw a succession of Division Directors beginning with Dr.
Ernest Howard in 1941 who, on April 20, 1942, received a military leave of absence
and entered the Armed Forces. He later resigned his position with the Depart-
ment. Dr. Howard was followed by Dr. John B. Hozier, Passed Assistant Surgeon,
U. S. Public Health Service, who was loaned to the Department. He was followed
by Dr. George E. Perkins in 1945 who died on April 3, 1947. On April 7, 1947, Dr.
Nicholas J. Fiumara was appointed Director of the Division and remains to the
present time.
Budget
In the following table may be seen at a glance the appropriations for the Di-
vision :
Table I
State
General Federal
Federal
Year Appropriation
Funds
R.T.C. Funds
Total
1942 .... 305,108.25
180,000.00
485,108.25
1943 .
250,397.00
143,100.00
393,497.00
1944 .
256,038.55
150,000.00
406,038.55
1945 .
262,881.35
106,366.60
369,247.95
1946 .
277,290.00
124,861.56
25,918.60
428,070.16
1947 .
279,690.00
53,560.00
32,537.07
365,787.07
1948 .
287,730.00
44,165.00
16,920.66
348,815.66
1949 .... 271,197.00
31,160.00
7,486.95
309,843.95
Modus Operandi. The object of the Division is to plan, promote, and carry out
a good, sound Venereal Disease Program in accordance with established rules and
regulations to the end that Venereal Diseases may be prevented, or if they occur
that they may be found and treated. Both of these objectives, prevention and con-
trol of venereal disease, imply the promotion of sound social hygiene in the former
and facilities for case finding, case holding and case treatment in the latter.
The Division is not alone in carrying out a preventive program for disease. It is
a well known fact that sexual promiscuity is the underlying factor in the spread of
venereal disease ; that if sexual promiscuity is reduced or controlled there will be a
corresponding decrease in venereal disease. One of the methods used to discourage
promiscuity is to make such illicit relationships illegal and punishable under the
law. Thus the fear of legal sanction decreases the extent of promiscuity.
More important than the fear of legal sanction is the education of the individual
in the principles of good, sound social hygiene. This is a continuing process be-
ginning in infancy and carried out into adulthood. The education begins in the
home and is supplemented by the teachings of the church, schools, physician, com-
munities, youth agencies, law enforcement groups, welfare, social agencies, etc.
All of these groups of people by their concerted action can influence the incidence of
sexual promiscuity and venereal disease.
228 P.D. 34
In the operation of its control program the Division of Venereal Diseases receives
daily the reports of venereal disease from physicians, hospitals and state venereal
disease cooperating clinics. The state cooperating venereal disease clinics are
twenty-four in number and are used for the diagnosis and treatment primarily of
the medically indigent with venereal disease. These clinics are located in the out-
patient departments of general hospitals with four exceptions. These four clinics
are located in the Board of Health Clinics, because out-patient facilities in that area
are lacking. The Department reimburses these hospitals and clinics for the main-
tenance and operation of these venereal disease clinics in accordance with the high
standards set by the Division of Venereal Diseases. Each of these clinics has a
chief in charge who is a physician particularly trained in the clinical aspects of
venereal disease. Therefore, he assumes the responsibility for the clinical manage-
ment of all patients in that clinic. He is assisted by one or more physicians in ac-
cordance with the size and case-load of the clinic. In addition to the physicians
the clinic has a number of clinic nurses. Social service workers are available either
on a full time or part time basis, in accordance with the clinic's case-load. There
are three clinics in which a social service worker is not employed either on a full
time or part time basis. However, these clinics use the social service worker in the
District Health Office to perform the social service work requested by the clinic
chief.
One of the key individuals in the Cooperating Clinic team is the epidemiologist
who interviews all patients for pertinent contacts and brings these latter individuals
to the clinic for diagnostic work-up and treatment if infected. However, if the con-
tact prefers to go to a private physician, arrangements are made to furnish this
physician with all pertinent data so that he may be on a particular watch for that
disease to which the contact was exposed. The epidemiologist, therefore, must be
an individual endowed with tact and understanding, an individual who wins the
confidence of patients, yet a forceful individual able to impress a patient with the
development of good social attitudes, particularly towards sex. The epidemiologist
must also be a person with perseverance, ingenuity and initiative capable of ferret-
ing out the locations of contacts of venereal diseases and bringing them back to
clinic.
The epidemiologist working from a cooperating clinic covers a specific area and
all patients and contacts residing within her area are her responsibility. Thus, the
epidemiologist will not only be responsible for the follow-up of people and contacts
living in her district and originating from her clinic, but she also does the follow-up
of any contact or person living in her district but originating from any other clinic
within the state or from out-of-state.
Case Finding. Essential to any good venereal disease control program is the
adequate reporting of patients with venereal diseases, because without a knowledge
of the number of cases of venereal disease occurring each year and the distribution
of these cases, no adequate control measures can be applied. By law physicians in
Massachusetts are required to report cases of gonorrhea, syphilis, chancroid, granu-
loma inguinale and lymphogranuloma venereum. Up to November 3, 1948, these
patients were reported only as cases and not by name and address unless :
1. The patient refused to protect his family.
2. The patient had open lesions of syphilis and was engaged as a food handler.
3. The patient failed to report for treatment or follow-up.
In 1949 these regulations were changed so that physicians are now required to
report patients with venereal disease by name or initial and other identifying data.
Doctors are also required to report by name and address and other identifying in-
formation the contacts of such patients. Table II depicts the reported incidence of
gonorrhea and syphilis from 1942 to 1949 inclusive (all statistical data in this report
will be on a calendar year basis unless otherwise specified). The minor venereal
diseases are not shown because as a group they comprise less than 1% of our total
venereal diseases.
As seen from table II there was an increase in both gonorrhea and syphilis during
the war years and a real decrease did not begin to show itself until 1947, although in
P.D. 34 229
1945 there were less cases of syphilis reported than in 1944, but in 1946 the reported
cases of syphilis increased again. From 1947 to the present time there has been a
steady decline in these reported cases.
With the increase in total syphilis during the war years there was also an increase
in primary and secondary stages of this disease. This increase in infectious syphilis
during World War II was also noted during World War I. The reasons for it will be
obvious and can be summarized as being due to the dislocation incident to a war
and the loss of the restricting influence of the home and family environment. Co-
incident with these, we may add behavior resulting from war hysteria. All these
tend to lower the morals and stamina of individuals resulting in an increased attack
rate in venereal disease.
Table III analyzes the reported cases of primary and secondary syphilis by age
group and by sex. Throughout this eight year period males were reported more
frequently than females and the most sexually active age group (20-30 years) ap-
peared more often than other age groups.
Table IV compares the reported incidence of latent and late syphilis by age and
sex with the primary and secondary cases of syphilis. Since the concept of early
latent syphilis as one of the potentially common stages of syphilis was not intro-
duced until 1948, for the purpose of this analysis latent syphilis is not subdivided
into its early and late latent stages.
It is interesting to note the source of our reported cases of gonorrhea and syphilis.
These may be found in tables V and VI. Over the years the State cooperating
clinics have reported more than half of the cases of gonorrhea and syphilis. It is
obvious from these tables and other sources of information that private physicians
are not reporting all their cases of venereal disease, and this statement is made in
spite of the fact that there has been a genuine decrease in gonorrhea and syphilis, in
the last three years in particular, which can be attributed to the effectiveness of
penicillin in controlling the infectious periods of both gonorrhea and syphilis. This
problem of incomplete physician reporting of cases is shared in common with other
States. To stimulate the reporting of venereal diseases, private physicians have
been encouraged to attend the State Cooperating Venereal Disease Clinics in order
to obtain the latest methods of diagnosis and treatment. They are also encouraged
to send their problem cases to these clinics for consultation. The quarterly issue of
the Bulletin of Venereal Diseases is sent to private physicians and medical students
in the State. This Bulletin features an original article on some phase of the clinical
aspects of the venereal diseases.
Contact Investigation
One of the most fruitful methods of finding a case of infectious syphilis is through
contact investigation. It is a well-known epidemiological principle that a patient
with venereal disease must contract it from another case with a similar infection.
However, in our program we are not satisfied in obtaining the source contact of any
infection but we attempt to obtain the spread contact also. In other words, we not
only want to know the names and addresses of all those contacts to whom the pa-
tient was exposed during the maximum incubation period of the disease but also
those whom the patient exposed since the onset of symptoms up to the moment
treatment could be expected to be effective. In order to carry out the contact in-
vestigation program more effectively standards for contact interviewing and meth-
ods of describing a contact were established early in 1949. These standards were
published in the medical literature under the titles, "Ten Principles of Venereal
Disease Contact Interviewing" and appeared in the Journal of Social Hygiene,
October 1949, and "Describing a Contact of Venereal Disease," which was printed
in the American Journal of Syphilis, Gonorrhea and other Venereal Diseases, July
1949. These publications remain as the standards for the epidemiologists and were
prepared for their guidance in interviewing patients for contacts. Good contact
interviewing is the foundation for any successful epidemiological investigation. To
illustrate this: in a sample of 677 cases interviewed in 1949 where adequate contact
information was obtained 81% of these contacts were found and brought to medical
attention. Where inadequate contact information was secured only 44% of these
contacts were found. Thus with inadequate contact data, the effectiveness of con-
tact investigation was reduced by almost 50%.
230 . P.D. 34
Screen Examination
Case finding by screen examination is one method of discovering new cases of
syphilis. The screen examination utilizes a simple, inexpensive laboratory test —
the Hinton blood test or similar test — to indicate to the physician the possible
presence of syphilis. The blood test per se is not diagnostic of syphilis but a posi-
tive blood test in the absence of all other conditions giving rise to an increase in the
reagin titre, with or without a past history of this infection, is indicative of this
disease. So important is the blood test screen examination, that by law physicians
are required to take blood tests for syphilis in the following instances :
1. All persons planning to be married. The premarital blood test law was
passed in 1941 and was amended in 1943. At this time the examination for
gonorrhea was omitted from the premarital law. The law, therefore, re-
quired that the examination be for syphilis only.
2. All pregnant women at the time of their first visit to the clinic or office.
3. All prisoners sentenced to a penal institution for thirty days or more.
4. All prospective blood donors.
At the State Wassermann laboratory approximately 1.8% of blood tests were
found to be positive. The State Wassermann laboratory performs approximately
one-half million blood tests a year.
To the blood test for syphilis was added in early 1949, the treponemo immobiliza-
tion test described by Nelson at Johns Hopkins University. For the first time,
physicians are able to test for the presence of the syphilis antibody as a measure of
present or past infection. Although this test is still in the research stage and not as
yet amenable to mass application, its practical potential in the diagnostic field
rivals in importance the revolutionary introduction of penicillin to the treatment of
syphilis.
War Program
The principles of the screen examination in contact investigation were used quite
extensively during the War. By Federal regulation, all persons inducted into the
Armed Forces were given a blood test for syphilis as part of their entrance physical
examination. Out of the first million men so examined 0.7% were found to be posi-
tive, and out of the second million 1.1% were likewise positive. It was the task of
the Division to carry out epidemiological investigation on all these cases. It was a
monumental task. Similiarly all persons on being separated from the Armed Forces
were given a blood test for syphilis as part of their discbarge physical examination.
Those found to have a positive blood test for syphilis were reported to the State
Health Department of the patient's residence. Again the Division carried out medi-
cal and epidemiological investigations on these individuals. This work of follow-up
of the selectees and separatees with positive blood tests continues on to the present
day, although the case load has diminished due to the small number inducted and
separated from the services.
The investigation of sexual contacts of infected military personnel was another
part of our busy program and continues even to the present day. Table VII sum-
marizes some of our experiences with such types of contact investigation.
Education
Because of our small staff and limited budget, our educational efforts must of
necessity be of a selective nature. Education of the patient is paramount and pays
good dividends in preventing reinfection; while, at the same time, it brings the mes-
sage of venereal disease to the patient's environment where other hereunto unde-
tected cases may possibly lurk. Patient education is done at a clinic level and is an
essential part of every contact interview.
Professional education is next in our order of priority; to this end, the Bulletin of
Venereal Diseases is published quarterly. It features one article on some phase of
the clinical management of these patients. It is sent without charge to every phy-
sician and medical student in Massachusetts. A concise and brief bulletin of this
P.D. 34 231
nature, in view of the changing drugs and schedules of treatment, is of considerable
value to the busy private physician. Lectures have also been arranged for physi-
cians at a District Medical Society level.
A six-hour course on the clinical and public health aspects of gonorrhea and syphi-
lis has been arranged for the nurse training schools in Massachusetts. Each year
courses of this nature are given by the central office and field staff to the various
training schools in the State.
On a lay level, numerous lectures have been given to PTA groups, religious orders,
and student school teachers. In connection with these lectures, an up-to-date film
library is maintained. This library contains movies, not only on the clinical as-
pects of the venereal diseases, but also on the subject of social hygiene. Examples
of the latter are the films, "Human Growth" and "Human Reproduction."
Treatment
The period of 1942 to 1949 saw a revolutionary change in the medical treatment
of all the venereal diseases. It saw efforts to speed up the treatment of syphilis
from one lasting eighteen months to one of six months, three months and even one
week duration. With the decrease in the time span of treatment, was an increase
in the amount of treatment reactions from the arsenical drugs. This was a calcu-
lated risk but the increase in the toxic reactions was overshadowed by the benefits
derived. The toxicity of the arsenicals could be dramatically overcome by the in-
jections of BAL. The latter drug was a war-time discovery and was not made
available for general use until about 1945. By this time, the importance and use of
the arsenicals waned and with it the frequency with which BAL needed to be used.
However, in the few cases of arsenical toxicities occurring since 1945 BAL proved
to be a boon and frequently a life saver.
As with syphilis, so also with gonorrhea. The sulfonamides when initially intro-
duced, cured more than 90% of all cases of gonorrhea, but as time went on, sulfa-
resistant gonococci were seen so that by 1943 in some areas, only about a 25% cure
rate was obtained with this drug. Fortunately and timely indeed was the discovery
by John Mahoney of the U. S. Public Health Service in 1943, that penicillin would
attack the organism of syphilis. It would also cure gonorrhea. Thus was the anti-
biotic era introduced.
Sulfonamides for the treatment of gonorrhea were therefore abandoned except
in certain selected cases where it was desirable not to mask a probable concomitant
syphilitic infection. With penicillin approximately a 95-98% cure rate could be
achieved. In the meantime refinements in penicillin itself were going on, so that
we saw an enhancement of the effectiveness of penicillin with each change. Peni-
cillin in 1943 was a mixture of at least four fractions. When it was found that
penicillin G was the most active component, this fraction was purified and crystal-
ized. Crystallin penicillin G is still used today. Crystallin penicillin G was then
suspended in oil and wax by Romansky to delay the rate of absorption and prolong
the effectiveness of penicillin. Another landmark was therefore reached. Finally
penicillin was combined with procaine and then the procaine penicillin was sus-
pended with oil and 2% aluminum monostearate and this combination of penicillin
is used at the present time. This preparation will give detectable blood levels of
penicillin even for 72 hours with a single injection. Procaine penicillin G in oil with
2% aluminum monostearate is used today.
The repository type of penicillin either with oil and beeswax and later with pro-
caine penicillin in oil with 2% aluminum monostearate made it possible to achieve
a 95-98% cure rate for gonorrhea with a single injection of 300,000 units of this
drug. This type of penicillin also made it possible to treat syphilis on an ambula-
tory basis and now effective treatment of this disease can be accomplished in 10
days.
Discovery of penicillin led to search for other antibiotics and soon streptomycin,
aureomycin and Chloromycetin were described. These three antibiotics were also
found to be effective for gonorrhea and syphilis, but could not match the effective-
ness of penicillin in the treatment of these diseases. However, they were found to
be effective for the treatment of the minor venereal diseases.
Today the sulfonamides remain the drug-of-choice for chancroid. Practically all
cases of chancroid will respond to this drug. But, for granuloma inguinale and
232
P.D. 34
lymphogranuloma venereum, Chloromycetin and aureomycin in that order of pref-
erence constitute our best therapeutic weapons for these two diseases. In some
medical and public health circles as the result of the discovery of these antibiotics
there prevails the optimistic view that the control of the venereal diseases and
particularly syphilis is imminent. If this contention is critically examined, it can
be seen that this optimism in respect to the immediate control of these diseases is
entirely premature.
It is apparent that syphilis can never be controlled while more than half of the
cases are not recognized for more than a year after onset. Although much has been
accomplished in venereal disease control during the past years as shown by the de-
clining rates of primary and secondary syphilis, yet, each year we are missing more
cases than we recognize. Can venereal disease control be imminent when only ap-
proximately one-third of our reported cases of syphilis are discovered as being in the
primary and secondary stages? In other words, approximately two-thirds of our
reported cases of syphilis are not recognized for more than a year after their onset.
Under these conditions syphilis control is not imminent. Much more needs to be
done particularly the early recognition of these diseases and the development of
new methods of venereal disease control particularly in the low prevalance areas in
the United States of which Massachusetts is one.
Table II — Reported Cases of Gonorrhea and Syphilis in Massachusetts
1942-1949
Year
Syphilis
Gonorrhea
All Other
Syphilis
Primary
Secondary
Congenital
Total
1942 .
429
524
312
4432
5697
4454
1943 .
477
655
298
4090
5520
4701
1944 .
511
638
299
3620
5068
4935
1945 .
684
597
217
2880
4378
5487
1946 .
1170
748
208
2844
4970
5062
1947 .
461
500
204
2046
3211
3805
1948 .
286
334
139
1554
2313
3103
1949 .
236
175
122
1510
2043
2920
Table III — Reported Cases 0} Primary and Secondary Syphilis in Massachusetts
by Age and Sex
1942-1949
Age
1942
1943
1944
1945
1946
1947
1948
1949
M.
F.
M.
F.
M.
F.
M.
F.
M.
F.
M.
F.
M.
F.
M. F.
Under 5
3
1
5-9
3
1
1
1
10-14
1
2
1
1
1
2
6
2
15-19
19
40
47
42
40
56
43
36
52
49
43
48
27
23
15 10
20-24
180
69
170
111
195
113
220
155
530
146
153
113
108
44
78 26
25-29
154
64
152
81
135
109
271
81
388
126
144
74
97
50
60 36
30-34
90
47
83
63
88
59
119
60
222
57
90
51
45
27
41 25
35-39
66
25
65
36
75
44
92
30
112
37
54
21
42
14
17 10
40-44
59
21
69
30
62
19
34
19
37
30
38
19
27
13
26 11
45-49
38
12
31
22
31
12
24
16
35
15
20
12
20
12
7 5
50-54
19
11
33
11
27
15
20
6
27
8
26
7
17
11
5 4
55-59
11
4
20
9
24
5
13
9
7
8
15
5
12
5
11 4
60 and o
ver 10
7
33
9
20
10
16
4
16
1
17
5
19
2
6 1
N. S.
4
6
5
5
2
2
6
4
4
2
1
5
6 6
Tota
1 651
302
710
422
703
446
854
427
1431
487
602
359
419
201
272 139
P.D. 34
233
Table IV — Reported Cases of Latent and Late Syphilis in Massachusetts
by Age and Sex
1942-1949
1
1942
1943
1944
1945
1946
1947
1948
1949
Age
M.
F.
>M.
F.
M.
F.
M.
F.
M.
F
M.
F.
M.
F.
M. F.
Under 5
1
1
1
5-9
2
10-14
3
3
2
3
1
1
1
1 1
15-19
20
42
59
45
52
53
28
48
39
42
17
51
17
24
16 21
20-24
151
157
190
163
165
198
123
170
275
195
135
145
73
98
88 86
25-29
243
179
288
179
251
206
195
181
236
171
108
133
78
112
75 83
30-34
325
228
346
184
269
183
182
158
195
120
77
101
54
87
50 98
35-39
399
195
330
169
267
188
212
147
140
126
92
128
64
73
70 78
40-44
511
183
318
168
187
137
154
118
125
114
100
89
75
67
64 51
45-49
324
163
290
175
227
128
170
97
150
91
113
70
92
61
75 47
50-54
297
171
223
154
215
123
166
95
156
74
105
68
114
61
119 56
55-59
246
114
223
no
200
102
146
72
134
84
125
56
94
50
99 47
60 and 0
ver 326
134
306
139
305
130
274
121
236
117
229
96
174
79
187 89
N. S.
11
10
19
8
20
7
11
11
14
10
3
3
2
3
5 4
Tota
I 2856
1576
2593
1497
2160
1460
1662
1218
1700
1144
1104
942
837
717
849 661
Table V — Sources of Reports of Gonorrhea
Total
Cases
PHYSICIANS
Clinics
Institutions
Military
Year
Number
Cases
Per Cent
Cases
Fer Cent
Cases
Per Cent
Cases
Per Cent
1942
4454
619
1440
32.3
1179
26.5
142
3.2
1693
38.0
1943
4701
551
1551
33.0
1210
25.7
193
4.1
1747
37.2
1944
4935
612
1679
34.0
1801
36.5
209
4.2
1246
25.3
1945
5487
503
2079
37.9
2078
37.9
187
3.4
1143
20.8
1946
5062
624
1681
33.2
2835
56.0
167
3.3
379
7.5
1947
3805
483
1097
28.8
2256
59.3
119
3.1
333
8.8
1948
3103
366
711
22.9
1727
55.7
104
3.3
561
18.1
1949
2920
268
577
19.7
1635
56.0
75
2.6
633
21.7
Table VI — Sources of Reports of Syphilis
Total
Cases
Physicians
Clinics
Institutions
Military
Year
Number
Cases
Fei Cent
Cases
Per Cent
Cases
Per Cent
Cases
Per Cent
1942
5697
1088
2257
39.6
2455
43.1
618
10.9
367
6.4
1943
5520
977
2266
41.0
2191
39.7
413
7.5
650
11.8
1944
5068
863
1904
37.6
2036
40.2
432
8.5
696
13.7
1945
4378
609
1574
35.9
2076
47.4
357
8.2
371
8.5
1946
4970
769
1492
30.0
3018
60.7
313
6.3
147
3.0
1947
3211
554
1153
35.9
1725
53.7
255
8.0
78
2.4
1948
2313
491
885
38.3
1099
47.5
218
9.4
111
4.8
1949
2043
422
832
40.7
964
47.2
130
6.4
117
5.7
234
P.D. 34
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235
DIVISION OF TUBERCULOSIS AND SANATORIA
CONSOLIDATED REPORT 1942-1949
Alton S. Pope, M.D., Dr.P.H., Director
Massachusetts was one of a group of some six industrial northeastern states which
during the war period experienced a flattening out of the curve of tuberculosis mor-
tality. After a steady decline since 1919 the mortality rate in Massachusetts be-
came practically stationary for eight years and in 1943 showed an increase of 12
per cent. The causes of this remission in the presence of a continued decline in
other parts of the country are not clear but it may well be due to the extra stress
and strain incidental to war time production in an industrial area, an hypothesis
supported by the fact that the increase in tuberculosis deaths was entirely in males
over 40.
The situation was complicated by a marked reduction in the hospitalization of
active cases of tuberculosis. Many patients left the sanatoria to take advantage of
wartime wages while others continued to work when they should have been under
treatment. Combined with an acute shortage of nursing personnel this resulted in
the closing of a quarter to a third of all sanatorium beds in the state. Not until
1948 did the mortality rates resume their previous rate of decline.
Table 1. — Tuberculosis Deaths and Death Rates Per 100,000
Massachusetts 1941-1949
Pulmonary
Other Forms
Total
Year
|
Deaths
Rate
Deaths
Rate
Deaths Rate
1940
1484
34.4
114
2.6
1598
37.0
1941
1520
35.1
112
2.6
1632
37.7
1942
1501
34.6
118
2.7
1619
37.3
1943
1697
39.1
109
2.5
1806
41.6
1944
1606
37.0
84
1.9
1690
38.9
1945
1557
34.5
79
1.8
1636
36.3
1946
1592
35 0
82
1.8
1674
36.8
1947
1495
32.6
89
1.9
1581
34.5
1948
1279
27.2
82
1.8
1361
29.0
1949
1061
22.8
59
1.3
1120
24.1
State Sanatoria
The closing of the tuberculosis wards at the State Infirmary together with the
shortage of nursing personnel at the sanatoria resulted in long waiting lists at both
state and county sanatoria; a situation only partially relieved by salary increases
for nurses in 1948. The only promising solution of the nursing problem in state
hospitals appears to be the training of attendant nurses to supplement the graduate
nursing in ward care. For this purpose an Interdepartmental Committee on the
Training of Licensed Attendants was established in 1949 in cooperation with the
Departments of Mental Health, Public Welfare and Education, and training schools
for attendants have been opened at Pondville and at Westfield.
Construction at state hospitals was resumed in 1949 with the reconstruction of
the power plant and engine room at Pondville. This was followed by a new 100-bed
nurses' home at Pondville, started in the fall of 1949. At the same time ground was
broken for a superintendent's house and a duplex house for physicians at North
Reading.
After the Legislature had authorized the location of the Department's new chronic
disease hospital in Boston the City presented to the Department an excellent site of
13.6 acres on Morton Street, Jamaica Plain, readily accessible to the public, the
medical schools and the general hospitals of the city. Plans for a modern 600-bed
chronic disease hospital on this site are now in preparation.
As soon as it became possible to obtain nurses, in April 1949, a 26-bed unit for
children with rheumatic heart disease was opened at the North Reading State Sana-
torium, as authorized by Chapter 453, Acts of 1945. The clinical work is under the
immediate charge of an assistant superintendent assigned to that service, with a
visiting staff from the Metropolitan Boston area.
Under the provisions of Chapter 412 of the Acts of 1948 the Department began
the hospitalization of crippled children at Lakeville in April 1949. The orthopedic
236
P.D. 34
staff and facilities of the sanatorium are admirably suited for the treatment of this
type of patient and the service provides a much needed supplement to the De-
partment's Crippled Children's Clinics. Approximately 35 children were admitted
to this service in 1949.
Chapter 412 of the Acts of 1949 authorized the establishment of a unit of 30 beds
for the treatment of children with cerebral palsy at the Lakeville State Sanatorium.
The necessary facilities and equipment have been provided, a special staff secured
and admissions were begun in December 1949.
County and Municipal Sanatoria
County and municipal sanatoria have in general experienced the same problems
and difficulties as the state institutions. Hundreds of beds have been closed on ac-
count of inability to obtain nurses. The shortage of staff physicians has been even
more acute than in state hospitals. Per capita costs have risen sharply, not only
on account of increases in salaries, foods and supplies but also because the sanatoria
were obliged to operate far below normal capacity.
New construction has been impossible until the past year. The Essex Sanatorium
now has a new 30-bed nurses' home nearing completion and Norfolk County Sana-
torium has plans drawn for a new operating suite and an addition of 25 patient beds.
Federal Grants
Beginning July 1, 1945, the Department has received under the provisions of
Public Law 410 grants-in-aid for the extension of case finding in tuberculosis. Funds
received under these grants have been used in part for the extension and improve-
ment of the Department's case finding program and in part for sub-grants to four
municipal health departments, to three county sanatoria and to eight general hos-
pitals for X-ray equipment, films, supplies and personnel for case finding purposes.
In the fiscal year 1949 these institutions reported a total of 255,664 chest X-ray ex-
aminations. Annual grants have ranged from $240,000 to $350,000.
Arthritis Hospitalization
Since 1938, under the provisions of Section 116A, of Chapter 111, the Depart-
ment has arranged for the hospitalization and study of a limited number of patients
with chronic rheumatism at the Massachusetts General Hospital. Under contract
with the hospital approximately 100 patients per year are admitted on this pro-
gram, and after discharge are followed by their personal physicians or by the out-
patient department of the hospital. An impressive amount of research has been
carried on in this service and the information gained has been summarized and made
available to the medical profession. The average patient's stay is approximately
2x/i months. About one-third of all admissions are readmissions.
Field Clinic Program
In the fall of 1943 a mobile photoroentgen unit using 4" x 5" films was given to
the Department by the Massachusetts Tuberculosis and Health League for the
promotion of mass X-ray surveys in industries and in communities of the Common-
wealth. This apparatus made possible a rapid expansion of the tuberculosis case
finding program in adults with a substantial reduction in the per capita cost. In
1945 two additional 70 mm. mobile X-ray units were purchased with Federal grants
and the community survey program was greatly expanded. Results of these sur-
veys, by years, are shown in the following table :
Table 2. — Breakdown by Year Groups of Number X-rayed
Year Group
Number
X-rayed
Number
Pulmonary
Tuberculosis
Number
Presumably
Active
Number
Presumably
Stable
Suspects
Other
Conditions
Cardiac
September 1943 to
December 1947 .
January 1948 to
December 1948 .
* January 1949 to
December 1949 .
446,623
200,087
157,811
4964(266)
1955(584)
1104(370)
1427(46)
314(65)
181(16)
3537(220)
1641(519)
923(354)
1287
530
276
1849
581
741(116)
2938
1705
1305(515)
Totals .
804,521
8023(1220)
1922(127)
6101(1093)
2093
3171
5948
( ) Previously known or reported cases.
* Previously known cases of conditions other than tuberculosis not noted in statistical reports prior to 1949.
A gratifying feature of these mass surveys has been the very effective cooperation
of the voluntary tuberculosis associations. They have regularly participated in the
preliminary organization in each community surveyed, have taken a major part in
the educational program and have mailed out the reports of negative examinations.
P.D. 34
237
LAKEVILLE STATE SANATORIUM
Table 1. — Admissions and Discharges — TUBERCULOSIS
Daily Average
Patients
Patients
Number of
Number of
Admitted
Discharged
Patients
Deaths
Adults
Males
75
74
63.2
8
Females
59
76
55.8
7
1942
Children
Males
26
36
45.5
5
Females
17
31
45.5
Total
177
217
210.0
20
Adults
Males
53
72
53.3
12
Females
52
50
44.9
6
1943
Children
Males
18
27
32.4
3
Females
17
20
31.3
2
Total
140
169
161.9
23
Adults
Males
39
56
43.0
3
Females
31
36
45.4
2
1944
Children
Males
11
15
24.3
_
Females
13
20
23.7
2
Total
94
127
136.4
7
Adults
Males
35
36
28.0
8
Females
34
38
41.0
4
1945
Children
Males
14
15
20.0
_
Females
8
11
17.0
-
Total
91
100
106.0
12
Adults
Males
39
36
35.3
7
Females
48
47
45.4
4
1946
Children
Males
18
17
20.4
1
Females
8
6
15.6
1
Total
113
106
116.7
13
Adults
Males
40
42
34.5
8
Females
46
56
43.4
5
1947
Children
Males
22
20
21.3
3
Females
17
14
17.5
2
Total
125
132
116.7
18
Adults
Males
48
40
39.0
3
Females
64
58
45.1
7
1948
Children
Males
8
10
18.7
1
Females .
7
11
11.9
Total
127
119
114.7
11
Adults
Males
51
59
40.1
Females .
49
65
38.0
4
1949
Children
Males
16
11
21.1
_
Females .
11
8
12.4
-
Total
127
143
111.6
4
238
P.D. 34
Table 1. — Admissions and Discharges
— POLIOMYELITIS
Daily Average
Patients
Patients
Number of
Number of
Admitted
Discharged
Patients
Deaths
Adults
Males
8
11
6.7
-
Females .
4
5
2.3
-
1942
Children
Males
21
20
18.0
—
Females .
8
14
9.5
-
Total
41
50
36.5
Adults
Males
5
5
2.6
-
Females .
—
1
.2
-
1943
Children
Males
14
18
12.4
-
Females .
12
7
6.2
-
Total
31
31
21.4
-
Adults
Males
3
4
1.9
-
Females
7
2
2.1
-
1944
Children
Males
13
11
10.
-
Females
13
17
7.
-
Total
36
34
21.
-
Adults
Males
2
3
3.
-
Females
2
6
4.
-
1945
Children
Males
16
17
9.
-
Females
12
6
7.
-
Total
32
32
23
-
Adults
Males
8
8
3.1
-
Females
12
10
4.9
1
1946
Children
Males
10
11
7.6
-
Female
13
11
11.5
-
Total
44
40
27.1
1
Adults
Males
5
4
3.3
-
Females
9
7
5.1
-
1947
Children
Males
11
12
7.3
—
Females
10
13
10.9
-
Total
35
36
26.6
-
Adults
Males
_
4
2.7
-
Females
8
14
4.9
-
1948
Children
Males
3
7
3.9
-
Females
3
10
3.9
1
Total
14
35
15.4
1
Adults
Males
9
5
1.6
-
Females
12
6
3.6
-
1949
Children
Males
22
6
5.5
-
Females
9
2
1.7
~
Total
52
19
12.4
-
Table 1. — Admissions and Discharges — CRIPPLED CHILDREN
Patients
Admitted
Patients
Discharged
Daily Average
Number of
Patients
Number of
Deaths
1948 Children
Total
Males
Females
3
5
8
—
.5
.6
1.1
—
1949 Children
Total
Males
Females .
16
19
35
12
13
25
6.1
12.6
18.7
—
P.D. 34
239
Table 1 . — Admissions and Discharges — TOTAL OF TUBERCULOSIS
POLIOMYELITIS AND CRIPPLED CHILDREN PATIENTS
Daily Average
Patients
Patients
Number of
Number of
Admitted
Discharged
Patients
Deaths
Adults
Males
83
85
69.9
8
Females
63
81
58.1
7
1942
Children
Males
47
56
63.5
5
Females
25
45
55.0
Total
218
267
246.5
20
Adults
Males
58
77
55.9
12
Females
52
51
45.1
6
1943
Children
Males
32
45
44.8
3
Females
29
27
37.5
2
Total
171
200
183.3
23
Adults
Males
42
60
44.9
3
Females
38
38
47.5
2
1944
Children
Males
24
26
34.3
Females
26
37
3.0,7
2
Total
130
161
157.4
7
Adults
Males
37
39
31.
8
Females .
36
44
45.
4
1945
Children
Males
30
32
29.
Females .
20
17
24.
-
Total
125
132
129.
12
Adults
Males
47
44
38.4
7
Females
61
57
50.3
5
1946
Children
Males
28
28
28.
1
Females
21
17
27.1
1
Total
157
146
143.8
14
Adults
Males
45
46
37.8
8
Females
55
63
48.5
5
1947
Children
Males
33
32
28.6
3
Females
27
27
28.4
2
Total
160
168
143.3
18
Adults
Males
48
44
41.7
3
Females
72
72
50.0
7
1948
Children
Males
14
17
23.1
1
Females .
15
21
16.4
1
Total
149
154
131.2
12
Adults
Males
60
64
41.7
Females
61
71
41.6
4
1949
Children
Males
54
29
32.7
_
Females
39
23
26.7
-
Total
214
187
142.7
4
240
P.D. 34
LAKEVILLE STATE SANATORIUM
Table 2. — Diagnosis and Classification on Admission ■ — TUBERCULOSIS
PATIENTS (classified by most serious lesion present)
Intestines
and
Peritoneum
Vertebral
Column
Other
Bones
and
Joints
Lymphatic
System
Genito-
urinary
System
Skin and
Subcutaneous
Cellular
Tissue
Other
Organs
Non-
Tuberculous
Disease
Adults Males
Females
1942
Children Males
Females
Total
2
9
1
.10
7
8
3
2
31
13
8
9
2
40
6
17
2
5
18
13
16
1
1
35
7
1
2
6
2
10
4
1
17
1
2
5
5
20
Adults Males
Female s
1943
Children Male-
Female
Total
3
8
1
12
13
16
4
5
38
9
6
6
1
22
3
9
2
14
14
5
2
3
24
5
2
7
5
5
4
3
17
1
1
2
2
6
Adult Males
Females
1944
Children Males
Females
Total
3
5
4
1
13
11
6
1
18
5
6
4
2
17
7
4
2
5
18
9
5
1
15
2
3
5
2
1
1
4
1
1
2
4
Adults Males
Females
1945
Children Males
Females
Total
2
4
1
2
9
8
11
2
1
22
9
4
2
1
16
3
4
4
1
12
9
6
1
16
J
4
5
3
3
15
1
1
Adults Males
Females
1946
Children Males
Females
Total
2
6
8
13
12
1
4
30
9
8
7
1
25
1
4
5
3
13
9
10
3
22
1
1
4
3
7
1
4
2
7
Adults Males
Females
1947
Children Males
Females
Total
9
1
2
12
12
8
4
2
26
11
8
7
4
30
4
5
3
7
19
12
10
2
2
26
1
1
1
5
1
7
4
4
Adult? Males
Females
1948
Children Males
Females
Total
4
5
9
9
13
1
23
13
13
2
3
31
4
8
3
2
17
11
14
1
1
27
1
1
2
9
1
1
13
5
1
6
Adults Males
Females
1949
Children Males
Females
Total
5
3
1
9
10
7
3
3
23
9
9
7
2
27
1
13
3
3
20
15
15
2
2
34
2
1
3
3
1
4
6
1
1
8
P.D. 34
Table 2.
241
Diagnosis and Classification on Admission — POLIOMYELITIS
PATIENTS
Stagell
Stage III
Stage IV Non-Poliomyelitis
Adults
Males
_
4
4
Females
—
—
4
1942
Children
Males
1
2
18
Females
-
8
-
Total
1
6
34
-
Adults
Males
_
_
4
1
Females
_
_
1943
Children
Males
3
-
10
1
Females
2
1
9
Total
5
1
23
2
Adults
Males
1
_
2
Females
4
_
3
. _
1944
Children
Males
2
1
10
Females
-
3
10
-
Total
Adults
Males
_
2
_
Females
2
_
_
1945
Children
Males
5
3
7
1
Females
3
2
7
Total
10
7
14
1
Adults
Males
2
3
3
Females
6
5
2
1946
Children
Males
6
2
2
Females
7
4
2
-
Total
21
14
9
-
Adults
Males
2
1
2
Females
5
2
2
1947
Children
Males
6
2
3
Females
3
3
4
-
Total
16
8
11
-
Adults
Males
_
_
Females
_
1
7
1948
Children
Males
_
1
2
Females
-
2
1
-
Total
-
4
10
-
Adults
Males
_
6
3
Females
_
6
6
1949
* Children
Males
_
18
4
Females .
-
5
3
-
Total
-
35
16
-
Table 2. — Diagnosis and Classification on Admission — CRIPPLED CHILDREN
1948 —
Males Females Total
Club Foot
Coza Plana
Rheumatoid Arthritis
Scoliosis, Idiopathic
Spastic Paraplegia .
Spastic Paraplegia; Coxa Plana
1949
Cerebro-spastic palsy
Club Foot
Congenital dislocation and deformities
Obsteti ical paralysis
Scoliosis .......
Non-cogenital deformities
Admission to Lakeville of crippled children began April 1, 194S
2
1
1
2
1
1
4
4
9
1
7
10
242
P.D. 34
Table 3. — Ages of Patients Admitted — TUBERCULOSIS
Under
5 yrs.
5 to
9 yrs.
10 to
14 yrs.
15 to
19 yrs.
20 to
29 yrs.
30 to
39 yrs.
40 to
49 yrs.
50 to
59 yrs.
60 to
69 yis.
70 and
over
1942 Males
Females
2
5
6
2
6
3
9
6
28
20
13
18
15
10
12
6
9
6
1
1943 Males
Females
2
4
1
2
7
9
7
18
14
14
23
10
6
8
7
5
1
1
1
1944 Males
Females
1
2
2
5
2
3
8
9
14
9
5
9
4
4
5
7
2
1
2
1945 Males
Females
2
2
3
7
2
2
3
9
11
10
7
11
9
4
6
1
2
-
1946 Males
Females
2
1
3
7
2
3
4
10
14
12
18
9
4
8
8
2
4
1
1
1947 Males
Females
4
4
2
2
5
2
7
7
12
16
9
15
5
8
11
3
5
4
2
2
1948 Males
Females
2
2
2
3
2
2
1
9
15
14
18
11
16
7
7
2
6
5
4
1949 Males
Females
3
1
4
2
3
1
6
6
9
12
14
14
9
11
9
7
9
2
2
4
Table 3. — ,4 pes of Patients Admitted — POLIOMYELITIS
Under
5 to
10 to
15 to
20 to
30 to
40 to
50 to
60 to
70 and
5 yrs.
9 yrs.
14 yrs.
19 yrs.
29 yrs.
39 yrs.
49 yrs.
59 yrs.
69 yrs.
over
1942 Males
_
4
4
12
3
5
1
_
_
_
Females
-
-
2
6
4
-
-
-
-
-
1943 Males
1
1
6
3
6
1
1
_
Females
1
1
3
6
1
-
-
-
-
1944 Males
1
1
2
9
3
_
_
_
_
_
Females
1
1
1
8
7
1
-
1
-
-
1945 Males
1
2
3
9
2
_
_
1
_
_
Females
-
3
3
5
2
1
-
-
-
-
1946 Males
_
3
3
3
2
5
o
_
_
_
Females
1
4
2
4
10
4
1
-
-
-
1947 Males
1
3
_
6
3
2
1
_
_
_
Females
1
1
2
5
4
5
1
-
-
-
1948 Males
_
_
2
1
_
_
_
_
_
_
Females
-
1
2
-
4
3
1
-
-
-
1949 Males
2
3
8
9
6
1
1
1
_
_
Females
-
2
3
3
8
2
2
"
"
—
Table 3. -
- Ages
of Patients Admitted
I — CRIPPLED CHILDREN
Under
5 yrs.
5 to
9 yrs.
10 to ! 15 to
14 yrs 19 yrs.
1948 Males
Females
1949 Males
Females
1
1
2
4
2
5
2
3
3
7
1
5
7
P.D. 34
Table 4.
243
Condition on Discharge— TUBERCULOSIS PATIENTS
Apparently
Unim-
Not
Non-
Arrested
Arrested
Quiescent
Improved
proved
Deaths
Considered
Tuberculous
Adults
Males
20
5
21
10
2
8
3
5
Females
16
4
12
19
5
7
3
10
1942
Children
Males
16
-
7
2
-
5
-
6
Females
15
3
2
2
1
-
2
6
Total
67
12
42
33
8
20
8
27
Adults
Males
13
4
24
7
4
12
5
3
Females
22
4
12
1
1
6
2
2
1943
Children
Males
14
1
2
-
1
3
2
4
Females
13
-
-
-
-
2
-
5
Total
62
9
38
8
6
23
9
14
Adults
Males
19
3
16
5
2
3
7
1
Females
12
4
7
2
7
2
_
2
1944
Children
Males
9
2
3
-
-
-
-
1
Females
8
1
2
1
2
2
-
4
Total
48
10
28
8
11
7
7
8
Adults
Males
8
2
13
2
1
8
2
_
Females
14
2
8
3
3
4
4
-
1945
Children
Males
7
2
2
1
-
-
-
3
Females
6
-
-
3
-
-
-
2
Total
35
6
23
9
4
12
6
5
Adults
Males
6
1
4
10
3
7
4
1
Females
19
-
4
12
3
4
1
4
1946
Children
Males
13
_
-
4
-
1
-
2
Females
4
1
-
-
-
1
-
-
Total .
39
2
8
26
6
13
5
7
Adults
Males
9
1
3
14
4
8
2
1
Females
4
2
2
31
5
5
7
-
1947
Children
Males
7
-
1
4
-
3
-
5
Females
4
1
-
6
1
2
-
-
Total .
24
4
6
55
10
18
9
6
Adults
Males
10
6
_
13
4
3
2
2
Females
28
2
1
15
2
7
2
1
1948
Children
Males
6
1
1
1
-
1
-
-
Females
8
-
-
2
- .
-
1
-
Total .
52
9
2
31
6
11
5
3
Adults
Males
16
7
6
17
5
_
_
8
Females
15
6
22
11
4
4
2
1
1949
Children
Males
6
1
-
3
-
• -
-
1
Females
5
-
2
-
1
-
-
-
Total .
42
14
30
31
10
4
2
10
244 P.D. 34
Table 4. — Condition on Discharge — POLIOMYELITIS PATIENTS
Improved Unchanged Deaths Non-Poliomyelitis
Adults Males 7 4--
Females 3 2
1942
Children Males 16 4
Females 13 .1 - -
Total 39 11
Adults Males 5 - - -
Females 1 -
1943
Children Males 16 2
Females 6 1 - -
Total 28 3 - -
Adults Males 2 11-
Females 2 - - -
1944
Children Males 10 - 1
Females 16 1 - -
Total 30 2 2 -
Adults Males 3 - - -
Females 6 - - -
1945
Children Males 16 1
Females 5 1--
Total 30 2
Adults Males 8
Females 7 2 1-
1946
Children Males 11
Females 11
Total 37 2 1 -
Adults Males 3 1--
Females 5 2--
1947
Children Males 11 1
Females 13 - - -
Total 32 4
Adults Males 4 - - -
Females 10 4
1948
Children Males 7 - - -
Females 9 - 1 -
Total 30 4 1 -
Adults Males 5 - - -
Females 6 - - -
1949
Children Males 6
Females 11--
Total 18 1 - -
Table 4. — Condition on Discharge — CRIPPLED CHILDREN
Improved Unchanged
1949 Children Males 11 1
Females 11 2
Total 22 3
Admission of crippled children to Lakeville began in April 1948 — no discharges until 1949
P.D. 34
245
Table 5. — Surgical Report — OPERATIONS ON TUBERCULOSIS
PATIENTS
1942'
1943
1944
1945
1946
1947
1948
1949
Amputations
4
1
1
-
3
1
2
1
Appendectomies
'—
-
1
—
—
-
1
-
Arthrodeses . . .
25
24
28
11
22
16
22
23
Biopsies ....
-
-
2
-
1
-
-
-
Exploratory, Laporatomy .
3
-
. 1
—
-
—
—
-
Incision for Drainage
2
4
-
1
-
1
-
—
Nephrectomies
6
9
2
3
3
2
2
5
Other Kidney Operations .
4
2
3
1
-
_
-
_
Tonsillectomies and
Adenoidectomies .
-
-
-
-
8
6
6
5
All other Operations .
14
13
6
14
9
7
17
11
Cystoscopies
39
32
20
20
23
21
25
22
Transfusions
19
16
27
10
17
34
29
28
Number of Operations at other
Hospitals included .
11
9
5
4
4
2
2
8
Table 5. — Surgical Report — OPERATIONS ON POLIOMYELITIS
PATIENTS
1942
1943
1944
1945
1946
1947
1948
1949
Muscle Transplants* .
10
2
4
7
5
4
2
2
Stabilizations* .
14
19
3
6
6
8
5
3
Stabilizations and
Muscle Transplants
4
-
3
—
1
o
-
_
Tonsillectomies and
Adenoidectomies
—
—
-
-
1
—
_
_
All Other Operations .
22
11
14
9
2
6
4
2
Transfusions
8
3
5
"
6
9
5
5
* (Includes other procedures such as plastics and tenotomies done at the same time)
Table 5. — Surgical Report — OPERATIONS ON CRIPPLED CHILDREN
Muscle Transplants
Stabilizations
Adenoidectomies .
All Other Operations
3
19
1
13*
(*Of these operations, 1 was performed at the Massachusetts General Hospital in Boston)
Table 6. — Deaths of Tuberculosis Patients by Length of Residence in Sanatorium
Less than 1 to 3 3 to 6 6 to 12 1 to 2 Over 2
1 month months months months years years
1942 Adults
Children
3 2 4 4 2
-1-2-2
1943 Adults
Children
3 2 4 3 15
-3-11-
1944 Adults
Children
2 2 1 -
1 - 2 1 2
1945 Adults
Children
13 2 2 3 1
1946 Adults
Children
12 2 3 2 1
1 - - - 1 -
1947 Adults
Children
1 3 - 3 3 -
- 1 2 11
1948 Adults
Children
4 2 2 2-
- - - 1 - -
1949 Adults
Children
111 1
246
P.D. 34
Table 7. — Causes of Death
Intestines
and
Peritoneum
Vertebral
Column
Other
Bones and i Lymphatic
Joints 1 System
Genito-
urinary
System
Other
Tuberculous
Conditions
Other | Anterior
Causes j Poliomyelitis
1942 Adults .
Children
1
1
5
3 1 1
2
5
1
-
-
-
1943 Adults .
Children
2
8
2
-
5
2
-
-
-
1944 Adults .
Children
2
-
: I
-
-
1945 Adults .
Children
1
2
3
1
3
1
-
1946 Adults .
Children
1
3
2
-
2
1
3
-
1
1947 Adults .
Children
1
1
2
3
1
-
2
1
-
-
-
1948 Adults .
Children
1
5
1
-
2
2
-
1
1949 Adults .
Children
-
1
:
1
2
-
-
NORTH READING STATE SANATORIUM
Table 1. — Admissions and Discharges— TUBERCULOSIS PATIENTS
Patients
Admitted
Daily Average
Patients Number of
Discharged Patients
Number of
Deaths
1942 Males .
Females
Total
66
58
124
72 75 . 8
93 95.3
165 171 . 1
5
10
15
1943 Males .
Females
Total
42
55
97
61 53.1
59 73 . 5
120 126.6
9
7
16
1944 Males .
Females
Total
43
52
95
41 52 . 7
49 71.2
90 123.9
2
3
5
1945 Males .
Females
Total
52
46
98
46 51.5
46 73.2
92 124.7
6
4
10
1946 Males .
Females
Total
36
37
73
32 52.3
42 68.6
74 120.9
4
5
9
1947 Males .
Females
Total
35
35
70
46 46.4
46 56.7
92 103 . 1
3
5
8
1948 Males .
Females
Totel
48
53
101
30 52.4
43 54.6
73 107.0
4
4
8
1949 Males
Females
Total
41
27
68
36 70.8
23 66.9
59 137.8
1
1
2
Table 1. — Admisi
'ions and Discharges — RHEUMATIC FEVER PATIENTS
Patients
Admitted
Patients Daily Average
Discharged Number of Patients
Number of
Deaths
1949 Males
Females .
Total
25
18
43
16 *
10
26
2
2
♦Included with number of Tuberculosis patients.
P.D. 34
Table 2.
247
Stage of Disease on Admission — TUBERCULOSIS PATIENTS"
Primary
Minimal
Moderately
Advanced
Advanced
Pleurisy
with
Effusion
Miliary
Observation
and
Non-Tuber-
culosis
Un-
classified
Other
1942 Males .
Females
32
28
6
4
1
3
3
3
5
3
2
2
13
9
4
4
2
1943 Males.
Females
22
29
. 1
9
2
4
4
7
2
2
-
6
4
3
2
1944 Males .
Females
31
24
3
0
2
5
1
5
1
2
1
4
9
1
-
1945 Males .
Females
20
24
6
6
10
8
2
2
6
10
2
-
2
1946 Males .
Females
25
20
3
2
2
8
3
1
1
-
3 2
2
1
1947 Males .
Females
24
20
2
3
1
1
1
3
1
1
4 2
4 3
-
1948 Males .
Females
29
31
8
7
3
4
3
2
3
1
1
4 2
1
2
1949 Males .
Females
19
15
3
5
1
2
1
1
2
1
3
3
1
1 3
2
♦Rheumatic Fever patients not included.
Table 3. — Ages of Patients Admitted — TUBERCULOSIS*
Under 5 yrs.
5-9 yrs.
10-14 yrs. 15-19 yrs
1942 Males .
Females .
16
21
20
15
20
15
10
7
1943 Males .
Females .
10
13
11
16
16
14
5
12
1944 Males
Females .
15
16
12
12
9
14
7
10
1945 Males
Females .
15
11
16
8
8
15
4
10
1946 Males
Females .
12
11
14
11
6
9
4
6
1947 Males .
Females
14
17
10
6
9
8
4
1948 Males .
Females .
18
27
15
11
12
10
3
5
1949 Males
Females .
19
10
11
8
5
5
6
4
*r>v, i- tp
i j
♦Rheumatic Fever patients not included.
Table 4. — Condition on Discharge — TUBERCULOSIS*
Arrested
Apparently
Arrested
Quiescent
Improved
Un-
improved
Not
Considered
Non-Tuber-
culous
Dead
1942 Males
Females
36
41
17
20
4
6
7
9
3
7
-
-
5
10
1943 Males
Females
33
21
11
22
1
2
4
3
4
3
-
9
7
1944 Males
Females
24
11
7
29
1
1
5
5
1
1
-
2
3
1945 Males
Females
26
14
8
20
2
2
8
2
-
-
6
4
1946 Males
Females
5
19
12
3
6
3
6
2
4
-
3
2
4
5
1947 Males
Females
30
24
4
2
2
4
2
3
1
3
1
4
4
3
5
1948 Males
Females
—
7
15
11
8
4
1
2
4
3 1
2
7
4
4
1949 Males
Females
24
11
1
2
3
3
4
3
1
-
3
2
1
1
♦Rheumatic Fever patients not included.
248
P.D. 34
Table 5. — Deaths of TUBERCULOSIS PATIENTS BY LENGTH OF
RESIDENCE IN SANATORIUM
1943
1944
1945
1946
1947
1948
1949
Less than 1 month,
2
_
_
2
_
_
1
1
1 to 3 months
3
2
1
-
1
2
2
-
3 to 6 months
2
6
1
-
2
-
3
1
6 to 12 months
1
3
2
2
3
2
-
-
1 to 2 years .
2
3
1
2
2
-
1
-
Over 2 years .
5
2
-
4
1
4
-
-
Table 6. —
- Causes of Death
TUBERCULOSIS
Tuberculosis
of Lungs
Tuberculosis
and Other
Conditions
Tuberculosis
Meningitis
Miliary
Tuberculosis
Miliary Tb.
with Other
Conditions
Other
Conditions
1942 Males .
Females
1
6
1
1
1
2
1
1
1
1943 Males .
Females
5
5
1
1
-
1
-
3
1944 Males .
Females
1
2
-
-
-
1
1
-
1945 Males .
Females
4
4
-
-
-
2
-
1946 Males .
Females
4
5
-
-
-
-
-
1947 Males .
Females
2
5
-
-
-
1
-
1948 Males .
Females
2
2
-
-
-
2
2
-
1949 Males .
Females
-
-
1
1
-
-
-
RUTLAND STATE SANATORIUM
Table 1. — Admissions and Discharges
Patients
Admitted
Patients
Discharged
Daily Average
Number of
Patients
Number of
Deaths
1942 Males
Females .
180
94
167
120
168.3
114.0
42
28
Total
274
287
282.3
70
1943 Males .
Females .
155
95
187
87
149.9
106.0
42
24
Total
250
274
256.0
66
1944 Males
Females .
137
108
130
113
140.5
106.1
25
20
Total
245
243
246.6
45
1945 Males
Females
100
68
108
78
134.9
96.2
35
25
Total
168
186
231.1
60
1946 Males
Females .
125
67
120
26
130.2
93.1
37
14
Total
192
188
223.3
51
1947 Males .
Females .
130
70
144
66
127.6
96.9
48
15
Total
200
210
224.5
63
1948 Males
Females
130
79
122
79
120.5
94.8
42
17
Total
209
201
215.3
59
1949 Males
Females
144
91
136
89
137.3
93.9
30
14
Total
235
225
231.2
44
P.D. 34
249
Table 2. — Stage of Disease on Admission
Moderately Far Non-
Advanced Advanced Unclassified Pleurisy Tuberculous Others
Minimal
1942 Males .
Females
26
12
40
19
95
46
10
10
4
4
4
2
1
1
1943 Males .
Females
15
14
39
29
89
46
5
4
1
1
5
1
1
0
1944 Males .
Females
7
15
36
33
79
50
10
5
3
0
0
1
2
4
1945 Males .
Females
7
6
27
23
54
33
10
4
0
0
1
1
1
1
1946 Males .
Females
8
8
32
20
75
34
7
4
0
0
0
0
3
1
1947 Males .
Females
8
6
29
13
81
40
11
10
0
0
0
0
1
1
1948 Males .
Females
7
16
33
23
76
36
8
2
0
0
0
0
6
2
1949 Males .
Females
7
11
26
30
94
40
9
8
0
0
0
0
8
2
Table 3. — Ages of Patients Admitted
Under
20 yrs.
20 to
29 yrs.
30 to
39 yrs.
40 to
49 yrs.
50 to
59 yrs.
60 to 70 and
69 yrs. over
1942 Males .
Females .
7
10
38
33
57
32
40
13
21
2
9
4
8
0
1943 Males .
Females .
9
7
30
42
45
29
29
10
26
5
15
2
1
0
1944 Males
Females .
8
12
30
37
41
37
33
13
13
5
12
3
0
1
1945 Males
Females .
2
3
18
28
29
17
23
12
16
3
8
4
4
1
1946 Males
Females
4
6
11
20
27
22
36
12
17
6
27
1
3
0
1947 Males .
Females .
3
5
16
31
22
18
39
11
25
3
23
2
2
0
1948 Males .
Females .
4
8
15
35
27
20
36
9
26
4
21
3
1
0
1949 Males
Females .
5
6
19
45
25
19
32
11
28
9
27
1
8
0
Table 4. -
- Condition on Discharge
Arrested
Apparently
Arrested
Quiescent
Improved
Un-
improved
Not
Considered
Non-Tuber-
culous
Dead
Other
Condi-
tions
1942 Males
Females
2
1
16
16
42
40
22
17
29
8
10
6
4
4
42
28
0
0
1943 Males
Females
2
3
14
12
58
19
32
11
25
12
9
6
5
0
42
24
0
0
1944 Males
Females
2
7
8
7
48
41
19
20
9
11
11
8
3
25
20
0
0
1945 Males
Females
8
10
11
10
24
14
19
8
4
4
6
5
35
25
0
0
1946 Males
Females
10
5
15
16
21
14
18
10
11
5
4
1
37
14
3
3
1947 Males
Females-
5
5
11
11
24
16
22
8
24
3
3
3
48
15
0
0
1948 Males
Females
6
8
7
16
25
23
18
6
13
3
2
3
42
17
4
2
1949 Males
Females
4
4
10
15
28
27
32
16
13
3
7
5
30
14
6
4
250
P.D. 34
Table 5. — Surgical Report — Operations on Patients
1942
1943
1944
1945
1946
1947
1948
1949
Pneumolysis ....
49
40
34
12
26
11
15
26
Bronchoscopy
58
34
69
64
45
28
21
32
Phrenic emphraxis .
-
—
4
—
1
6
—
-
Rib resection
-
3
—
3
3
1
1
1
Other operations
43
7
12
18
28
33
17
13
Thoracoscopy
-
-
-
-
4
1
-
3
Pneumoperitoneum
—
-
—
—
58
195
129
113
Artificial pneumothorax refills .
3747
3857
3052
2363
2710
1864
1771
2019
Aspirations ....
184
145
144
106
115
128
166
100
Total number of in patients who
received pneumothorax
146
*
68
130
190
119
196
156
Total number of outpatients who
received pneumothorax
78
*
38
40
47
45
47
47
*Figure not available.
Table 5. — Surgical Report — Operations at Massachusetts General Hospital
1942 1943 1944 1945
1946 1947
1948 1949
Thoracoplasty ... 18 14 22 16
Pneumonectomy ... 2 3 8 3
Lobectomy .... 2 1 5 3
Other operations ... 9 1 4 4
16 8
2
2 2
24 31
2 1
1 2
Table 6. — Deaths of Tuberculosis Patients by Length of Residence in
Sanatorium
Less than 1 month
1 to 3 months
3 to 6 months
6 to 12 months
1 to 2 years .
Over 2 years .
1942
12
20
12
7
6
13
1943
5
15
15
9
9
13
1944
6
8
7
5
11
1945
6
11
14
11
5
13
1946
6
6
1
8
14
16
1947
7
15
10
11
4
16
1948
6
9
8
12
12
12
1949
4
6
6
8
7
13
Table 7. — Causes of Death
1942
Pulmonary tuberculosis .....
Pulmonary tuberculosis and tuberculous larynigitis .
Pulmonary tuberculosis, laryngitis, and anorectal fistula
Bronchopneumonia ......
Bromchopleural fistula due to pulmonary tuberculosis
Epidermoid carcinoma of the left bronchus; multiple lung abscesses, left; left bron
chopleural fistula; ihcapsulated empyema, left; probable massive pulmonary in
farction ........
Pulmonary tuberculosis and tuberculous empyema .
Cerebral hemorrhage due to arteriosclerosis, arteriosclerosis
Perforation of intestine and pulmonary tuberculosis .
Diabetes mellitus .......
Pulmonary tuberculosis and tuberculous enteritis
Pulmonary tuberculosis; pyopneumothorax ; amyloidosis of kidney, liver and spleen
Pulmonary tuberculosis; tuberculous pneumonia; tuberculous enteritis
Pulmonary tuberculosis; diabetes mellitus; lues; progressive muscular atrophy
Pulmonary tuberculosis; tuberculous laryngitis; tuberculous enteritis; tuberculous
meningitis ............
Pulmonary tuberculosis and silicosis ........
Pulmonary tuberculosis and diabetes mellitus . . . . .
bronchopneumonia
1948
Pulmonary tuberculosis .........
Pulmonary tuberculosis; tuberculous laryngitis; amyloidosis of liver and kidneys
Pulmonary tuberculosis and intestinal fistula .....
Pulmonary tuberculosis; tuberculous laryngitis; tuberculous enteritis .
Pulmonary tuberculosis and diabetes mellitus .....
Pulmonary tuberculosis; tuberculosis of spine; tuberculous peritoneum
Pulmonary tuberculosis; tuberculous enteritis; ulceration of bronchi .
Pulmonary tuberculosis; pernicious anemia; tuberculous enteritis
Pulmonary tuberculosis; pericardial effusion .....
Hypertrophy of heart due to overstrain; pulmonary tuberculosis
Pulmonary tuberculosis; emphysema; mild hypertension; acute laryngitis
Pulmonary tuberculosis; tuberculous enteritis .....
Pulmonary tuberculosis; tuberculous laryngitis ...
Pulmonary tuberculosis; peripheral arteriosclerosis ....
Pulmonary tuberculosis; nephrosclerosis ......
Males
Males
Female
24
20
6
-
1
-
1
1
1
-
1
1
1
1
-
-
1
-
1
3
1
1
-
-
1
-
1
1
_
1
-
Females
33
13
-
1
—
1
1
0
1
3
1
0
-
1
-
1
1
-
1
0
1
—
-
3
1
1
1
-
1
-
P.D. 34
Table 7. — Causes of Death — Continued
19U
Pulmonary tuberculosis . . .
Pulmonary tuberculosis and tuberculous meningitis
Pulmonary tuberculosis and tuberculous laryngitis
Pulmonary tuberculosis and tuberculous enteritis
Coronary thrombosis and pulmonary tuberculosis
Pulmonary tuberculosis; glandular tuberculosis; lymphogranuloma inguinale
Pulmonary tuberculosis and mixed empyema . . ...
Pulmonary tuberculosis ; tuberculosis of peritoneum ; tuberculosis of kidney
Pulmonary tuberculosis and rheumatic heart disease
Pulmonary tuberculosis and tuberculosis pleurisy
Pulmonary tuberculosis and acute laryngitis
Pulmonary tuberculosis and bronchial tuberculosis
Pulmonary tuberculosis and glandular abscesses
Pulmonary tuberculosis and bronchopleural fistula
Pulmonary tuberculosis and tuberculous empyema
1945
Pulmonary tuberculosis . .
Pulmonary tuberculosis and arteriosclerotic nephrosclerosis
Pulmonary tuberculosis and pulmonary insufficiency
Pulmonary tuberculosis and cor pulmonale . . . . .
Pulmonary tuberculosis, tuberculous pleurisy and tuberculous enteritis
Pulmonary tuberculosis and simple laryngitis .....
Bronchopneumonia due to aspiration of foreign body
Pulmonary tuberculosis and tuberculous laryngitis ....
Tuberculous meningitis and pulmonary tuberculosis ...-.,
Pulmonary tuberculosis and tuberculous pleurisy ....
Pulmonary tuberculosis and bronchial tuberculosis ....
Pulmonary tuberculosis and bronchiectasis .....
Pulmonary tuberculosis and empyema
Pulmonary tuberculosis, chronic myocarditis and bronchopleural fistula
Pulmonary tuberculosis and generalized abdominal tuberculosis
Pulmonary tuberculosis and cardiac insufficiency ....
Pulmonary tuberculosis, tuberculous enteritis, tuberculous ascites and chronic al
coholism .........
Pulmonary tuberculosis and bronchial ulcers
Pulmonary tuberculosis, empyema and bronchopleural fistula
Pulmonary tuberculosis and diabetes mellitus . . .
Tuberculosis of cervical spine and pulmonary tuberculosis
Pulmonary tuberculosis, tuberculous colitis and nephritis with edema
Pulmonary tuberculosis, hypertension, arterial cerebral shock, encephalomacia due
to arterial hypertension ..........
1946
Pulmonary tuberculosis .....
Pulmonary tuberculosis, biliary cirrhosis .
Pulmonary tuberculosis, chronic alcoholism, malnutrition
Pulmonary tuberculosis, tuberculous laryngitis
Pulmonary tuberculosis, tuberculous enteritis .
Pulmonary tuberculosis, tuberculosis of seminal vesicles
Pulmonary tuberculosis, myocarditis
Pulmonary tuberculosis, bronchial asthma
Lung abscess, bronchiectasis . . .
Pulmonary tuberculosis, tuberculous peritonitis
Pulmonary tuberculosis, chronic cor pulmonale
Pulmonary tuberculosis, cirrhosis of liver
Pulmonary insufficiency due to tuberculosis, pneumoconiosis, tuberculous laryn
gitis . . . ...
Pulmonary tuberculosis, tuberculous empyema, tuberculous fistula of chest wall
Pulmonary tuberculosis, dilatation of the heart due to pulmonary lesion, cardiovas
cular heart disease ......
Pulmonary tuberculosis, tuberculous pleurisy .
Pulmonary tuberculosis, pneumoconiosis .
Pulmonary tuberculosis, tuberculous empyema
Pulmonary tuberculosis, tuberculous empyema, tuberculous enteritis, tuberculosis
of thoracic spine, cerebral hemorrhage, tuberculous meningitis .
Pulmonary tuberculosis, bronchopleural fistula, tuoerculous empyema
Pulmonary tuberculosis, diabetes mellitus .....
Pulmonary tuberculosis, tuberculous enteritis, tuberculous pleurisy _ .
Pulmonary tuberculosis, chronic alcoholism, malnutrition, avitaminosis, chronic
gastritis . . . . . . . ■ • • . . •
Pulmonary tuberculosis, tuberculous empyema, tuberculous laryngitis
1947
Pulmonary tuberculosis . . . . . . ■
Pulmonary tuberculosis, tuberculous enteritis .......
Pulmonary tuberculosis, tuberculous enteritis, generalized tuberculosis of the ab-
domen .............
Males
10
1
1
2
2
3
1
Males
17
1
2
1
1
1
1
1
1
1
1
1
1
1
2
Males
31
3
251
Females
10
14
1
-
2
2
4
-
1
-
—
1
-
1
1
0
1
-
1
1
1
-
1
-
1
-
1
-
-
1
Males
Females
Females
Females
252
Table 7. — Causes of Death, 1947 — Continued
Pulmonary tuberculosis,
Pulmonary tuberculosis,
Pulmonary tuberculosis,
Pulmonary insufficiency
Pulmonary tuberculosis,
Pulmonary tuberculosis,
Pulmonary tuberculosis,
holism
Pulmonary tuberculosis,
Myocarditis, pulmonary
Pulmonary tuberculosis,
Tuberculous meningitis,
Pulmonary tuberculosis,
Pulmonary tuberculosis,
Pulmonary tuberculosis,
tuberculous enteritis, chronic alcoholism
tuberculous laryngitis
malnutrition, amyloidosis
due to pulmonary tuberculosis, silicosis
tuberculous enteritis, tuberculous sigmoiditis
lymphadenitis ....
tuberculous laryngitis, tuberculous enteritis, chronic alco
empyema, endobronchial tuberculosis
tuberculosis ....
tuberculous empyema
pulmonary tuberculosis
tuberculous enterocolitis
tuberculous epiglottis
tuberculous meningitis, pneumonia
194s
Pulmonary tuberculosis .........
Pulmonary tuberculosis, diabetes mellitus . . .
Pulmonary tuberculosis, tuberculosis of larynx .....
Pulmonary tuberculosis, tuberculosis of intestine .....
Pulmonary tuberculosis, tuberculosis of intestine, tuberculous peritonitis
Cerebral hemorrhage, pulmonary tuberculosis . .
Pulmonary tuberculosis, tuberculous enterocolitis .....
Pulmonary tuberculosis, bronchiectasis, emphysema, amyloidosis of liver, spleen
kidney ............
Pulmonary tuberculosis, moderate hypertension, heart failure, emphysema, chronic
alcoholism . . . . . . .
Pulmonary tuberculosis, tuberculosis of bronchus, tuberculosis of intestine .
Pulmonary tuberculosis, bronchiectasis .......
Pulmonary tuberculosis, tuberculous empyema, tuberculosis of bronchus, nephrosis
chest wall tuberculosis .........
Silocisis ............
Pulmonary tuberculosis, tuberculous empyema, bronchopleural fistula, tuberculosis
of thoracic wall ..........
Pulmonary tuberculosis, diabetes mellitus, chronic alcoholism
Pulmonary tuberculosis, spontaneous pneumothorax, tuberculous empyema
Pulmonary tuberculosis, tuberculous empyema .....
Pulmonary tuberculosis, tuberculosis of kidney .....
Pulmonary tuberculosis, arteriosclerosis, generalized acromegalia
Pulmonary tuberculosis, dilatation of heart due to overstrain .
Pulmonary tuberculosis, tuberculosis of larynx, tuberculosis of intestine
Dilatation of heart, pulmonary tuberculosis ......
1949
Pulmonary tuberculosis . . . . . . . .
Pulmonary tuberculosis, tuberculous meningitis, tuberculosis of intestine
Pulmonary tuberculosis, tuberculosis of intestine, tuberculosis of larynx
Granulocytopenia .....
Pulmonary tuberculosis, diabetes mellitus
Pulmonary tuberculosis, secondary anemia
Pernicious anemia, pulmonary tuberculosis
Pulmonary tuberculosis, tuberculosis of intestine
Pulmonary tuberculosis, ulcerative colitis
Pulmonary tuberculosis, tuberculosis of larynx
Males
1
4
1
1
1
Males
19
3
1
4
1
1
1
Males
20
1
1
1
1
1
1
2
1
1
P.D. 34
Females
Females
9
1
4
Females
WESTFIELD STATE SANATORIUM
Table 1. — Admissions and Discharges — TUBERCULOSIS PATIENTS
Patients
Admitted
Patients
Discharged
Daily Average
Number of
Patients
Number of
Deaths
1942 Males .
Females .
106
64
92
81
78.8
77.0
28
11
1943 Males
Females .
104
94
125
105
79.1
79.2
31
17
1944 Males
Females
129
81
149
94
63.2
69.0
30
12
1945 Males
Females .
156
94
123
71
66.2
68.7
38
27
1946 Males
Females .
80
65
91
76
70.4
77.6
26
17
1947 Males .
Females .
57
69
69
71
60.1
73.3
18
16
1948 Males .
Females .
68
54
63
50
57.4
73.6
23
10
1949 Males
Females .
56
50
54
53
63.
73.
12
7
P.D. 34
Table 1.
253
Admissions and Discharges — CANCER PATIENTS
Patients
Admitted
Patients
Discharged
Daily Average
Number of
Patients
Number of
Deaths
1942 Males
Females
320
386
327
380
19.5
21.5
42
15
1943 Males
Females
172
211
175
218
8.1
10.6
1944 Males
Females
150
214
151
214
7.6
10.2
1945 Males
Females
128
209
125
211
6.7
10.2
18
6
1946 Males
Females
170
275
172
272
8.4
9.4
1947 Males
Females
180
296
180
291
7.3
11.6
18
14
1948 Males
Females
159
252
158
253
8.2
12.7
22
15
1949 Males
Females
208
267
206
268
23
13
Table 2. — Stage of Disease on Admission — TUBERCULOSIS PATIENTS
Moderately Far Non-
Minimal Advanced Advanced Unclassified Pleurisy Tuberculous Others.
1942 Males .
Females
11
14
24
14
55
27
3
3
1
12
4
1
1
1943 Males .
Females
15
23
21
22
51
42
3
1
4
4
8
3
1944 Males .
Females
21
17
20
17
70
35
8
7
2
1
4
3
4
1
1945 Males .
Females
8
8
9
9
101
46
27
23
2
1
7
5
2
2
1946 Males .
Females
5
13
5
7
37
17
30
26
1
-
3
1
1947 Males .
Females
3
13
14
14
27
23
12
15
3
1
1
1948 Males .
Females
3
4
13
14
38
25
12
10
1
1
-
1
1949 Males .
Females
1
0
10
11
27
25
17
13
1
0
-
0
1
Table 2. — Stage of Disease on Admission — CANCER PATIENTS
Early
Moderately
Advanced
Advanced Non-Malignant
1942 Males
Females
22
49
60
46
92
98
44
64
1943 Males
Females
23
26
44
54
38
23
18
41
1944 Males
Females
16
29
19
38
55
52
21
24
1945 Males
Females
17
28
16
55
56
41
10
31
1946 Males
Females
17
26
31
57
64
46
18
66
1947 Males
Females
20
33
28
46
52
47
29
85
1948 Males
Females
17
36
30
35
48
46
28
73
1949 Males
Females
34
26
26
33
48
50
22
77
254 P.D. 34
Table 3. — Ages of Patients Admitted — TUBERCULOSIS PATIENTS
Under
20 yrs.
20 to
29 yrs.
30 to
39 yrs.
40 to
49 yrs.
50 to
59 yrs.
60 to
69 yrs.
70 to 80 and
79 yrs. over
1942 Males
Females
4
8
30
26
18
20
20
5
15
3
16
2
2
1
1943 Males
Females
5
11
22
27
24
28
22
13
20
13
7
1
4
1
1944 Males
Females
4
18
22
31
28
16
25
6
31
6
18
4
-
1
1945 Males
Females
4
9
21
38
30
17
47
17
24
9
26
3
4
1
-
1946 Males
Females
1
6
12
31
15
12
25
6
12
6
11
3
3
0
1
1
1947 Males
Females
3
10
4
28
7
19
17
3
10
6
10
3
6
0
0
0
1948 Males
Females
4
7
6
22
22
18
14
2
9
2
12
2
1
1
0
0
1949 Males
Females
1
4
5
21
11
16
21
5
11
1
3
3
2
0
2
0
Table 3. — Ages of Patients Admitted — CANCER PATIENTS
Under
20 yrs.
20 to
29 yrs.
30 to
30 yrs.
40 to
49 yrs.
50 to
59 yrs.
60 to
69 yrs.
70 to 80 and
79 yrs. over
1942 Males
Females
1
3
5
4
12
21
20
67
52
78
74
53
47
26
7
5
1943 Males
Females
3
4
1
4
3
16
8
22
24
29
42
42
36
25
6
2
1944 Males
Females
5
3
2
5
2
14
13
21
22
35
40
35
23
26
4
4
1945 Males
Females
3
2
2
7
2
20
6
29
16
37
39
36
26
20
5
4
1946 Males
Females
2
2
1
2
2
19
9
49
35
56
52
40
26
25
3
2
1947 Males
Females
2
4
2
6
2
24
12
43
30
50
37
46
32
28
12
10
1948 Males
Females
5
3
0
9
2
21
11
35
22
50
48
41
29
22
6
9
1949 Males
Females
1
0
3
10
3
16
12
43
26
43
44
37
30
33
11
4
Table 4. — Condition on Discharge — TUBERCULOSIS PATIENTS
Arrested
Apparently
Arrested
Quiescent
Improved
Unimproved
Deaths
Not
Considered
Non-
Tuberculous
1942 Males .
Females .
:
30
31
2
1
13
18
19
18
28
11
-
2
1943 Males .
Females
-
34
41
7
5
31
16
22
26
31
17
-
-
1944 Males .
Females .
6
2
30
32
-
32
15
50
33
30
12
-
-
1945 Males .
Females .
-
16
16
2
19
9
43
18
39
27
-
1946 Males .
Females .
-
13
30
1
18
15
31
11
26
17
1
1947 Males .
Females .
1
17
29
5
5
8
11
15
8
18
16
-
1948 Males .
Females .
1
3
1
8
16
2
10
11
5
14
3
23
10
: ! 1
1949 Males .
Females .
1
1
2
37
2
3
4
1
13 1
3
12
7
i i
P.D. 34
255
Table 4.
— Condition
on Discharge
— CANCER PATIENTS
Improved Unimproved Died
1942 Males .
Females
212 73 42
278 87 15
1943 Males .
Females
122 44 9
166 50 2
1944 Males .
Females
109 31 11
165 43 6
1945 Males .
Females
78 29 18
156 49 6
1946 Males
Females
118 36 18
211 48 13
1947 Males .
Females
130 32 18
222 55 14
1948 Males .
Females
109 27 22
200 38 15
1949 Males .
Females
154 29 23
229 26 13
Table 5. — Surgical Report — TUBERCULOSIS
1942 1943 1944 1945 1946 1947 1948 1949
Thoracoplasty
7
10
-
-
13
53
32
67
Pneumolysis
27
6
-
-
49
40
17
12
Bronchoscopy .
4
7
13
10
6
28
55
26
Phrenic Emphraxis .
3
2
5
3
3
3
3
-
Thoracoscopy .
4
2
-
1
-
3
4
-
Other Operations
16
20
40
42
54
51
120
27
Aetificial Pneumothorax .
6602
3509
2869
1245
1564
3934
2954
2876
Table 5. — Surgical Report — CANCER
1942
1945
1946
1947
1948
1949
Operations
Biopsies .
Endoscopies
Transfusions
Anesthetics given
Autopsies
X-ray Treatments
Radium Treatments
652
399
434
404
549
590
566
613
465
443
411
289
352
328
434
322
448
354
402
444
289
226
231
246
195
171
149
289
365
470
518
593
1445
937
966
979
1230
1219
1305
1279
36
8
11
16
23
25
20
20
8278
5726
6200
6639
5552
5596
5818
5279
113
62
99
83
70
56
53
71
Table 6. — Deaths of TUBERCULOSIS PATIENTS by Length of
Residence in Sanatorium
Less than 1 to 3 3 to 6 6 to 12 1 to 2 Over 2
1 month months months months years years
1942 Males .
Females
4 6 7 4 4 3
4 2 2 2 10
1943 Males .
Females
8 6 3 8 15
3 6 2 2 3 1
1944 Males .
Females
10 5 5 5 3 2
12 3 14 1
1945 Males .
Females
19 9 4 3 3 0
4 3 3 6 7 4
1946 Males .
Females
4 5 6 3 3 5
12 3 3 5 3
1947 Males .
Females
5 3 13 5 1
14 2 3 4 2
1948 Males .
Females
3 15 3 7 4
0 10 14 4
1949 Males .
Females
11 13 2 4
0 3 0 2 2 0
256
P.D. 34
Table 7. — Causes of Death
- TUBERCULOSIS PATIENTS
1942
Pulmonary tuberculosis, silicosis, cardiac failure ....
Bronchiogenic carcinoma ........
Carcinoma of right kidney ........
Carcinoma of sigmoid; pulmonary embolism; bronchiectasis
Coronary thrombosis, carcinoma of left breast with metastases, pulmonary tuber
culosis — apparently arrested .......
Miliary tuberculosis with tuberculous meningitis ....
Pulmonary tuberculosis ........
Pulmonary tuberculosis; carcinoma of left breast ....
Pulmonary tuberculosis and pulmonary hemorrhage
Pulmonary tuberculosis, diabetes mellitus, old coronary thrombosis
Pulmonaiy tuberculosis, tuberculous enteritis and laryngitis . .
Pulmonary tuberculosis, and tuberculous laryngitis ....
Pulmonary tuberculosis, pneumonia ......
Pulmonary tuberculosis, Pott's Disease, Spontaneous pneumothorax .
Pulmonary tuberculosis, tuberculous pyonephritis ....
Pulmonary tuberculosis, rheumatic heart disease, cirrhosis of liver _
Pulmonary tuberculosis, silicosis, tuberculous kidney, adrenal and ileum, pulmon
ary hemorrhage .........
Pulmonary tuberculosis and uremia ......
Tuberculous adenitis . . . . . . . -.
Tuberculous meningitis, pulmonary tuberculosis, tuberculosis empyema
1943
Bronchiectasis and Lung Abscess
Miliary tuberculosis .....
Miliary tuberculosis with pericarditis
Pulmonary tuberculosis ....
Pulmonary tuberculosis with brain abscess
Pulmonary tuberculosis with diabetes
Pulmonary tuberculosis with tuberculous enteritis
Pulmonary tuberculosis with tubercuious laryngitis
Pulmonary tuberculosis with tuberculous meningitis
1944
Bilateral pulmonary tuberculosis ....
Pulmonary tuberculosis .....
Pulmonary tuberculosis with tuberculous meningitis
Pulmonary tuberculosis with pulmonary neoplasm
Pulmonary tuberculosis with unknown heart disease
Tumor of kidney, probably hypernephroma
Pulmonary tuberculosis with circulatory failure, unknown cause
1945
Bilateral pulmonary tuberculosis ......
Bronchiogenic carcinoma ........
Clinical tuberculosis with unknown heart disease . .••..■
Extrapulmonary tuberculosis with tuberculous enteritis and peritonitis
Pulmonary fibrosis with sarcoid disease ......
Pulmonary tuberculosis ........
Pulmonary tuberculosis with tuberculous enteritis ....
Pulmonary tuberculosis with epilepsy ......
Pulmonary tuberculosis with tuberculous laryngitis ....
Pulmonary tuberculosis with tuberculous meningitis
Pulmonary tuberculosis with tuberculous spine ....
Retroperitoneal sarcoma ........
1946
Pulmonary fibrosis, coronary thrombosis, bronchiectasis and bronchial pneumonia
Pulmonary tuberculosis . .......
Pulmonary tuberculosis, question of brain tumor . . . • .
Pulmonary tuberculosis with right pleural effusion .....
Pulmonary tuberculosis with diabetes .......
Pulmonary tuberculosis with miliary tuberculosis .....
Pulmonary tuberculosis with Pott's disease ......
Pulmonary tuberculosis with tuberculous empyema, bronchiopleural fistula and
tuberculous enteritis .........
Pulmonary tuberculosis with tuberculous enteritis ....
Pulmonary tuberculosis with tuberculous enteritis, tuberculous empyema and tu
berculous tongue .........
Pulmonary tuberculosis with tuberculous laryngitis ....
Pulmonary tuberculosis with tuberculous meningitis
Pulmonary tuberculosis with tuberculous meningitis, tuberculous laryngitis and
tuberculous enteritis .........
Pulmonary tuberculosis with tuberculosis of right tonsil
Males
Male3
Males
Females
1
0
1
0
1
0
1
0
0
1
0
1
15
4
0
1
1
0
0
1
1
0
2
-
0
1
1
0
0
1
1
0
1
0
1
0
1
0
0
1
Males
Female*
0
1
0
1
1
0
26
12
1
0
2
1
0
1
1
0
0
1
Females
0
1
25
11
1
0
1
0
1
0
1
0
1
0
Females
4
0
1
0
1
0
0
1
1
0
24
21
0
1
1
0
5
0
0
3
0
1
1
0
Males
Females
1
0
14
14
0
1
1
0
0
1
1
0
1
0
i
1
0
2
0
0
1
2
0
1
0
i
1
0
1
0
P.D. 34
257
Table 7. — Causes of Deaths — TUBERCULOSIS PA TIENTS— Continued
1947
Males
Advanced pulmonary tuberculosis
Advanced with endenocarcinoma of rectum
Advanced with bronchopleural fistula
Advanced with diabetes .
Advanced with diabetes, hypertension with hemiplegia
Advanced with empyema .
Advanced with tuberculous enteritis
Advanced with tuberculous laryngitis
Advanced with tuberculous meningitis . . .
Advanced with tuberculous spine, hip and renal tuberculosis
Minimal with chronic arthritis and self-induced hemorrhage
Meningitis, origin undetermined .....
Moderately advanced with effusion, diabetes and presumably tuberculous enteritis
Moderately advanced, question activity, with gastric hemorrhage
1948
Advanced Pulmonary Tuberculosis . . . .
Advanced with Diabetes .
Advanced with pleurisy with effusion ........
Advanced with pleural-cutaneous fistula, tuberculous empyema and bronchopleural
fistula .............
Advanced with pleuro-cutaneous fistula, tuberculous empyema and tuberculous
enteritis . . .
Advanced with tuberculous enteritis . . .
Advanced with tuberculous enteritis and myocardial insufficiency
Advanced with tuberculous laryngitis .
Carcinoma of lung with pleurisy with effusion . _ . . .
Advanced with widely disseminated bone tuberculosis superimposed on sarcoid
disease . . . . . . . . ...
1949
Advanced pulmonary tuberculosis .........
Coronary heart disease with congestive heart failure, advanced pulmonary tubercu-
losis .............
Drowning in fluids due to rupture, advanced pulmonary tuberculosis
Questionable cerebral hemorrhage, advanced pulmonary tuberculosis .
Terminal hemorrhage, advanced pulmonary tuberculosis .....
Males
Females
9
7
1
0
1
0
0
2
0
1
0
1
2
1
1
2
1
0
1
0
0
1
0
1
1
0
1
0
Males
Females
14
10
1
0
1
0
1
0
1
0
1
0
1
0
1
0
1
0
Females
8
7
1
0
1
0
1
0
1
0
PONDVILLE HOSPITAL
Table 1. — Admissions and Discharges
Patients
Admitted
Patients
Discharged
Daily Average
Number of
Patients
Number of
Deaths
1942 Males .
Females
528
584
537
602
40.8
40.0
64
32
Total
1,112
1,139
80.8
96
1943 Males .
Females
392
470
405
481
26.6
25.0
42
20
Total
862
886
51.3
62
1944 Males .
Females
342
380
349
388
21.4
20.4
19
8
Total
722
737
41.8
27
1945 Males . • .
Females
292
362
274
353
17.7
16.4
23
10
Total
654
627
34.1
33
1946 Males .
Females
329
398
295
378
19.6
19.6
27
14
Total
727
673
39.2
41
1947 Males .
Females
370
430
347
420
17.0
19.8
28
14
Total
800
767
36.8
42
1948 Males .
Females
365
461
328
430
21.8
23.5
30
26
Total
826
758
45.3
56
1949 Males .
Females
362
495
337
472
22.1
25.9
35
18
Total
857
809
48.0
53
258
P.D. 34
Table 2. — Stage of Disease on Admission
Moderately Non-
Early Advanced Advanced Malignant Unclassified
1942 Males .
Females
Total
31
39
70
80
169
134
104
238
59
153
212
16
1943 Males .
Females
Total
28
29
57
77
62
139
42
111
153
11
1944 Males .
Females
26
26
64
55
72
56
40
91
5
3
Total
52
119
128
131
8
1945 Males .
Females
20
24
46
42
79
61
34
96
-
Total
44
88
140
130
0
1946 Males .
Females
11
13
59
69
82
53
38
100
1
Total
24
128
135
138
1
1947 Males .
Females
12
19
59
39
94
71
45
120
2
3
Total
. . 31
98
165
165
5
1948 Males .
Females
14
15
71
48
89
68
36
155
3
3
Total
29
119
157
191
6
1949 Males .
Females
25
28
50
58
86
61
54
158
2
8
Total
53
108
212
10
Table 3. — Ages of Patients Admitted
Under
20 yrs.
20 to
29 yrs.
30 to
39 yrs.
40 to
49 yrs.
50 to
59 yrs.
60 to
69 yrs.
70 to
79 yrs.
80 to
89 yrs.
90 to
99 yrs.
Un-
known
1942 Males
Females
3
6
10
15
14
39
26
94
86
92
93
79
57
49
21
17
1
1
2
1943 Males
Females
3
2
3
6
9
28
20
66
49
64
64
58
57
40
12
11
1
1
-
1944 Males
Females
2
4
3
15
4
24
12
46
41
58
77
48
49
33
16
3
3
-
1945 Males
Females
3
3
1
18
2
23
14
47
36
55
61
41
-
-
-
-
1946 Males
Females
2
6
2
8
8
29
12
39
34
53
56
50
57
43
21
6
-
-
1947 Males
Females
2
4
7
11
9
39
25
44
33
49
65
48
58
50
15
5
-
-
1948 Males
Females
2
9
4
16
6
36
14
62
48
65
73
58
52
34
16
6
1
-
1949 Males
Females
5
7
2
21
8
35
13
76
37
66
80
56
56
43
16
8
1
-
P.D. 34
259
Table 4. — Condition on Discharge
Improved Unimproved Deaths
1942 Males
Females
368 105 64
465 105 32
1943 Males
Females
299 64 42
388 73 20
1944 Males
Females
262 68 19
343 37 8
1945 Males
Females
205 69 23
284 69 10
1946 Males
Females
223 72 27
311 67 14
1947 Males
Females
257 90 28
345 75 14
1948 Males
Females
248 80 30
360 70 26
1949 Males
Females
267 71 35
391 80 18
Table 5. — Surgical Report
1942
1943
1944
1945
1946
1947
1948
1949
Operations .... 983
814
792
741
833
963
967
982
Biopsies
351
156
91
161
297
180
328
341
Endoscopies
324
257
213
205
304
343
410
406
Transfusions
322
276
269
258
468
454
706
716
Anesthetics given
1162
889
855
770
893
979
1064
1059
Autopsies
69
51
23
25
29
37
41
45
X-ray treatments
9201
4946
5379
5290
5783
5809
5401
5642
Radium treatments
242
172
198
148
123
191
139
126
Table 6. — Clinic Examinations
1942
1943
1944
1945
1946
1947
1948 1949
Visits to regular Thurs-
day Clinics
4022
3754
3932
3682
4232
4889
5166 5611
Average attendance .
82.1
75.8
77
75
86.3
97.8
103.3 110.0
First visits
1024
814
931
880
836
*
* *
Total clinic visits
6455
6084
6815
6205
7025
8085
8687 9660
Clinic patients admitted
to Hospital
475
368
367
381
405
420
456 465
* Information not available
260 P.D. 34
DIVISION OF BIOLOGIC LABORATORIES
CONSOLIDATED REPORT 1942-1949
Geoffrey Edsall, M.D., Director
General Statement
The impact of World War II during this period brought the laboratory into a
close cooperative effort with the Harvard Medical School in O.S.R.D. biologic
studies for the armed forces and plasma fractions pilot work for the Navy. It
should be noted that personnel depletion was continuous throughout the period.
Plans for a statewide civilian blood program culminated in the dedication on
March 26, 1947 of the third major physical expansion of the laboratory, built with
funds furnished through the generosity of the Godfrey M. Hyams Trust. The ex-
panded facilities allowed the establishment of a tetanus laboratory, new smallpox
quarters, and additional stockroom space.
As the whole blood program developed, the American Red Cross, in an expanding
national program, began financing this work and also began the operation of the
field units on March 1, 1948. On March 1, 1950 they assumed operation of the
whole blood processing and distribution. Pilot studies in plasma fractions began
under the same auspices in 1949. State funds for blood were then only applied to
the fractionation of outdated plasma for the State's use.
In 1946 the laboratory began the control testing of human blood fractions pro-
duced under the Cohn patents and financed by Research Corporation.
Licenses were granted by the Federal Security Agency for :
Immune Serum Globulin (Human)
Anti Hemophilus Influenzae Type b Serum
Schick Test Control
Tetanus Toxoid (Fluid)
Pertussis Vaccine
Licenses revoked without prejudice:
Diphtheria Toxin-Antitoxin Mixture
Pneumococcus Typing Serum
Dr. Elliott S. Robinson, Director of the Division since 1933, was re tired in 1947
because of ill health, and Dr. Geoffrey Edsall, wartime Acting Director, assumed
the Directorship.
Investigations:
An incomplete fisting includes :
1 . Human albumin and plasma fractions
2. Shellfish studies
3. Smallpox studies
4. Diphtheria antitoxin, enzyme digestion
5. Diphtheria toxin and Schick toxin
6. Diphtheria toxoid purification
7. Tetanus toxin, toxoid and antitoxin
8. Pertussis vaccine
9. Serum jaundice
10. Purification of typhoid vaccine
P.D. 34
261
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264 P.D. 34
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH
Accounting Office
A & V Lab.
Budgets
Appropriated Funds
Expenditures
Expenditures
Personnel
Services Expenses
Personnel
Services Expenses
Personnel
Services Expenses
1941-1942
4120-07 +Pneu. Control .
2007-07
812,721.84 $14,068.86
80.000.00 36,200.00
$11,563.94 $12,467.68
73,590.47 35,432.90
Dec. '42 to June '43 (7 mos.)
2007-07 ....
43,441.43
17,487.12
$16,844.43
43,441.43
16,753.18
1942-1943
4120-07 + Pneu. Control
9,776.00
9,662.43
11,650.19
VD ....
866.25
866.25
1943-1944
2007 07 .
75,834.00
41.800.00
$76,445.15
37,904.41
76.43S.54
37,837.76
4120-07+Pneu. Control .
7,917.76
4,538.50
7,257.95
3,258.70
VD ....
1,163.35
1944-1945
2007 07 .
77,625.00
41,800.00
74,482.51
37.801.79
74,482.50
37,666.36
4120-07+Pneu. Control .
7,264.00
25,004.20
6,489.25
24,902.36
VD ....
1,289.35
1945-1946
2007-07 ....
82,700 00
40,000,00
81,362.22
37,538.07
81,359.25
37,533.53
4120-07 ....
8,162.52
5,652.42
8,065.27
4,681.65
VD ....
1,010.00
1,010.83
6160-01 ....
3,676.12
3,676.12
2008-01 ....
43,665.00
49,335.00
36,927.94
41,564.29
36,660.53
41,156.31
2008-02 ....
23,223.39
23,223.39
191,000.00
1946-1947
2007-07 ....
109,550.00
40,000.00
95,293.32
39,221.68
95,089.69
39,135.45
4120-07 ....
10,113.44
12.586.56
10,015.74
7,458.48
10,015.74
11,880.50
VD ....
1,449.00
1,449.02
6160-01 ....
7,091.70
2,451.11
7,091.70
2,451.11
2008-12 ....
117,000.00
60,000.00
102,810.27
58,026.61
102,532.07
56,277.35
2008-02 ....
71,776.61
73,072.40
4120-50 ....
2,770.58
2.770.58
Blood Group Lab.
1,080.00
R.C. Jaundice Study
5,850.00
1947-1948
2007-07 ....
114,293.00
40,000.00
102,788.33
39,357.98
109,312.71
38,902.16
4120-07 ....
12,522.28
1,110.80
VD ....
1,720.00
1,720.00
6160-01 ....
8,642.14
2,666.99
8,642.14
2.666,99
2008-11 ....
135,360.00
70,000.00
103,420.94
66,668.67
108,229.98
67,030.97
2008-11 R.C. .
32,000.00
4120-50 ....
28,708.42
22,915.53
B.G.L
9,910.00
R. C. Jaundice
1,732.00
1948-1949
2007-07 ....
117,180.00
36,525.00
107,097.37
33,183.32
4120-07 ....
11,750.05
470.17
VD ....
1,740.00
1,740.00
2008-11-00 Pilot
27,500.00
47,500.00
6.43S.62
17.100.78
2008-11 ....
89,000.00
37,215.00
58,475.66
31,802.19
2008-11-99
6,090.39
3,891.57
2008-ll-W.B.\
2008-1 1-Rx) /
68,000.00
41,262.00
33,100.24
10,440.95
/ 14,274. 74
\ 5,168.60
6160-01 ....
10,072.95
4,855.88
10,072.95
4,855.88
B.G.L
1,680.00
U. S. Army Study .
5,000.00
If no figures appear under the heading "Accounting Office — Personnel Services or Expenses," it is because the Labora -
ory did not receive a final statement of appropriation and expense for that year.
P.D. 34
265
DIVISION OF DENTAL HEALTH
CONSOLIDATED REPORT 1946-1949
William D. Wellock, D.M.D., M.P.H., Director
General Statement
The Dental Division was established July 1, 1946, and has been taking the funda-
mental steps necessary to accomplish its primary objective — the prevention and
control of tooth decay. During this period the knowledge of when, where and under
what conditions this most common disease occurs has been observed and recorded
for the first time in the history of the Commonwealth. Extensive research and epi-
demiological studies have been made. These activities have played no little part in
helping to educate the public and profession. In this short time, an intense interest
has been aroused in most communities to attack this problem at its inception in
childhood by the formation of local dental health programs for pre-school and
school children. Programs resulting from this interest are, at this date, as extensive
as can be found in the nation.
The beginnings of a preventive program have been made by the demonstration of
recommended dental techniques and their resultant adaptation to the care pro-
grams.
Dental Division
The objectives of the Dental Division are to conduct or stimulate research de-
signed to reduce the present caries prevalence and concurrently to stimulate ade-
quate care programs to ameliorate the existing conditions.
Although great strides have been made in the development of preventive meas-
ures, tooth decay remains a vexatious problem which must be conquered during
childhood and adolescence if control is to be achieved. At the date of present ob-
servations, preventive methods are new and cumbersome, and control methods by
means of care programs inadequate, yet the latter represents one of the greatest
efforts of any state in the nation.
In the Division's history, no observation of a geographical differentiation has
been made on the incidence of caries in children of the Commonwealth. Because
of the newness of preventive measures, no significant results of their use have, as
yet, been observed.
Representative state- wide dental findings in school children are attached.
Average Number of Decayed and Filled Deciduous Teeth per Child By Age
in Eleven Representative Massachusetts Communities
1950
Age
Number Number of Number of Number of
of Decayed Teeth Filled Teeth df Teeth
Cases Per Child Per Child Per Child
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
80
3.52
.64
4.16
556
4.83
.52
5.35
594
4.44
.82
5.26
521
4.43
.75
5.18
490
3.59
.67
4.26
476
2.68
.41
3.09
489
1.37
.19
1.56
383
.52
.06
.58
321
.23
.03
.26
214
.08
.00
.08
122
.08
.00
.08
92
.05
.05
.10
51
.01
.00
.01
15
.00
.00
.00
3
.00
.00
.00
Total
4407
266
P.D. 34
Avekage Number of Decayed, Missing and Filled Permanent Teeth per
Child by Age
in Thirteen Representative Massachusetts Communities
1950
Age
Number
of
Cases
Decayed
Teeth
Per Child
Missing
Teeth
Per Child
Filled
Teeth
Per Child
DMF Teeth
Per Child
5
6
7
8
9
10
11
12
13
14
15
16
17
18
80
.07
.00
.00
.07
556
1.21
.00
.05
1.26
594
1.91
.00
.20
2.11
521
2.51
.04
.48
3.03
506
2.81
.08
.71
3.60
505
3.37
.14
.99
4.50
524
4.27
.29
1.48
6.04
410
5.50
.37
1.73
7.60
373
6.31
.62
2.26
9.19
264
7.29
.90
2.50
10.69
198
7.26
.85
2.85
10.96
145
6.89
1.10
4.78
12.77
98
7.42
1.37
4.50
13.29
31
9.00
1.70
3.93
14.63
Total
4805
Findings Made During Topical Fluoride Demonstration
in Ten Massachusetts Communities
1949
;H«
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Missing Permanent Teeth
J3 M
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1.4
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71.
8
85.
21.
18.
1.9
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9
90.
31.
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1.5
10.6
72.
10
95.
39.
14.
1.8
16.9
77.
11
97.
36.
7.
1.9
28.3
85.
12
98.
51.
2.
2.1
41.9
77.
13
100.
49.
1.
2.2
53.5
78.
14
98.
55.
0.
2.6
55.5
73.
15
97.
55.
0.
3.3
60.0
68.
16
100.
50.
0.
3.1
66.7
75.
P.D. 34 267
DIVISION OF HOSPITALS
CONSOLIDATED REPORT 1942-1949
Richard P. MacKnight, M.D., Director
Chapter 111 of the General Laws, Section 71 to 73 inclusive as amended by Chap-
ter 661 of the Acts of 1941, authorizing the licensing of hospitals and sanatoria by
the Department of Public Health, was passed by the Legislature in 1941 and ap-
proved on October 20, 1941.
This function was placed in the Bureau of Hospital Licensing in the Division of
Administration under the direct supervision of the Commissioner and began to
function as such on June 1, 1942. The Bureau personnel consisted of a physician,
the Superintendent of Hospital Inspection, a registered nurse, the Hospital In-
spector and a junior clerk.
In accordance with the provisions of the Act, an Advisory Committee on Hos-
pitals and Sanatoria was appointed to suggest standards and policies for the ad-
ministration of the program. Prior to the effective date of the licensing law, this
Committee, together with representatives of the Department and other advisors,
prepared the Hospital Standards which included the classification of hospitals and
sanatoria and minimum regulations for the conduct of the licensing program. These
Standards were approved and adopted by the Department on April 14, 1942,
amended on February 9, 1943 and December 14, 1943. At the present time we are
revising these Standards. The revised Standards will become effective July 1, 1950.
During the first year of the program, ten hospitals converted into nursing
homes and five closed because of their inability to meet minimum standards. By
January 1, 1944, 170 of the 186 hospitals existing at that time were licensed for two
years as specified in the statute.
As our program progressed we were frequently called upon to assist Hospital Ad-
ministrators and Trustees with their problems chiefly in relation to administration,
medical and nursing staff organization and medical records.
In 1944, the inspection and licensing of clinics and dispensaries was transferred
from the Division of Communicable Diseases (District Health Officers) to the bureau
of hospital licensing.
In September 1945, Chapter 661 of the Acts of 1941 was amended by Chapter
527 of the Acts of 1945. This provided for the issuance of a certificate of inspection
by a building inspector in the Department of Public Safety for each hospital licensed.
This transfer of the responsibility for the safety and fire protection from the bureau
of licensing was enthusiastically received by the Department and greatly strength-
ened the relationships between the Departments of Public Safety and Health.
In December 1945, the first plans for Survey of Hospitals under the guidance of
the Commission on Hospital Care was initiated with the temporary appointment,
of a Director of Survey (a physician) who officiated in that capacity until the middle
of July 1946.
In the latter part of June 1946, the first outbreak of Infectious Diarrhea of the
Newborn occurred in one of our licensed hospitals necessitating the closing of their
maternity service. Again in October 1946, a large number of cases developed in a
hospital in the same community. Their obstetrical service was closed from Novem-
ber 7, 1946 to February 21, 1947.
In the Metropolitan area explosive outbreaks in seven other institutions occurred
and less serious outbreaks in five additional hospitals, almost simultaneously.
It is difficult to estimate the exact number of deaths or even the number of cases
during this series of outbreaks, but there were well over 70 deaths of newborn in-
fants. In each instance, sometimes voluntarily and sometimes acting on the advice
of the Department, obstetrical admissions ceased and the service was not reopened
until all of the recommendations of the Department, including a rigid cleaning up
process and revision of medical and nursing techniques had been complied with.
The purchase of new equipment was necessary and in some instances structural
changes had to be effected.
In general, it was apparent that overcrowded nurseries, inadequate physical facili-
ties and equipment, sanitary hazards, poor techniques and acute shortages of quali-
fied personnel, particularly graduate nurse supervision for the twenty-four hour
period, were contributing factors.
268 P.D. 34
It was a well-known fact that the increased number of hospital deliveries had
created unforeseen demands on the institutions, but the expansion of hospital facili-
ties and personnel necessitated by this increase had not kept pace.
As a result of these epidemics it was realized that drastic reorganization of the ma-
ternity services throughout the Commonwealth was necessary, which was initiated.
It is noteworthy that there have been no infant deaths from infectious diarrhea
of the newborn in hospitals with maternity services licensed by the Department of
Public Health from July 1947 to date; but there was one death in May, 1948, that
occurred in an institution not under the jurisdiction of the Department of Public
Health.
During the period from July, 1947, to date there were 32 suspicious episodes re-
ported to the Bureau of Hospital Licensing with no resulting deaths. This un-
questionably was due to the wholehearted cooperation which exists between the
Licensing Bureau, Hospital administrators, local boards of health and the Director
of the Division of Communicable Disease. Other influencing factors included con-
ferences with pediatricians, obstetricians, trustees and maternity and pediatric
nursing supervisors to interpret Department policies and to assist in the establish-
ment of safe procedures and techniques and the development of proper facilities.
It would seem proper at this time to mention the "Institutes on Infectious Diar-
rhea of the Newborn" which were really a result of the shocking outbreaks and were
held the latter part of May and early in June 1947 in Springfield, Salem, New Bed-
ford and Boston. A hearty response to these Institutes was manifested by the at-
tendance and extreme general interest.
Through the cooperation of the Divisions of Maternal and Child Health and
Communicable Diseases, the proceedings of the Institute was published and for-
warded to all licensed hospitals in May, 1949.
The responsibility assumed by the Department with the enactment of Chapter
618 of the Acts of 1948 can be best judged when it is known that there are 871 nursing
and convalescent homes and boarding homes for the aged throughout the state.
This figure includes 137 charitably incorporated homes which became subject to
licensure by the repeal of Section 22A of Chapter 121 of the General Laws which
had exempted the charitably incorporated group. To date 255 convalescent and
nursing homes and 289 boarding homes for the aged have been licensed by the De-
partment.
Chapter 618 of the Acts of 1948 also includes the licensing of homes conducted by
the body known as the Church of Christ Scientist which were previously exempt.
However, such homes are not subject to inspection by the Department except for
sanitation although all other requirements for the issuance of a license must be met.
In accordance with the provisions of the Act after a public hearing, rules and regu-
lations were established under authority of the General Laws, Chapter 111, Section
71 to 73 inclusive as amended by Chapter 618 of the Acts of 1948 which provided
for the licensing of convalescent and nursing homes and boarding homes for the
aged as part of the existing program for the licensing of hospitals and sanatoria.
The rules and regulations for the licensing of convalescent and nursing homes and
boarding homes for the aged were approved and adopted at a meeting of the De-
partment on November 3, 1948.
The licensing program for convalescent and nursing homes and boarding homes
for the aged was organized to function through the district health officers in an en-
deavor to provide a mere efficient service, but with no additional appropriation for
the necessary personnel, travel and equipment the program has been seriously handi-
capped from the onset. In fact, in order to initiate this program it was necessary
to effect the transfer of four temporary employees from the Department of Public
Welfare. The Department of Public Welfare also transferred funds for their salaries
for the first year. A further handicap arose when one of the inspectors resigned in
October 1948. We now have six districts covered by three inspectors and no pro-
vision for this service in the North and South Central Districts.
Previous to June 1948 no Department policy had been effected relative to the
licensing of sanatoria for non-committable psychiatric individuals. This situation
created a controversial issue since June 1942 because, according to the General Laws,
Chapter 123, the Department of Mental Health had no authority to license institu-
tions that did not commit patients. In agreement with the Department of Mental
P.D. 34
269
Health and the Department of Public Health, the first two of these institutions were
licensed on June 14, 1948. Since that date, three other similar sanatoria have been
licensed by the Department and we will continue to do so since this procedure has
become an established policy.
The Hospital Standards were completely revised in 1949. This project entailed
a tremendous amount of time and effort. In the compilation of these Standards,
the Bureau has worked closely with the Advisory Committee, the State Academy
of Pediatrics, Hospital Administrators, Obstetricians and Surgeons. The Director
of the Division of Communicable Disease, the Director of Maternal and Child
Health and the Director of the Division of Sanitary Engineering, also rendered
valuable assistance.
The Committee on Maternal Welfare of the Massachusetts Medical Society in
cooperation with the Division of Maternal and Child Health and the Division of
Hospitals began a five year studv of maternal deaths in Massachusetts in January,
1949.
Other important contributions were the assistance given by the Division in the
preparation of the "Standards and Recommendations for the Hospital Care of New-
born Infants" bjr the American Academy of Pediatrics. Also we worked closeby
with the National and State Committee for the improvement of child health.
Interstate communications have increased and there were many visitors as well
as an increased number of requests from other states seeking information on our
licensing program.
From an interdepartmental level we continue to work in excellent cooperation
with the Department of Public Safety, the Department of Public Welfare and the
Department of Mental Health.
We are very appreciative of the excellent relationship that exists between the di-
vision of Hospitals and the following : The Massachusetts Medical Society, Massa-
chusetts Hospital Association, Hospital Council of Boston, Massachusetts Hospital
Service Inc., American Hospital Association, American Medical As ociation, Ameri-
can College of Surgeons, Massachusetts Federation of Nursmg Homes Inc, the
local boards of health, and the Boards of Registration in Medicine and Nursing.
Looking ahead we are somewhat encouraged by the prospects of the appointment
of four permanent hospital inspectors. However, we realize that the minimum
personnel requirements to effectively carry out the functions of the program require
that one inspector be assigned to each district except the North Metropolitan
Health District which needs at least two inspectors. This is a very conservative
requirement when one considers that there are seventy-five hospitals, 128 clinics
and dispensaries, 138 convalescent and nursing homes and 132 boarding homes for
the aged in the latter district.
We are also cognizant of the fact that only a fraction of the existing industrial
clinics and dispensaries and school and college infirmaries throughout the Common-
wealth have been licensed because of insufficient personnel to make the necessary
inspections.
Because of the tremendous hospital building program underway, hospital visits
and conferences with architects, administrators and trustees have greatly increased.
This burden will be intensified when the final revision of the Hospital Standards
becomes available.
For this project to function satisfactorily due thought and consideration must be
given to the need of increased personnel for supervisory, field and clerical activities.
We must plan and execute an intensive in-service training program.
General Summary
Forty New Hospitals Have Been Licensed Since 1944
1944 .
. 11
1945
. 1
1946 .
. 3
1947 .
... 4
1948 .
. 16
1949 . • .
. 5
270
Number of Hospitals Closed Totaled Thirty
1943
1944
. 0
1945
. 1
1946
. 7
1947
. 6
1948
. 5
1949
. 1
P.D. 34
All of these institutions closed voluntarily except two whose licenses were re-
voked by action of the Department following public hearings in 1947 and 1948.
At the present time there are 197 licensed hospitals.
DEPARTMENT OF PUBLIC HEALTH
Division of Hospitals
197 Licensed Hospitals
Type of Service
General without Maternity Service .
14
General with Maternity .
131
Maternity .....
6
Tuberculosis and Isolation
14
Other
32
School and College Infirmary
9
Pediatric ....
9
Chronic Disease
5
San. Nervous Disorders
5
Rectal Surgery
1
Gynecology ....
1
Nose and Throat .
2
Groups
Group A 1-49 beds 74
B 50-149 beds 79
C 150 plus 44
DEPARTMENT OF PUBLIC HEALTH
Division of Hospitals
District
' Licensed Hospital Licensed Clinic
or Sanatoria* or Dispensary**
Southeastern
South Metropolitan
North Metropolitan
Northeastern
South Central
North Central
Connecticut Valley
Berkshire
18
2
15
4
75
28
29
5
16
3
16
2
19
4
9
0
197
4S
*Federal, state and county institutions, municipal infirmaries and institutions licensed by or under the
supervision of the Department of Mental Health are not included.
**lncludes dental clinics.
DEPARTMENT OF PUBLIC HEALTH
Division of Hospitals
Licensed
Unlicensed
Nursing and
Nursing and
Licensed
Unlicensed
District
Convalescent
Convalescent
Boarding Homes
Boarding Homes
Total
Homes
Homes
for Aged
for Aged
Southeastern
22
14
37
13
86
South Metropolitan
46
12
53
19
130
North Metropolitan
88
50
49
83
270
Northeastern
47
18
71
67
203
South Central .
8
5
31
9
53
North Central .
15
8
9
19
51
Conne cticut Valley
23
0
25
10
58
Berks hire .
6
0
14
0
20
8
255
107
289
220
871
P.D. 34 271
BUREAU OF HOSPITAL SURVEY AND CONSTRUCTION
CONSOLIDATED REPORT 1946-1949
A. Daniel Rubenstein, M.D., M.P.H., Director
Although preliminary steps had been taken prior to this fiscal year to obtain
hospital survey and construction data throughout the state, the Bureau of Hospital
Survey and Construction owed its origin to the enactment of Public Law 725 of the
79th Congress on August 13, 1946 which provided assistance to the various states
to survey the need for construction of hospitals and to develop programs for con-
struction of such public and other non-profit hospitals that in conjunction with
existing facilities would furnish adequate hospital, clinic and similar services to all
the people of the state.
During the early month of the fiscal year beginning July 1, 1947, the work of this
Bureau was concerned mainly with the preparation of the State Plan for the ad-
ministration of Public Law 725 — the Hospital Survey and Construction Act. The
Massachusetts State Plan was completed several months ahead of schedule at the
request of the Surgeon General of the United States Public Health Service and was
forwarded to Washington, D. C. on October 13, 1947. The State Plan, in accord-
ance with the regulations pertaining to Public Law 725, was presented to and unani-
mously approved by the State Advisory Council on November 5th. Also in keeping
with the law, a public hearing was held in the Gardner Auditorium, State House,
one week later, November 12th. Hospital administrators and trustees and all inter-
ested persons were invited to attend the meeting at which Dr. Getting and staff
members presented a symposium on the State Plan. On November 18th, the Plan
was approved by the Public Health Council, and immediately after was sent to the
Surgeon General in its final approvable form. This approval was given on December
2, 1947.
Following approval of the Plan, applications were solicited from general hospitals
in areas receiving an A priority, from all hospitals in Massachusetts for chronic di-
sease projects and from all local boards of health for public health center projects.
The second meeting of the State Advisory Council was held on January 12, 1948
at which time the first approval was given to an application for Federal funds. This
was the Glover Memorial Hospital in Needham. On the following day, the Public
Health Council approved the application, and on February 10th, the United States
Public Health Service gave their approval.
During these first months of the fiscal year, a new study was developed with the
cooperation of the Massachusetts Department of Public Safety. The original
State Plan listed as acceptable facilities all hospitals licensed by the Commonwealth,
regardless of type of construction. (Table 1 and Table 2.)
Table 1. — Distribution of Hospitals by Type
Type
General .....
Maternity .....
Contagious .....
Other special .....
Subtotals of general and allied special
Tuberculosis .....
Nervous and mental
Chronic and convalescent
Grand Total .... 219 44,044
*The figures referring to number of beds indicate the normal bed capacity — that is, the number of beds
for which the hospital was built. In many instances because of overcrowding, this figure is smaller than the
actual number of beds in use for inpatient care (complement) .
Total Number
Hospitals
Beds*
147
16,968
6
379
6
564
12
1,267
171
19,178
20
3,299
24
21,050
4
517
272
P.D. 34
Table 2. — Distribution of General Hospitals by Size
Total Number
Size
• Hospitals
Beds*
Less than 25 beds
. . 23
436
25-49 beds
32
1,113
50-99 beds
37
2,460
100-249 beds .
44
7,178
250^99 beds .
8
2,597
More than 500 beds
3
3,184
Totals
147
16,968
*The figures referring to number of beds indicate the normal bed capacity — that is, number of beds
for which the hospital was built. In many instances because of overcrowding, this figure is smaller than the
actual number of beds in use for inpatient care (complement).
It was known that many hospital buildings were obsolete, or even hazardous to
public safety. With this in mind, Public Safety inspectors visited each hospital
viewing it from the aspects of type of construction and means of fire prevention and
control. Members of the staff also visited for a preliminary study certain areas with
hospital facilities of frame construction. As a result, at a State Advisory Council
Meeting on April 8, 1948, these areas were reclassified to an A priority on the basis
of non-acceptable Class VI wood frame construction. Following this reclassifica-
tion, the Council approved applications for Federal funds for two hospitals — the
Emerson Hospital, Concord, and the Clinton Hospital, Clinton. At the same meet-
ing, approval was given to an application for the first chronic disease project at the
Children's Hospital, Boston, and for a general hospital project, the Lawrence
Memorial Hospital, Medford. Funds for this last project were to be taken from the
1949 Federal allocation.
During the fiscal year, therefore, five projects were approved by the State Agency
and the United States Public Health Service. Four were in the general hospital
category, and the fifth a chronic disease project. The first application approved,
that of Needham, was subsequently processed with such dispatch that construc-
tion was begun on June 14, 1948, the first project in Massachusetts under Federal
assistance.
On June 21, 1948, an interim revision of the Massachusetts State Plan was ap-
proved by the United States Public Health Service. The important changes were
the reclassification of areas mentioned above and the formation of a new rural area
in the Town of Milton.
Other events occurring during the year 1947-1948 were an in-service training
course given jointly by the Department and the Massachusetts Hospital Association
in the form of eight seminar lectures on Hospital Administration ; a comprehensive
study of patient distribution data collected from all general hospitals in Massa-
chusetts ; and supplementing the reports of the Department of Public Safety, mem-
bers of the staff began visits to all the hospitals in Massachusetts to determine the
physical facilities available. Based upon these studies, a complete revision of the
State Plan was contemplated for the second fiscal year of the program.
The primary consideration of the Bureau during the fiscal year 1948-1949 with
regard to survey activities was the preparation of the annual revision of the Massa-
chusetts State Plan for the administration of Public Law 725. This revision was
based on two major reclassifications of the general hospital facilities in Massa-
chusetts. Our primary concern was the status of the general hospital with regard
to three items: 1. Type of construction, that is fire-proof or non fire-proof; 2. The
adequacies of ancilary services, such as operating rooms, delivery suites, etc. ; 3. The
normal capacity of the hospital, that is the number of beds for which the hospital
was built. Since the only data available were from the Schedules of Information
filled out by hospitals in 1946 or 1947, it became necessary to visit each general
hospital to determine these factors. Table 3 shows the non-acceptable beds in gen-
eral hospitals as determined by this study.
P.D. 34
273
Table 3. — Acceptable and Non-acceptable Beds by Type of Area
Type of
Area
Number
of
Hospitals
Total
Beds
Acceptable
Beds
Per Cent
Acceptable
Beds
Non-
Acceptable
Beds
Per Cent
Non-
Acceptable
Beds
Total
Beds
Needed
Per Cent
Need
Met
Base .
Intermediate
Rural .
50
91
21
9,374
7,600
967
7,474
4,742
713
80%
62%
74%
1,900
2,858
254
20%
38%
26%
10,481
11,468
994
71%
41%
72%
Total .
162
17,941
12,929
72%
5,012
28%
22,943
56%
Subsequently during the year a team of workers consisting of a physician and an
engineer visited all of the general hospitals in the Commonwealth. The second
major item considered in the revision of the State Plan was the use of general hos-
pitals as determined by patient flow data. On the basis of this use the State was
redistricted and new general hospital service areas delineated.
Upon completion of these two reclassifications the first annual revision was pre-
pared and subsequently approved on March 2, 1949 by the State Advisory and
Public Health Councils. Later it was submitted and subsequently approved b> the
Surgeon General of the U. S. Public Health Service on June 2, 1949. The revision
of the Plan also included an addendum concerned with the necessity for assisting
teaching hospitals in base areas. Since most base areas, especially that of Boston,
had a low priority even upon revision of the Plan, it was decided by the Advisory
Council, and subsequently approved by the Surgeon General, that any teaching
hospital fulfilling certain criteria could be given an A priority and thereby would be
eligible for federal assistance under Public Law 725. The criteria were as follows:
1 . The hospital must be intimately associated with a medical school as a teaching
facility for undergraduate and graduate medical education.
2. Facilities must be available in the hospital for training in at least two special-
ties.
3. Post-graduate courses should be given for general practitioners or specialists.
4. The hospital must be an integral and organized part of an existing or proposed
medical center.
5. The teaching center, upon completion of the proposed project, shall be able
either to instruct a larger number of graduate and post-graduate students, or
to give more extensive and longer courses or demonstrate satisfactorily that its
teaching facilities will be of greater use to the medical schools.
As to the construction activities of the Bureau, four State Advisory Council meet-
ings were held during the fiscal year on August 5, December 15, March 2, and April
29, at which times several projects were given approval for federal assistance under
Public Law 725. The approved projects include one chronic disease addition at the
Cape Cod Hospital, Hyannis; eight general hospital projects at Milton Hospital;
Wing Memorial Hospital, Palmer; Marlboro Hospital; Brockton Hospital; St.
Luke's Hospital, New Bedford; Community Memorial Hospital, Ayer; Mary Lane
Hospital, Ware ; and Bon Secours Hospital, Methuen (equipment only) . One Public
Health Center was given approval for the City of Quincy. Two projects which fell-
into the category of teaching hospital in Boston were approved ; one at the Massa-
chusetts Eye and Ear Infirmary, and the second at the Beth Israel Hospital (equip-
ment only) . In addition to these projects, of the six projects given approval during
the last fiscal year, one project at the Glover Memorial Hospital, Needham is near-
ing completion, and four others were in the process of construction. Table 4 indi-
cates all projects approved under Public Law 725.
Table 4. — Summary of Projects Approved Under Public Law 725
Type of Project No. op Projects
No. of Beds Added
General Hospital ....... 20
Chronic Hospital ....... 4
Public Health Center ....... 1
Total 25
1197
638
1835
274 P.D. 34
DIVISION OF FOOD AND DRUGS
CONSOLIDATED REPORT 1942-1949
Carl S. Ferguson, B.S., Director
The Food and Drug Division during the years 1942-1949 has been engaged in the
usual routine work relative to the enforcement of the laws pertaining to the sale of
milk, foods and drugs; the slaughtering laws; the cold storage laws; bakery laws; the
frozen dessert laws; the laws pertaining to the pasteurization of milk; the laws per-
taining to the bottling of carbonated non-alcoholic beverages ; certain phases of the
narcotic law ; the law pertaining to the sale of wood alcohol ; the laws pertaining to
the sale of articles of bedding and upholstered furniture; and the examination of
liquors, chemicals, etc. for Police Departments.
In addition to the routine work in the enforcement of the above laws, the follow-
ing details have demanded our attention during this period.
Poultry Fat — Investigations had shown that the quality of poultry fat as sold on
the Massachusetts market was definitely below standard, containing varied degrees
of rancidity and foreign matter. In cooperation with the inspectors of the Boston
Health Department and members of the U. S. Food and Drug Administration, an
investigation was conducted which showed excessive contamination and rancidity
in various samples collected. This investigation led to considerable improvement
in the handling of poultry fat from a sanitary viewpoint, so that the undesirable
conditions were eliminated.
Adulterated Coffee — Due to the shortages of coffee incurred during this period,
it was found upon analysis that a certain portion of the coffee supply was adulter-
ated, in that the coffee was being mixed with cheap substitutes. Constant offenders
were prosecuted in 1943, twenty-eight complaints being entered in the courts, with
convictions in twenty-six instances. The following year the adulteration of coffee
was insignificant.
Locker Plants — An increase in locker plants became evident in 1943, which ne-
cessitated a change in the cold storage law. The desired change became effective in
1944 and subjected the locker plants to the general cold storage law but exempted
the plants as to the monthly report requirement and the placing of the date of
original storage upon foods going into the lockers. Consent of the Department is
not required in case a storage period longer than twelve months is desired by the
owners of the food held in the lockers.
Prosecutions — Several unusual prosecutions which resulted in high penalties oc-
curred during this period. In one instance, it involved the attempted bribery of an
inspector and the other involved highly unsanitary conditions in a jam factory, the
penalties being $100.00 and $500.00, respectively.
Slaughtering — In 1943, a significant change was made in the slaughtering law
which gave the Department the authority to close a slaughterhouse licensed by a
town board of health when found to be operated in an unsanitary condition.
In 1944, an increase in the number of slaughtering violations was noted, probably
due to the shortage of meat.
In 1946, regulations were adopted under the provisions of Chapter 679 of the
Acts of 1945 which pertained to poultry slaughterhouses. A full-time inspector was
appointed and assigned to the routine inspection of poultry slaughtering establish-
ments. By the end of 1946, copies of 292 poultry slaughtering license applications
had been received and of this number 165 licenses were issued, following a total of
637 inspections. In most cases, joint inspections were made with the local authori-
ties, and their assistance had been enlisted in carrying out changes which were
necessary to bring the slaughterhouses in full compliance with the regulations.
Since that time, a great degree of improvement has been observed in the sanitary
condition of poultry slaughterhouses.
Dairy Farm Work — The quality of the milk on dairy farms in 1944 was still poor
due to the lack of farm help and the inability of the owner to spend the necessary
time required to keep the equipment cleaned.
P.D. 34
275
In 1946 a decided improvement in the quality of raw milk for pasteurization pur-
poses was noticed. This was due to the special attention given to the dairy farms
in the past years. The major causes for the unsanitary conditions in dairy farms
are listed below.
1946
1944
1943
Causes
No.
% of Total
No.
% of Total
No.
%
of Total
Inadequate cooling
23
22.4
49
19.1
131
39.7
Dirty milking machines
55
53.4
107
41.8
113
34.2
Other dirty utensils . ...
10
9.7
76
29.7
54
16.3
Repeated use of cloth strainer
2
1.9
24
9.4
9
2.7
Dirty milking cans
9
8.7
5
2.0
-
-
Miscellaneous causes .
4
3.9
Not
compiled
16
4.8
Pasteurization Plants — In 1946, the use of the high-temperature, short-time
pasteurization method offered the problem of performing efficiency tests on this
equipment. The task of performing these tests was undertaken with the assistance
of sanitarians of the U. S. Public Health Service. At that time, there were approxi-
mately thirty plants with this high-temperature equipment. This method of pas-
teurization is apparently eliminating many of the sources of contamination which
formerly existed as a result of open exposure of the milk during pasteurization or
during the subsequent operations of cooling and bottling. Complete protection
from air contamination is possible by the high-temperature, short-time pasteuriza-
tion method.
Emergency Milk — Emergency milk from the mid- West originating upon un-
inspected dairy farms was received during November and December of 1946. This
"emergency milk" was necessary to relieve a threatened shortage and was legalized
by the Milk Regulation Board through permits which were issued by the Director
of Dairying of the Department of Agriculture. Examination of this milk upon ar-
rival indicated that much of it was of inferior quality before shipment and a number
of lots were also found to have been flash pasteurized. Standard plate counts were
obtained upon certain shipments and were found to exceed several million
colonies per cc.
In 1947, "emergency milk" was again necessary and was shipped into Massa-
chusetts from great distances. Examination of as many lots as possible indicated
that there was an improvement in the quality of this milk received during the pre-
vious year. This improvement may be noted by the following:
Standard Plate Count
Original Sample Count Count After Laboratory
Pasteurization
8 shipments in 1946
11 shipments in 1947
1,100,000
470,000
280,000
21,000
The Food and Drug Division has attempted to require of this "emergency milk"
a quality as nearly as possible approaching that of our normal supply. Following
recommendations, the Department of Agriculture has been quick to respond with
the revocation of several "emergency" permits. In our opinion, it is possible for
"emergency milk" of a satisfactory quality upon arrival to be supplied from the
Middle West. The examination of three shipments would seem to indicate this.
Shipment Number
Standard Plate Count
Original Raw Count Count After Laboratory
Pasteuri zation
460,000
93,000
290*000
13,000
3,000
12,000
The phospatase test upon each of these shipments was positive, indicating that the
milk had not been previously heated.
276
P.D. 34
Research Conducted on Vitamin A Deterioration in Oleomargarine — In 1944 and
continuing through 1945, research work was staited to determine the deterioration
of Vitamin A in oleomargarine during storage. A lot of oleomargarine was pur-
chased and half of the lot was stored in a commercial storage warehouse and the
other half in a laboratory refrigerator. Samples were examined from each lot at
regular intervals over a one-year period. The examination consisted of assay of the
Vitamin A content and tests for rancidity development. The portion stored in the
laboratory refrigerator lost nearly half of the Vitamin A potency during the year
and developed rancidity as evidenced by a high peroxide number. A tallowy taste
had also developed. The portion left in the commercial warehouse lost about 35%
of its original Vitamin A during the year and retained its original flavor through the
period, although there was some chemical evidence of slight rancidity near the close
of the period.
Drug Stores — During the routine checks on prescriptions filled by drug stores
chosen at random, it was found that there was much to be desired in the accuracy
of compound prescriptions. Of 41 samples of prescriptions of percentage solutions,
5 were found to contain much less than the specified concentrations.
It was also found that retail druggists were not complying with the provisions of
the U. S. Pharmacopoeia in keeping certain biological products under proper re-
frigeration. We used insulin preparation as the basis of our investigations and found
only 15 out of 51 retail drug stores keeping this preparation under refrigeration as
required.
Further study was given to the deterioration of thiamin hydrochloride as sold in
tablets by retail druggists. It was determined that many of the samples had de-
teriorated by reason of long standing upon the retailers' shelves. This does not
involve the manufacturer who has been found to prepare his product with at least
a 10% addition above the specified concentration but who has been reluctant to
date his package although he has assumed that it would be sold within two years of
the time of manufacture. The rate of deterioration has been found to be approxi-
mately 15% a year. Retail drug stores, in general, have failed to take this problem
of deterioration into account.
It has been noted that certain drug manufacturers are now dating their vitamin
products. The problem of low-potency vitamin products appears to be largely one
of systematic handling and rapid turnover in the retail store. During the past year,
ten samples of thiamine hydrochloride tablets were assayed in the laboratory when
received and again approximately a year later. The results as shown by the re-
spective assays in terms of percentage of labeled potency are as follows:
Sample
10
Approximately
Original Assay
One Year Later
97.5
86.2
98.1
97.5
90.4
90.4
98.5
97.5
103.0
86.9
84.3
80.0
99.0
95.2
99.0
91.7
87.7
86.5
88.1
87.3
These results would indicate that there is no great amount of deterioration during
the first year.
Mineral Oil in Food — The year 1945 saw the entrance upon the market of foods
such as salad dressings and salad oil containing mineral oil. The use of mineral oil
in place of vegetable oils occasioned the undertaking of research in the Westfield
Laboratory which confirmed the fact that mineral oil in foods prevented the utiliza-
tion by the body of oil soluble vitamins present in other foods. A salad dressing
which had been previously fortified with additional Vitamins A and D beyond the
saturation point of their solubility in mineral oil was fed to experimental rat colonies
which had been made nutritionally deficient in these vitamins. It was determined
that even though these vitamins were present in excess in a food containing mineral
oil, they were still not utilized to the point of correcting the nutritional deficiencies.
P.D. 34 277
Vitamin Laboratory in Westfield — ■ The growth of the vitamin laboratory has
been especially satisfactory, and a regular breeding schedule has been developed,
which has resulted in a sufficient number of rats to perpetuate the breeding colony.
This laboratory is now used for the routine check on Vitamin D milk samples and
Vitamin A capsules which have been sorted out by general spectrophotometry
analysis. The vitamin laboratory has matured to a point where it is now a full fledged
arm of our laboratory facilities.
Legislation — Several important pieces of legislation were enacted during the
1948 legislative session.
Chapter 598 of the Acts of 1948 amended the sections of the law pertaining to the
adulteration and misbranding of foods and drugs and contains important provisions
which will bring our Massachusetts law into closer agreement with the Federal Food,
Drug and Cosmetic Act. The provisions relative to seizure and relative to the dis-
tribution of harmful drugs are especially important.
Chapter 444 makes compulsory the enrichment of white bread and rolls with cer-
tain vitamin and mineral constituents.
Chapter 473 limits the retail sale of medicinal preparations containing small
quantities of narcotic drugs to licensed drug stores. .
Chapter 189 requires that restaurants, hotels and the like notify patrons whenever
horsemeat is being served.
Chapter 453 removes certain restrictions upon hotels and restaurants serving oleo-
margarine and also permits the manufacture and sale of oleomargarine colored to
look like butter. Whether the latter amendment will result in increased frauds re-
mains to be seen.
During 1947, the slaughtering of horses was on the increase due to the high cost
of beef. Many of these horses were shipped from the West for the purpose of slaugh-
ter. There was a limited amount of substitution of horsemeat for beef, but most of
the horsemeat was used in the manufacture of animal food, or if purchased fresh,
by the operators of mink farms and for the use as food for raising dogs. In 1949 a
change in the slaughtering law was instituted, because it was felt that much of the
uninspected horsemeat coming into this Commonwealth under the guise of "animal
food only" was being diverted upon arrival for use as human food. The law stated
that all meat intended for food purposes, whether for man or animal, shipped into
the Commonwealth must have been derived from animals inspected, passed and
stamped by the U. S. Bureau of Animal Industry. This will give added protection
to those who desire to purchase horsemeat for human consumption. Of the total of
97,066 animals that were slaughtered in Massachusetts in 1949, 4,027 were horses.
During the 1948-1949 period, legislation was proposed, which, if enacted, would
have resulted in better control over cream sold in Massachusetts. Most of our
cream is shipped from distant points to our Massachusetts market, and originates
from uninspected dairy farms. As a result, exceedingly high bacterial counts have
been noted upon cream, and the measures for controlling these counts have been
inadequate. The proposed legislation, which would have materially improved our
cream, was referred to the next annual session.
During the same period mentioned directly above, legislation proposed by the
Department for the strengthening of the bedding and upholstered furniture laws
was defeated through the opposition of the reupholsterers and repairers. This de-
feat has meant not only the loss of much greater protection against misrepresenta-
tion for the consumer but also a loss of at least $40,000.00 or $50,000.00 in revenue
to the Commonwealth. There is great need for uniformity among the various states
as to their bedding and furniture laws. The proposed legislation would have been
an important step toward uniformity.
Watered Clams — Shucked clams containing added water fhrough prolonged soak-
ing procedures were still found upon the market in 1947. A number of court prose-
cutions resulted, and in addition, there has been undertaken further research upon
commercial washing processes with a view of setting up a standard which is now
possible under the amended food law.
During March of 1948, the provisions of the recently amended food law with re-
spect to seizure were invoked, resulting in the confiscation of 41 gallons of soaked
278 P.D. 34
clams. The effect was almost instantaneous. The soaking stopped and clam
dealers have since been able to supply the market with a product well above the
advocated 18% total solids.
In addition to the aforementioned specific details handled during the 1942-1949
period, the following matters also demanded our effort and attention.
In 1944, an increase in the substitution of saccharin for sugar, particularly in soft
drinks, was noted and also much decomposed meat was sold.
An increase in the sale of milk containing added water was also noted and was
probably encouraged by the fact that the United States Government pays a subsidy
to milk producers selling milk on a weight basis.
In 1945, among the significant violations encountered were carelessness exercised
by restaurants in the handling of perishable meat and the continued use of saccharin
as a sugar substitute in soft drinks. Also during this time, there were black market
operations in violation of the slaughtering laws.
In 1946, a number of cream substitutes appeared on the market. These substi-
tutes were mixtures of milk and cream with or without the addition of concentrated
skimmed milk or skimmed milk powder. These products were sold to restaurants
and also delivered to homes for serving in coffee and upon cereals in place of cream.
The resulting combination contained varying amounts of milk fat below the required
16% standard for legal cream. It was necessary to institute prosecutions for the
correction of this practice.
Laboratory examinations also revealed the adulteration of cider vinegar by the
addition of distilled vinegar or commercial acetic acid. Warnings were issued to a
number of vinegar manufacturers and packers.
In 1947, little or no substitution of saccharin for sugar by the manufacturers of
soft drinks was found. A number of frozen dessert manufacturers, however, were
found not to be exercising sufficient care in the matter of overrun leading to the in-
corporation of air in the finished product to an extent resulting in less than 1.6
pounds of food solids per gallon, the required standard.
The continued high price of eggs led to a more or less widespread violation and
disregard of the cold storage egg law, which requires the labeling of eggs which have
been in cold storage with the words, "cold storage eggs." Very few eggs have ap-
peared on the market under the labeling "cold storage eggs" although the ware-
houses actually contain large quantities of eggs in storage. An enforcement pro-
gram was started to require stricter adherence on the part of egg distributors to the
provisions of the cold storage egg law.
Competition being very keen within the feather industry resulted in some pillow
manufacturers attempting to label their filling materials as "all down," when in
some instances the filling material contained actually a very small percentage of
down. Chicken feathers were also found in filling materials labeled as "down." Our
most reliable information concerning feathers and down or mixtures of feathers and
down as a filling material is to the effect that the manufacturer is able to control the
quantity of down in any mixture to a very fine degree, and we were in some cases
forced to the conclusion that the incorrectly labeled filling materials result from de-
liberate action. The bedding laws of Massachusetts are in need of revision, with
provision for a more adequate budget allowance for their enforcement. At the pres-
ent time, one inspector must cover the entire industry, consisting of manufacturer,
wholesaler, repairer and retail dealer.
In 1949 coliform organisms were found in many samples of pasteurized milk, in-
dicating that more attention must be given to the question of contaimination of
milk after pasteurization. Seventy-seven samples of pasteurized milk out of 310
examined were found to contain coliform organisms. The contamination has been
found to extend to Grade A milk as well as to the grade of "milk pasteurized."
During the fiscal year between July 1, 1948 and July 1, 1949, 38 persons carried
out the duties of the Food and Drug Division, under a total budget of $123,265,
representing a cost of approximately three cents per year for each citizen of the
Commonwealth. A part of this cost has been in effect returned as a dividend to the
consumer, with the confiscation and removal from market channels of $75,000 worth
of unfit foods. A new program was instituted wherein Miss Olive Sheridan, Bac-
teriologist of the Division, was placed in charge of the Laboratory Approval Pro-
gram which was authorized by Chapter 344 of the Acts of 1939. She has approved
P.D. 34
279
17 laboratories within the regulations established by the Act. An advisory com-
mittee for the Food and Drug Division was appointed so that a closer bond of co-
operation could be established between industry, consumer and the Department in
certain of the Department's law enforcing and additional activities.
As a final item, on July 1, 1946, Mr. Hermann C. Lythgoe, Director of the Di-
vision of Food and Drugs since its origin in 1915, was retired at the age of 72. His
successor was Mr. Carl S. Ferguson who had served as Chief of Laboratory for many
years.
The attached tables give summaries of the laboratory examinations; food con-
fiscations; reports submitted by local slaughtering inspectors; extensions of time
granted on foods in cold storage ; prosecutions ; and licenses and permits issued, to-
gether with the fees received therefrom.
Summary of Laboratory Examinations
Milk and
Milk and
Milk Products
Milk Products
Chemical
Bact.
Foods
Drugs
Misc.*
Dec. 1941-Nov. 1942
5,654
7,741
2,260
155
2,056
Dec. 1942-Nov. 1943
6,256
5,949
1,654
153
123
Dec. 1943-Nov. 1944
5,971
5,267
1,569
247
Dec. 1944-June 1945
3,488
4,588
1,440
225
101
July 1945-June 1946
6,611
5,244
2,146
372
219
Julv 1946-June 1947
4,777
6,143
1,725
150
200
July 1947-June 1948
3,872
4,420
2,498
115
202
July 1948-June 1949
2,024
5,059
3,127
95
604
Totals
38,653
44,411
16,419
1,512
3,505
* Includes liquors and narcotics for Police Departments, vitamin preparations, anti-freeze prepara-
tions, bedding and upholstered furniture materials.
Summary of Food Confiscations
Dec. 1941-Nov.
Dec. 1942-Nov.
Dec. 1943-Nov.
Dec. 1944-June
July 1945-June
July 1946-June
July 1946-June
July 1948-June
Total
1942
1943
1944
1945
1946
1947
1948
1949
84,577 lbs
35,188 lbs
80,406 lbs
65,660 lbs
100,000 lbs
74,294 lbs
80,000 lbs
160,149 lbs
680,274 lbs.
Summary of Slaughtering Reports Submitted by
Local Slaughtering Inspectors
Dec. 1941-Nov.
Dec. 1942-Nov.
Dec. 1943-Nov.
Dec. 1944-June
July 1945-June
July 1946-June
Julv 1947-June
July 1948-June
Totals
1942
1943
1944
1945
1946
1947
1948
1949
Carcasses Inspected
Carcasses Condemned
149,630
2,166
167,925
1,698
183,046
1,718
139,425
1,111
208,251
1,373
152,188
1,209
135,851
1,114
97,142
685
1,233,458
Dec. 1941-Nov.
Dec. 1942-Nov.
Dec. 1943-Nov.
Dec. 1944-June
July 1945-June
July 1946-June
July 1947-June
July 1948-June
Total
Summary of Extensions of Time Granted on Foods
in Cold Storage Warehouses
1942
1943
1944
1945
1946
1947
1948
1949
150
84
129
44
34
196
243
96
976
Summary of Prosecutions
Dec. 1941-Nov.
Dec. 1942-Nov.
Dec. 1943-Nov.
Dec. 1944-June
July 1945-June
July 1946-June
July 1947-June
July 1948-June
Totals
1942
1943
1944
1945
1946
1947
1948
1949
Number
Convictions
Dismissals
349
314
35
219
201
18
238
215
23
112
90
22
224
200
24
179
163
16
114
104
10
108
97
11
1,543
1,384
159
280
P.D. 34
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P.D. 34
281
DIVISON OF SANITARY ENGINEERING
CONSOLIDATED REPORT 1942-1949
Akthur D. Weston, C.E., Director and Chief Sanitary Engineer
Oversight and Care of Inland Waters
Introductory
Prior to World War II it was customary to prepare for distribution an annual
report of this Division covering matters relating to the oversight of inland waters
and other environmental sanitation problems. Because of conditions created by
World War II the 1940 annual report was the last printed report of the Division of
Sanitary Engineering. A limited edition of a report covering the period January 1,
1941 to June 30, 1946 was mimeographed.
Because of the considerable demand for data covering the period of the war and
the post-war period, it has seemed advisable to prepare the following combined re-
port which covers the period January 1, 1941 to June 30, 1949.
Applications for the Advice of the Division
The applications for the advice of the Department as submitted to the Division
of Sanitary Engineering during the period January 1, 1941, to June 30, 1949, are as
follows :
January 1-December 31
Jan.-June
7/1/46-
7/1/47-
7/1/48-
1941
1942
1943
1944
1945
1946
75
6/30/47
133
6/30/48
154
6/30/49
Public Water Supply .
247
219
69
173
203
121
Wells*
234
94
59
85
101
52
187
158
149
Water Supply
Schools .
22
8
8
2
8
8
21
28
42
Camps .
—
—
2
1
1
2
17
17
32
Ice ....
22
10
4
5
2
3
1
—
1
Bathing
54
47
35
60
66
30
77
132
130
Shellfish Areas .
50
27
16
17
31
9
24
23
22
Stream Pollution
19
8
26
34
24
14
72
62
88
Boarding Homes
—
—
—
—
—
—
—
—
16
Sewage Disposal
283
122
65
67
86
52
125
96
150
Cross Connections
14
11
20
5
5
3
5
8
10
CCC Camps
2
—
—
—
—
—
—
—
—
Industrial Waste
—
—
—
—
—
—
— ■
— ■
14
Institution
Water Supply &
Sewage Disposal .
8
5
2
19
4
2
15
22
31
Plumbing .
—
—
—
— ■
—
—
2
1
—
Land Taking
10
10
2
8
4
—
3
6
4
R. & R.-Water Supply
1
—
—
1
—
—
1
2
Cemeteries
—
—
—
—
—
—
9
4
8
Police Stations .
3
2
1
—
2
—
—
—
1
Miscellaneous
99
58
74
66
67
114
210
240
232
Common Carriers
—
—
—
— ■
—
—
2
9
4
Labs
—
—
—
—
—
—
9
3
—
Questionnaire .
—
—
—
—
—
—
—
4
1
Total
1068
621
383
543
604
364
913
969
1056
Water Supply
Pasteur Plants
—
—
—
—
—
—
8
Private Wells** .
314
387
193
327
508
343
795
1044
1191
Camps*** .
710
504
274
325
350
310
514
830
642
Shellfish Inspections .
449
422
84
342
432
78
397
367
267
Grand Total
2541
1934
934
1537
1894
1095
2619
3210
3164
* Exam, by Sanitary Engineer
** Exam, by Sanitary Inspectors or Others
***Exam. under Chapter 140 — General Laws, as amended
Routine Work
The routine activities of the Division of Sanitary Engineering, in spite of the de-
crease in personnel, increased considerably during the period of the war. These
activities have been as follows :
Assistance to the armed forces in matters of water supply, sewerage and sewage
disposal and other environmental sanitation problems.
282 P.D. 34
General advice to cities, towns and persons in matters of water supply, drainage,
sewerage and sewage disposal.
Investigations leading to the adoption of rules and regulations for protecting
sources of water supply and enforcement of such rules and regulations.
Investigations leading to removal of sources of pollution of water supplies.
Investigations relative to the efficiency of the operation of sewage treatment
works.
Investigations relative to pollution of streams, examinations of sewer outlets,
enforcement of legislation relating to pollution of certain streams and certain coastal
waters.
Investigations relative to the use of emergency sources of water supply.
Approval of the acquisition of lands for protecting sources of water supply and
lands for sewage treatment works.
Investigations as to effect of industrial wastes on sewers and sewage treatment
works.
Investigations leading to approval of plans for police stations, lockups and houses
of detention.
Investigations relative to offensive trades.
Investigations relative to the approval of the use of lands for cemetery purposes
and for the construction of mausoleums and crematories.
Investigations leading to advice to cities, towns and persons in matters of bathing
places, garbage and refuse disposal, nuisances, private water supplies and similar
problems.
Investigations relative to sources of water supply where the water is bottled and
sold or used in the manufacture of nonalcoholic beverages.
Investigations relative to pollution of water supplies by cross connections.
Investigations as to the location of public institutions.
Preparation of plans for water supply and sewerage for institutions of the De-
partment and certain other state institutions.
Approval of municipal plumbing rules and regulations.
Investigations relative to the pollution of coastal waters from which shellfish are
taken.
Investigations relative to sanitary conditions of shellfish-handling establishments
and consideration of certificates of out-of-state shellfish shippers.
Investigations relative to the approval of shellfish purification plants and the
operation thereof.
Representatives of the Division have attended various meetings of the State
Planning Board and the Department has been represented on the State Reclama-
tion Board by an engineer of the Division.
Representatives of the Division have participated in the Sanitation Courses at
the University of Massachusetts. The work has included lectures, field trips and
assistance to the faculty in preparation of courses.
Representatives of the Division have from time to time given lectures on general
sanitation matters at various hospitals throughout the State to classes of nurses in
training.
Papers on the problem and solution of stream pollution have been presented to
many civic and professional organizations throughout the State by engineers of this
Division.
General advice to the Legislature in matters of water supply, drainage, sewerage
and sewage disposal, shellfish and other environmental sanitation problems.
Special Legislative Investigations
This Division has assisted in the following special investigations directed by the
resolves of the Legislature during the period from January 1, 1941, to June 30,
1949:
Resolve Subject Report
Chapter 71 of 1941 Investigation and study relative to requir- House 1632 of
ing owners of tenements and other dwellings 1943
leased or rented for human habitation to
bring them up to certain standards to pro-
mote the health and well being of persons
P.D. 34
Resolve
283
Subject
residing therein and relative to limited divi-
dend corporations under the control of the
State Housing Board.
Chapter 91 of 1941 Investigation relative to the use by addi-
tional municipalities of the Quabbin Reser-
voir for water supply purposes, and relative
to the relation of the city of Boston to and
its share of the expenses of the Metropolitan
District Commission.
Chapter 93 of 1941 Investigation relative to additional sewer-
age works for the South Metropolitan Sew-
erage District in the Dorchester District of
the city of Boston and the town of Milton.
Chapter 40 of 1943 Study and survey of the Neponset River.
Chapter 50 of 1943
Chapter 35 of 1945
Chapter 38 of 1945
and Chapter 51 of
1946
Chapter 51 of 1945
Chapter 59 of 1945
Chapter 62 of 1945
and Chapter 47 of
1946
Chapter 83 of 1945
Chapter 58 of 1946
and Chapter 22 of
1947
Chapter 60 of 1946
Chapter 93 of 1946
Chapter 43 of 1947
and Chapter 60 of
1948
Chapter 63 of 1947
and Chapter 40 of
1948
Chapter 26 of 1948
Investigation and study of the laws of the
Commonwealth relative to housing and of
drafting a housing law.
Investigation and study relative to the pro-
tection of the public health and the relief
from the mosquito nuisance in the Charles
River Valley and the Jennings Pond area.
Investigation and study relative to the de-
cay of teeth resulting from a lack of fluorine.
An investigation relative to excluding cer-
tain areas in the city of Boston from the
South Metropolitan sewerage system.
Investigation relative to the condition of
flow of water in the Neponset River, and
related matters.
Investigation and study of, and the prepara-
tion of plans and maps for, the disposal of
sewage in the Merrimack River Valley.
Investigation and study relative to the
water supply needs of municipalities in the
Connecticut, Chicopee, Swift, Ware, Qua-
boag and Millers river valleys.
Investigation and study relative to the pro-
tection of the public health and the relief
from the greenhead fly nuisance in the tidal
areas in northern Essex County.
Study relative to providing for the construc-
tion of a bulkhead at Clark's Cove in the
city of New Bedford, for the purpose of abat-
ing a nuisance.
Investigation and study relative to the cause
and eradication thereof of poliomyelitis in
the Commonwealth,
Investigation and study relative to edible
shellfish and shellfish purification plants.
Continuing the investigation of the disposal
of sewage in the Merrimack River Valley.
Investigation and study of the causes creat-
ing a nuisance on the shore and beaches of
Swampscott, and of means of rectifying such
conditions.
Report
House 1334 of
1943
House 1278 of
1943
House 1925 of
1945
House 4 of 1945
House 1439 of
1946
House 1608 of
1946 and House
1786 of 1947
House 190 of
1946
House 1440 of
1946
Senate 550 of
1947
House 1667 of
1947
Senate 60 of
1947 and Senate
429 of 1948
Senate 70 of
1947
Senate 50 of
1947
House 1770 of
1948 and House
2275 of 1949
House 148 of
1948 and House
2045 of 1949
House 2095 of
1949
284 P.D. 34
Resolve Subject Report
Chapter 41 of 1948 Investigation relative to the disposal of sew- House 2151 of
and Chapter 57 of age in the South Metropolitan Sewerage 1949 and House
1949 District and to the extension of said district. 2263 of 1950
Chapter 26 of 1949 Investigation and study of the causes creat- House 2236 of
ing a nuisance on the shore and beaches of 1950
Marblehead, Salem, Danvers, Beverly and
Manchester, and of means of rectifying such
conditions.
Chapter 31 of 1949 Investigation and study of the disposal of Senate 555 of
sewage and industrial wastes in the Housa- 1950
tonic River Valley.
Chapter 34 of 1949 Study relative to the Sudbury River and its House 2351 of
environs. 1950
Special Activities During the War Years
National Defence and War Agencies
Early in the year 1940, it became apparent that a greater degree of public pro-
tection was necessary because of the possibility of sabotage which might affect the
production of war materials and the health of persons employed in industry, as well
as the resident population. The water departments were advised as to necessary
additional precautions and the Department advised in accordance with the instruc-
tions of the Surgeon General of the Public Health Service that all surface water
supplies be properly chlorinated, unless otherwise properly treated. The authority
delegated to water works officials to permit boating and fishing on public water sup-
plies was revoked by the Department. Storage depots for water works chemicals
were established at key points. The Division was represented on the staff of the
State Adjutant General and the Division advised the First Service Command of the
U. S. Army and the U. S. Navy as to critical public water supplies requiring guard-
ing and assisted the Massachusetts Committee on Public Safety in the training of
chemists and bacteriologists in the decontamination of areas affected by war gases.
In addition, the Division carried out environmental sanitation surveys in the vicinity
of military establishments.
Fully 50% of the work of the Division of Sanitary Engineering during the years
1941 through 1944 was taken up with such activities furthering the war effort. By
the end of 1944, however, conditions warranted little activity in connection with
security matters. The duties of the Massachusetts Committee on Public Safety
were transferred to the Governor's Disaster Relief Commission.
Hurricane of 1944
In addition to the work of the Division of Sanitary Engineering in National De-
fense, the Division was called upon to assist the Massachusetts Committee on Public
Safety during the hurricane of September 14, and 15, 1944. The hurricane inter-
rupted public water supplies in only two instances. While the damage to power
lines prevented the operation of motor-driven pumps, auxiliary power was available
in all cases for public water supplies in the areas most seriously affected, i.e., on
Cape Cod. Service was temporarily interrupted in the town of Fairhaven because of
a broken water main and in the town of Tisbury on Martha's Vineyard because of
the overflowing of the supply with salt water during the extreme high tides which
resulted from the hurricane. Water was supplied to certain areas by tank trucks
and local boards of health were assisted in examination of private wells inundated
with sea water.
Water Shortages
In the period covered by this report, the years 1941 to 1949 were especially dry,
the drought in the year 1949 being the most severe of recent years. The experiences
during the drought of 1941 had been a warning to public water supply officials. Dur-
ing and after the war many wells were installed for additional water supply. The
drought of 1949 began much earlier in the season than usual, the month of June,
P.D. 34
285
1949, being especially dry and encouraging the greater use of water during the grow-
ing season in private and market gardening. The following is a list of the municipali-
ties experiencing water shortages covered by this report through the month of June,
1949:
Amesbury
1941
Marblehead .
1941
-1943
Ashland
1941
Maynard
1941-
-1943
Ayer
1941
Millbury
1941-
-1943
Brookfield
1941
Newburyport
1941-
-1943
Brookline
1941
Newton
1941
-1943
Clinton .
1941
Northbridge .
1941-
-1943
Dedham
1941
Orange .
1941
Dracut .
1941
Scituate
1941
Easton .
1941
Spencer
1941
(No.EastonVill.Dist.)
Shelburne (Shelburne
Falls
Fitchburg
1941
Fire Dist.) .
1941
Greenfield
1941
So. Hadley (So. Hadley Fire
Ipswich .
1941
Dist. No. 2) .
1941
Leicester
1941
Wakefield
1941
(Leicester
Water Supply Board)
Waltham
1946
Leominster
1941
Winchendon .
1947-
-1948
-1949
Lincoln .
1941
Winchester
1941
Lowell
1941
-1943
West Springfield
1941
Examination of Public Water Supplies
On June 30, 1949, 264 of the 351 cities and towns in the Commonwealth with an
aggregate population of 4,404,480 persons are considered as having public water
supplies. The population of these cities and towns is about 98 per cent of 4,493,235
persons — the total population of the State. There still remain 87 municipalities
in the State not considered as having public water supply systems. A total popu-
lation of those municipalities not supplied by public water supplies is 88,755 of
which 6,000 persons are supplied from semi-public supplies or in public institutions.
The following table summarizes the major additions and improvements in con-
nection with the pubic water supplies in the State during the years 1941 through
June 30, 1949.
Establishment of Public Water Supplies
West Boylston
(West Boylston Water District) 1941
Dennis
(Dennis Water District) . . . . . . . . . . 1946
Wenham 1946
Bourne
(South Sagamore Water District) . . . . . . . 1947
(North Sagamore Water District) . . . . . . . 1947
Mendon (in part) 1947
Seekonk Water District 1948
Sandwich Water District . . . . . . . . 1948
Rowley 1948
Newbury (Byfield Water District) 1949
Topsfield 1949
Essex . . 1949
Additions and Improvements in Source of Supply
Abington and Rockland
Acton
West and South Water Sup-
ply District .
Adams .
Amesbury .
Improvements to inlet of Great Sandy Bot-
tom Pond (1943)
Reconstruction of collecting system (1941)
Two gravel-packed wells . . (1949)
23 additional tubular wells . . . (1942)
286
P.D. 34
Additions and Improvements in Source of Supply (Continued)
Ashland . . .
Attleboro ....
Auburn ....
*Ayer ....
*Ayer
Fort Devens . . .
Avon ....
Barnstable
Cotuit Fire District
Barnstable Water Company
Centerville-Osterville Fire
District ....
*Bedford
Billerica . . . ,
Bourne
No. Sagamore Water Dis
trict
Boylston
(Morningdale Water Dis
trict) .
Braintree .
Brewster .
Bridgewater
Cambridge
*Chicopee .
Concord ....
Dedham
Dedham Water Company
Dennis
Dennis Water District
Douglas ....
Dracut . . . • .
Dudley ....
Duxbury
Duxbury Fire and Water
District
*East Longmeadow
Grafton
Grafton Water Company
Easton
North Easton Village Dis-
trict .
Edgartown
Edgartown Water Com-
pany ....
Essex . . .
Two gravel-packed wells installed
and concrete standpipe installed
Two gravel-packed wells
Additional tubular wells
Gravel-packed well
Additional tubular wells installed
Gravel-packed well
(1941-1942)
(1941)
(1947)
(1944)
(1947)
(1941)
(1943)
Gravel-packed well and 40 tubular wells
installed (1941)
Gravel-packed well . . . (1941-1942)
Additional gravel-packed well . . (1942)
Additional gravel-packed well . . (1949)
Two gravel-packed wells . . . (1947)
Test wells (1947)
Connecting mains to Lexington and con-
crete reservoir . .... (1942)
New gravel-packed well . . . (1943)
Reconditioning of gravel-packed wells . (1943)
Additional gravel-packed well . (1949)
Test wells (1947)
Test wells (1949)
Increased storage by new dam in Great
Pond . . " . . . (1943)
Test wells (1947)
Gravel-packed wells . . . (1948-1949)
Test wells installed .... (1941)
36" connecting main to Springfield-Lud
low system
Test wells .
Gravel-packed well
Two gravel-packed wells
Three gravel-packed wells
Two 6-inch wells
New gravel-packed well
New gravel-packed well
Additional tubular wells
(1942-1945)
. (1947)
(1949)
(1943-1944)
(1945-1946)
(1943-1944)
(1941-1942)
(1949)
(1943)
Test wells and pumping test . . (1947)
10" connecting main to Springfield system ( 1 942)
Gravel-packed well
Tubular test wells
Gravel-packed well
Gravel-packed well being installed .
(1944)
(1941)
(1947)
(1948)
*Because of War Activities
P.D. 34
287
Additions and Improvements in Source of Supply— (Continued)
*Fall River
*Falmouth . .--••.
Foxborough
Franklin .
Georgetown
Gloucester
Grafton
Grafton Water Company
Granville Centre Water Co
Greenfield
Great Barrington
Great Barrington Fire Dis
trict
Groton-Groton Water Co.
*Hanover .
Hamilton .
Haverhill .
Hingham
Hingham Water Co.
Hopkinton
*Hudson . . . .
Ipswich .
Kingston .
Lanesborough
Berkshire Cooperative Wa-
ter Works .
Leicester Water Supply Dis-
trict . . . .
Littleton .
Lowell ...
Marion .
Marsh field
Maynard .
Medway .
Merrimac .
Methuen .
Middleboru
Milford .
Montague Bartlett Supply .
Natick ....
North bridge Whitin Machine
Works ....
Norfolk ....
Northborough .
Norton ....
♦Because of War Activities
Industrial supply from
River
Two tubular well fields
Three gravel-packed wells
Gravel-packed well
Not jret developed for use
Connection to Byfield Water District
New covered reservoir
Gravel-packed well
Deep tubular well
Gravel-packed well . .
Noquochoke
. (1942-1943)
(1942)
(1949)
(1944)
(1945)
(1949)
(1941-1942)
(1947)
. (1949)
. (1947)
Enlargement of East Mountain Reservoirs (1947)
Test wells (1947)
Gravel-packed well . . . . (1943)
Connection for supply from Essex . . (1949)
New pumps at Kenoza Lake . (1948)
Pumping station at Crystal Lake . . (1949)
Gravel-packed well . . . (1942-1943)
Well supply at Maspenock Lake . ( 1 943-1 944)
Tubular well supply .... (1944)
Crystal Spring . . . . (1947)
One gravel-packed well . . . (1942)
One gravel-packed well . . (1942-1943)
Gravel-packed well . . . . (1947)
Distribution main and pump . (1941-1942)
Deep tubular well .... (1949)
Additional tubular wells . . (1944)
Two gravel-packed wells . . . (1942)
Two gravel-packed wells . . (1949)
Tubular test wells .... (1941)
Gravel-packed well . . . (1942-1943)
Two gravel-packed wells . . (1948)
Test wells . ._ . . _ . . (1947)
New supply main and pumping sta-
tion (1941-1942)
Gravel-packed well . . . (1942-1943)
Additional tubular wells . . . (1949)
Local supplies abandoned . . . (1942)
All water purchased from Lawrence
since October 1, 1942
Gravel-packed wells at Rock Village . (1948)
New tubular wells .... (1942)
New dug well .... (1941-1942)
Old supply abandoned
Gravel-packed well . . . . (1947)
Additional tubular wells
Pipe line completed
Test wells .
Large tubular well
Gravel-packed wells
(1941-1942-1949)
. (1946)
. (1947)
. (1941)
. (1947)
288
P.D. 34
Additions and Improvements in Source of Supply — (Continued)
North Andover .
Norwood ....
''Orange ....
Palmer
Three Rivers Fire District
Peabody ....
Pittsfield ....
Plymouth .
Rowley
Saugus
Salisbury Water Supply
Scituate
Seekonk Water District
Sharon .
Shelburne and Buckland
Shelburne Falls Fire Dis-
trict ....
Shrewsbury
South Hadley
South Hadley
trict No. 1 .
Fire Dis-
South Hadley Fire Dis-
trict No. 2 .
Somerset ....
*Springfield
Stoughton
Sutton
Sutton Water Company .
Swansea Water District
Templeton
Upton
Upton Center Water Dis-
trict ....
Uxbridge .
•Walpole ....
Wareham
Wareham Fire District
Wayland ....
Wenham ....
Weston ....
West Boylston
West Boylston Water Dis-
trict ....
West Brookfield
West Stockbridge
West Stockbridge Water
Company ,
New pumps ..... (1949)
Gravel-packed well .... (1943)
Gravel-packed well .... (1943)
New water supply . . (1943-1946)
Tubular test wells .... (1941)
Not finally developed .... (1945)
New Reservoir on Sackett Brook . . (1947)
New Cleveland Brook Reservoir in Hins-
dale started (1948)
Tubular wells (1941)
Gravel-packed well .... (1948)
Test wells and pumping test . . (1946)
Joined Metropolitan Water District . (1946)
Two gravel-packed wells . . . (1949)
Gravel-packed well . . . (1943-1944)
Gravel-packed well .... (1948)
Tubular wells (1947)
Gravel-packed well . . . (1943-1945)
Tubular wells (1941)
New gravel-packed well South St. . (1941-1942)
Test wells for additional supply . . (1949)
Increased storage capacity
Brook Reservoir
New pump and pump house
Storage reservoir on North
Elmer Brook .
Gravel-packed wells
of Buttery
(1941)
. (1944)
Branch of
. (1941-1949)
(1947-1948-1949
Auxiliary supply main from Cobble Moun-
tain supply . . . (1942-1943)
Gravel-packed well
Development of a spring
Test wells .
Test wells
Test wells .
Gravel-packed well
50 additional tubular wells
Two gravel-packed wells
Gravel-packed well
Test wells and pumping test
Gravel-packed well
(1941)
(1947)
(1948)
(1947)
(1947)
(1944)
(1943-1944)
. (1947)
. (1944)
. (1946)
(1941)
Gravel-packed well and distribution
system (1941)
Additional gravel-packed well . (1942)
Additional tubular wells . . . (1944)
Development of additional springs (1941)
♦Because of War Activities
P.D. 34
289
Additions and Improvements in Source of Supply — (Continued)
Weymouth
Ground water supply .
( )
Tubular test wells
(1942)
Gravel-packed well . .
(1944)
Worthington Fire District .
Deep tubular well
(1949)
Wrentham
Additional water supply Test wells
(1942)
Gravel-packed well . . . (1943-1944)
Yarmouth . .
Four gravel-packed wells and reconstruc
tion of pumping station
(1947)
Treatment Works
Ashland . . .
Iron and manganese removal plant (1943-1944)
Chicopee ....
Equipped for use of activated carbon and
chlorine dioxide for taste and odor con
trol (1943-1945)
Lanesborough
Lanesborough Village Fire
and Water District
Zeolite water softening plant
(1941)
Leicester
Cherry Valley and Roch-
dale Water District
Slow sand filter ....
(1948)
* Leominster
Four additional rapid sand filters .
(1942)
Sunderland
Sunderland Water Co.
Slow sand filter plant .
(1948)
Winchester
Zeolite water softening plant
(1941)
Chemical Treatment for Correction of Corrosiveness
Andover . .
Haggett's Pond — Soda Ash .
(1946)
Auburn
Auburn Water Company
Tubular wells — Soda Ash
(1942)
Barnstable
Barnstable Water Co.
Tubular wells Cedar Swamp Pumping
■
Station — Soda Ash . . . .
(1941)
Barnstable
Cotuit Fire District
Gravel-packed wells — Lime or Soda Asr
(under investigation)
L
Brookfield
Tubular wells — Soda Ash
(1943)
Chelmsford
North Chelmsford Water
District
Tubular wells — Hexametaphosphate
(1942)
Chatham ....
Tubular and gravel-packed wells — Soda
Edgartown
Edgartown Water Com-
Ash . . . .
(1945)
Tubular and gravel packed wells — Sods
i.
pany ....
Ash ......
(1947)
Foxborough
Tubular wells and gravel-packed well-
Soda Ash .
(1941)
Gosnold (Cuttyhunk)
Dug well — Soda Ash . .
(1948)
Hanover ....
Gravel-packed well — Soda Ash
(1943)
Haverhill ....
Kenoza Lake (Lime and hexametaphos
Hingham
Hingham Water Company
phate) ......
(1949)
Gravel-packed well — Lime .
(1943)
Hudson ....
Tubular wells — Soda Ash
(1944)
Lowell ....
Cook wells — Soda Ash
(1945)
Millbury
Massachusetts Water
Works Company
Dug well ......
(1941)
North Andover .
Lake Cochichewick — Soda Ash
(1943)
Salem and Beverly
Wenham Lake (Hexametaphosphate)
(1948)
290
P.D. 34
Chemical Treatment for
Correction of Corrosiveness — (Continued)
Scituate
. Tubular wells — Soda Ash
. (1941)
Stoughton
. Collecting gallery — Soda Ash
. (1941)
Townsend
. Tubular wells — Soda Ash or Lime under
investigation . . ...
. (1947)
Upton
Wm. Knowlton & Sons Co. Tubular wells — Septaphosphate
. (1945)
Uxbridge .
. Tubular wells — Hexametaphosphate
. (1942)
Westfield
Westfield State Sanatorium Tubular wells — Soda Ash
. (1941)
Winchester
. Reservoir supply. Later removed. .
. (1941)
Chlorinators Installed
Amesbury
. Tubular wells ....
. (1942)
Athol
. At filter plant ....
. (1942)
Attleboro .
. Orr's Pond, dug and gravel-packed
wells .....
(1941-1942)
Barre
. Allen Hill Reservoir
. (1943)
Bedford
Tubular wells ....
(1942-1943)
Beverly
Prechlorination ....
(1942)
Brockton .
. Silver Lake ....
. (1942)
Cheshire Water Co.
. Kitchen Brook Reservoir
. (1949)
Chicopee .
. Cooley Brook Reservoir prechlorination (1941)
Clinton
. Wachusett supply
. (1942)
Colrain Fire District Is
To. 1 . Mountain Brook Reservoir .
. (1948)
Deerfield
South Deerfield Wa
ter
District
. Reservoir .....
. (1942)
Falmouth .
Long Pond ....
. (1941)
Fitchburg .
. Reservoir . .
(1942-1944)
Grafton
Grafton Water Co.
. Dug well .....
. (1944)
Grafton
Fisherville Mfg. Co.
. Tubular wells ....
. (1941)
Hatfield .
Hingham
Hingham Water Co
Running Gutter Brook
. (1944)
Gravel-packed well
. (1943)
Holyoke
. Whitin Street Reservoir
. (1941)
Hudson
. Gates Pond ....
(1944-1945)
Lawrence .
. Distribution Reservoir Outlet
. (1949)
Leicester
Cherry Valley and
Roch-
dale Water Dist.
. Dug well and Henshaw Pond
. (1941)
Lee .
Reservoirs ....
. (1947)
Lenox
. New chlorinator building
. (1943)
Mar bleb ead
. Thompson Meadow wells
. (1943)
Medfield
State Hospital
. Old tubular wells
. (1943)
Monson
Ingalls Brook ....
(1941-1942)
Monson
Monson State Hospi
tal . Tubular well supply
. (1941)
Monroe
Monroe Water Dist
rict . Filter plant ....
. (1942)
Montague
Lake Pleasant ....
. (1942)
New Bedford
Little Quitticas Pond .
. (1942)
North Adams
. Notch Brook Reservoir
(1941-1942)
Mt. William supply
(1941-1942)
North Anclover
. Lake Cochichewick-Duplicate chlorin-
ators . . . .
. (1941)
Oak Bluffs
. Well supply ....
. (1943)
P.D. 34
Chlorinators Installed— (Continued)
Peabody
Shelburne Falls Fire District
Somerset ....
Springfield
Stockbridge
Stockbridge Water Co.
Taunton .
Ware
Westfield .
Weymouth
Williamsburg
Williamstown
Worcester .
Pumping Station Duplicate chlorinators
Fox Brook Reservoir
Tubular wells
Ludlow supply .
Lake Averic
Pond supply
Ground water supply
Granville Reservoir
Great Pond
Reservoir .
Reservoir and spring
Reservoirs
291
(1942)
(1949)
(1947)
(1942)
Ammoniators Installed in Connection with Chlorinators
Amherst .
Athol .
Chicopee .
Falmouth .
Fitchburg .
New Bedford
Palmer
Palmer Fire Dist. No. 1
Springfield
Ware
Westfield .
Reservoirs
At filter plant
Cooley Brook Reservoir-
tion
Long Pond
Reservoirs
At pumping station
Reservoirs
Ludlow supply .
Ground water supply .
Granville supply
(1947)
(1943)
(1942)
(1941)
(1942)
(1941)
(1947)
(1942-1943)
. (1942)
. (1942)
-Pre-ammonia-
. (1941)
. - . (1941)
(1943-1944)
. (1942)
(1941)
(1942)
(1942)
(1941)
Quality of Public Water Supplies
The Division of Sanitary Engineering provides for the chemical analysis and the
microscopic and bacterial examination of samples of water from the public and
semi-public water supplies in the Commonwealth. Containers are sent to the of-
ficials in charge of these works and are returned to the appropriate laboratories of
this Division. Chemical analyses are made of the natural and treated waters three
to six times per year. Microscopic examinations are regularly made of all surface
water supplies, and bacterial examinations are made of the water of samples col-
lected from distribution systems at intervals of four weeks. The results of the chemi-
cal analyses are sent regularly to the officials in charge of public water supplies, and
upon request the results of the microscopic and bacterial examinations are also sent.
Where the microscopical or bacterial results indicate approaching trouble, special
investigations are made by the sanitary engineers of the Division. The results of
the chemical analyses of samples collected during the calendar year 1949 are
shown in the following tables :
292
P.D. 34
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P.D. 34
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P.D. 34
Sanitary Protection of Public Water Supplies
Rules and regulations are enforced by the Department through the Division of
Sanitary Engineering under the following provisions:
Section 160 of Chapter 111 of the General Laws:
Rules and regulations for protecting the drainage areas and sources of
water supply in cities and towns and fire and water districts and water
companies.
Rules and regulations relative to cross connections between public water
supplies and fire and industrial water supplies.
The following table shows the municipalities having public water supplies pro-
tected by rules and regulations adopted under the provisions of Section 160 of Chap-
ter 1 1 1 of the General Laws :
Abington and Rockland .
Adams (Fire District)
Amherst
Andover
Ashburnham
Ashfield (Water Company)
Athol ....
Attleboro .
Blandford (Fire District)
Braintree . . . 1910,
Brockton . . . 1905,
Brookfield
Cambridge .
Cheshire (Water Company)
Chester (Fire District) .
Chicopee
Clinton
Cohasset (Water Company)
Colrain (Fire District)
Colrain (Giiswoldville) .
Concord
Dalton (Fire District)
Danvers and Middleton . 1901,
Deerfield (South Deerfield Wa-
ter Supply District)
Easthampton
Egremont (South Egremont
Water Company)
Fall River ....
Falmouth ....
Fitchburg 1903, 1907, 1918,
Franklin (Beaver Pond) .
Gardner ....
Gloucester
Great Barrington (Housatonic
Water Works Company) 1929,
Greenfield ....
Hadley (Water Supply Dis-
trict) ....
Hatfield ....
Haverhill ....
Hingham and Hull (Hingham
♦Readopted
tRescinded 1936
1927 Water Company) . . 1912
1921 Hinsdale (Fire District) . .1941
1941 Holden . . . 1914, 1935*
1908 Holyoke . 1908, 1918, 1948*
1922 Huntington (Fire District) . 1938
1923 Ipswich .... 1941
1934 Lake ville (State Sanatorium) . 1926
1926 Lee (Berkshire Water Com-
1941 pany) . . 1919
1941 Leicester (Cherry Valley and
1926* Rochdale Water District) . 1914
1934 Lenox (Water Company) . 1933
1941 Leominster . . 1919, 1927*
1899 Lincoln and Concord . .1903
1933 Lynn 1907
1914 Manchester .... 1934
1906 Marlborough . . .1901
1935 Mavnard .... 1907
1923 Medfield (State Hospital) . 1922f
1 932 Metropolitan Water District 1 925, 1 940 *
1934 Milford (Water Company) . 1924
1910 Monroe (Water District) . 1941
1919 Monson .... 1941
1920* Montague (Turners Falls Fire
District) . . . 1908, 1936*
1932 Montague (Bartlett Supply) . 1941
1904 New Bedford . . .1932
Newburyport . . . 1921
1932 Norfolk (State Hospital) . 1926
1907 North Adams (Mt. Williams
1930 and Notch Brook Reservoir) 1941
1938* Northampton . . .1904
1942 North Andover . . . 1912
1910 Northborough . . 1905, 1934*
1930 North Brookfield . . . 1935
Northfield (Water Company) . 1941
i<wu Northfield (Schools, Inc.) * . 1941
y Norwood . . . .1901
1941 Orange .... 1939
1934 Palmer (Fire District No. 1) . 1933
1921 Palmer (Holden Supply) 1941
Peabody .... 1922
P.D. 34
Pittsfield (Regular Supplies)
(Onota Lake)
Pittsfield (Junction Water
Company)
Plymouth
Randolph and Holbrook
Rockport
Russell
Rutland . . .1914,
Salem and Beverly . 1901,
Scituate
Shelburne and Buckland (Shel-
burne Falls Fire District)
Southbridge (Southbridge Wa-
ter Supply Company) .
South Hadley (Fire District
No. 1)
South Hadley (Fire District
No. 2)
*Readopted
307
1903 Spencer .... 1934
1944 Springfield . . . 1904, 1910*
Stockbridge (Water Company) 1910
1941 Stoughton .... 1941
1908 Sunderland (Water Company) . 1941
1926 Taunton .... 1932
1902 Templeton Colony (Walter E.
1910 Fernald State School) . . 1947
1935* Wakefield . . . .1904
1938* Wareham (Onset Fire District) 1941
1927 Westborough . . . 1929
Westfield .... 1922
1941 Westhampton (Water Company) 1941
West Springfield . . . 1907
1931 Weymouth . . . 1903, 1935*
Williamsburg . . . 1914
1937 Williamstown . . . 1941
Winchester .... 1909
1941 Worcester . . . 1926
The following table shows the municipalities where, the public water supply
agency acquired land during the period from January 1, 1941, to June 30, 1949, in-
clusive :
Acquisition of Land for Protection of Water Supplies
Area of Land
Citt ob Town
Source of Supply
Location of Land
in proposed
taking (acres)
1941
Auburn ....
Wells
Auburn
2.1
Falmouth ....
Long Pond
Falmouth
180
Fitchburg .
Wachusett Lake
Westminster
13.3
Granville
Wells
Granville
22.4
Marion ....
Well
Marion
5
Montague
Lake Pleasant
.Montague
189
Webster ....
Wells
Webster
1.3
Weston ....
Well
1942
Weston
1.6
Colrain (F.D. No. 1) .
Mountain Brook
Colrain
74
Gardner ....
Crystal Lake
Gardner
8.75
Ipswich ....
Brown G. P. Well
Ipswich
8.14
Reading ....
Driven Wells
Reading
15
Wakefield ....
Bay State Road
Lynnfield
1|5}38.5
Wakefield
West Springfield
Bear Hole Brook
1943
Holyoke
West Springfield
58
Adams (Adams Fire District)
Bassett Brook Reservoir
Cheshire
0.75*
Westfield ....
Montgomery Supply
Montgomery and Westfield
1.0*
Granville Supply
Granville
47.9*
1944
Barnstable (Barnstable Water
Co.) ....
Tubular well field
Barnstable (Hyannis)
6.0*
Concord ....
Magog Pond
Acton and Littleton
15.0*
Gardner ....
Crystal Lake
Gardner
30.0*
Montague (Turners Falls Fire
Distiict)
Lake Pleasant
Montague
460.0*
Pittsfield ....
Ashley Lake System
Dalton and Washington
631.0*
Salem ....
Wenham Lake
Beverly
1.1*
Sharon ....
Wells
Sharon
21.0*
Spencer ....
Shaw Pond
1945
Leicester
66.1*
Salem and Beverly
Wenham Lake
Beverly
1.14*
Sharon ....
Wellfield
Sharon
21.0*
New Bedford
Great and Little Quitta-
cas Ponds
Lakeville
143 *
Tisbury ....
Lake Tashmoo
1946
Tisbury
5 *
Concord ....
Nagog Pond
Acton and Littleton
4
Danvers ....
Middleton Pond
Middleton
1.62
Dennis ....
Wells
Dennis
34.43
North Andover
Lake Cochichewich
North Andover
1 *
308 P.D. 34
Acquisition of Land for Protection of Water Supplies — Continued
City or Town
Source of Supply
Location of Land
Area of Land
in proposed
taking (acres)
1947
Athol ....
Pittsfield ....
Shrewsbury
Newton or Buchman Brook
Reservoir
Sackett Brook Reservoir
Oak Street wells
Athol
Washington
Shrewsbury
398 *
760 =*
11 =h
1948
Pittsfield .
Cleveland Brook Reser-
voir Construction
1949 to July 1
None
Hinsdale
600
Consumption of Water for Protection of Water Supplies
The average daily water consumption for each of the years 1941 to 1949, inclusive,
in the various cities and towns where records are kept and submitted to the Division
and the estimated population and per capita water consumption for the year 1949
are shown in the following table.
P.D. 34
309
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P.D. 34
Climatological Data
During the 9-year period 1941-1949, many extremes of weather were experienced
in Massachusetts. During the summer and fall of the year 1941, one of the most
severe droughts in the history of the State was experienced. A second severe
drought also was experienced during the summer and fall of 1949. The winter sea-
sons of the years 1942-43, 1943-44, 1944-45 and 1947-48 were much colder than
normal and cold periods of comparatively long duration were experienced in De-
cember, January, and February of each season. The winter season of 1947-48 pro-
duced an unusually large amount of snow. An average of 93 inches was received in
Massachusetts which was about 41 inches more than normal.
In September 1944, a severe hurricane of tropical origin passed over southeastern
Massachusetts, with wind velocity as high as 85 miles an hour. During this storm
considerable damage was done to shore property in southeastern Massachusetts on
Cape Cod. The rainfall preceding and accompanying the hurricane was extremely
heavy just to the northeast of the center of its path. More than 8 inches of precipi-
tation was received at several stations during the 3-day period immediately preced-
ing and during the hurricane. In July 1945, extremely heavy rains were reported in
the northwestern section of Massachusetts, resulting in flash floods which caused
considerable property damage.
At the end of the year 1948, a merging of two atmospheric disturbances south of
New England resulted in extremely heavy rainfall in the western part of Massa-
chusetts. During the 3-day period in which this storm occurred certain rainfall sta-
tions received more than 10 inches of rain. This heavy rainfall caused the Hoosic,
Housatonic, Deerfield and Westfield Rivers to reach flood stages on December 31.
In general, the flood peaks exceeded those of the flood of 1927 but were less than
those of September 1938. The Housatonic River near Great Barrington, however,
reached a stage which was greater than any on record since the establishment of a
gaging station in 1913. The flood control reservoir on the Westfield River un-
doubtedly eliminated what would have been a major flood on the Westfield River.
The organization set up under the office of the Adjutant General of the Massa-
chusetts Committee on Public Safety was called to action during the hurricane of
September 1944. At the time of the New Year's Eve flood of 1948 the Massa-
chusetts Committee on Public Safety had been dissolved and the Governor's Dis-
aster Relief Commission took action. In this connection the Division of Sanitary
Engineering supervised the rehabilitation of water supplies and sewerage works in
the affected areas.
Rainfall
The average rainfall in Massachusetts has been below normal in all except three
of the past nine years. The total rainfall deficiency for the past nine years has
amounted to 14.51 inches.
The following table shows the normal rainfall as deduced from the records of
seven long-term stations located at Amherst, Boston, Dalton, Fitchburg, Lowell,
New Bedford and Northbridge; also the rainfall for the years 1941-1949, inclusive.
Monthly Rainfall
in Inches for
Years 1941-1949 Inclusive
Month
Normal
1941
1942
1943
1944
1945
1946
1947
1948
1949
January
3.58
3.17
3.76
3.63
1.99
3.60
3.47
3.10
4.34
4.00
February .
3.31
2.25
2.84
1.59
2.48
4.24
3.50
1.86
2.42
3.31
March
3.79
2.34
7.38
3.71
4.43
2.10
1.58
3.41
3.44
1.98
April
3.59
1.21
1.38
3.65
4.17
4.03
2.49
4.69
3.42
4.18
May
3.61
2.80
2.81
5.47
1.36
5.65
5.93
4.19
6.74
3.97
June
3.53
4.11
4.04
2.52
5.67
6.49
4.05
3.54
5.17
1.00
July
3.82
4.27
5.08
4.92
2.89
4.75
3.17
4.45
3.89
2.49
August
4.06
3.69
3.03
2.38
2.42
3.16
7.26
1.61
2.19
2.83
September
3.58
0.96
3.17
1.65
6.51
2.14
3.97
3.46
1.08
4.56
October
3.45
2.23
3.74
4.88
2.30
2.82
1.37
1.75
3.25
1.94
November .
3.82
2.91
5.37
4.29
5.61
6.80
1.10
5.39
5.57
2.44
December .
3.56
3.73
5.88
0.98
3.23
5.74
3.80
3.35
3.29
2.40
Totals .
43.70
33.67
48.48
39.67
43.06
51.52
41.69
40.80
44.80
35.10
P.D. 34
315
Flow of Streams
Sudbury River
The average annual yield of the Sudbury River during the past nine years has
varied from 351,000 gallons per day per square mile in 1949 to 1,100,000 gallons per
day per square mile in 1945.
In the extremely dry year of 1941 the flow was below normal for every month and
in 1945 was above normal in seven of the twelve months. The following table gives
the record of the yield of the Sudbury River in million gallons per day per square
mile for each of the past nine years and the mean for the past 75 years ; the drainage
area at the point of measurement is 75.2 square miles.
Yield of the Sudbury River Drainage Area in Million Gallons per Day
per Square Mile
Mean for
75 years
Month
1941
1942
1943
1944
1945
1946
1947
1948
1949
1875-1949
January-
.736
.443
.994
.264
.970
2.153
1.022
.343
.748
1.112
February
1.359
.741
1.458
.565
1.016
1.514
1.085
1.023
1.549
1.429
March
1.353
3.046
2.342
1.857
3.044
2.508
2.003
3.507
1.292
2.621
April
1.025
1.134
1.157
2.642
1.084
1.005
1.642
1.758
.976
1.953
May
.352
.459
1.683
.490
1.758
1.235
1.489
1.485
.604
1.078
June
.164
.110
.246
.372
1.261
0.906
0.597
1.663
— .241
.536
July
— .050
.345
— .045
— .343
.459
— .077
0.306
.628
— .315
.222
August
— .235
.099
— .165
— .519
.191
.545
— .041
— .090
— .263
.178
September
— .243
— .092
— .216
.148
.061
.233
.000
— .362
— .156
.246
October
— .210
.106
.157
— .139
.103
.239
— .082
— .072
— .104
.346
November
.015
.667
.550
.739
.978
.217
.578
.646
— .066
.735
December
.185
1.937
.119
1.566
2.237
.445
.381
.394
.247
0.963
Average
for year
.364
.753
.686
.633
1.100
.909
.746
.910
0.351
.949
Average for
driest 6 mos.
— .094
.173
.065
— .001
.504
.267
.189
.192
— .187
0.375
The rainfall on the Sudbury River watershed and the total yield expressed in
inches in depth (inches of rainfall collected) for each of the past nine years 1941-
1949, inclusive, together with the average for 75 years are given in the following
table :
Rainfall in Inches, Received and Collected on the Sudbury River Drainage Area
Column (1) Rainfall
— Column {2) Rainfall Collected
Month
1941
1942
1943
1944
1945
(1)
(2)
(1)
(2)
(1)
(2)
(1)
(2)
(1)
(2)
January .
3.81
1.313
4.42
0.790
3.37
1.772
1.77
.304
3.09
1.730
February
2.14
2.190
2.96
1.194
1.49
2.350
2.60
.609
5.12
1.637
March .
2.75
2.413
7.39
5.433
4.05
4.178
4.68
2.140
2.21
5.430
April
1.30
1.769
1.73
1.958
3.54
1.997
4.68
2.947
3.04
1.871
May
2.24
0.628
2.51
0.819
4.80
3.002
0.91
.565
5.07
3.135
4.56
0.284
3.08
0.190
2.17
0.424
5.13
.415
6.22
2.176
July
3.68
—0.089
7.90
0.616
4.71
—0.079
1.80
— .395
2.78
.819
August .
2.99
— 0 . 420
2.34
0.176
1.80
—0.295
1.65
— .598
4.23
.341
September
0.53
—0.419
1.89 —0.158
0.85
—0.374
6.33
.165
1.59
.105
October .
1.73
—0.373
3.20
0.190
5.74
0.280
2.09
— .160
2.25
.183
November
2.70
0.025
5.10
1.151
3.95
0.950
6.54
.824
7.06
1.688
December
3.46
0.331
7.02
3.454
1.20
0.212
3.53
1.798
6.50
3.990
TOTALS .
31.89
7.652
49.54
15.813
37.67
14.417
41.71
8.614
49.16
23.105
Mean for
75 Years
Month
1946
1947
1948
1949
(1875-1949)
(1)
(2)
(1)
(2)
(1)
(2)
(1)
(2)
(1) (2)
January .
3.83
3.841
2.91
1.823
5.19
0.612
3.65
1.335
3.96 1.983
February
3.41
2.438
2.18
1.749
2.18
1.706
3.24
2.496
3.82 2.322
March .
1.71
4.475
3.26
3.572
3.41
6.255
1.78
2.305
4.18 4.676
April
2.65
1.734
4.65
2.835
2.91
3.035
3.80
1.685
3.65 3.372
May
5.01
2 . 203
3.89
2.656
5.70
2.649
4.02
1.078
3.29 1.923
June
2.86
1.564
3.26
1.031
4.88
2.871
0.71
— .370
3.42 .925
July
1.81
— 0 . 138
4.82
0.547
4.83
1.120
1.54
— .563
3.62 .397
August .
8.58
.972
1.88
—0.073
1.36
— .160
4.69
— .468
3.74 .317
September
4.32
.402
3.45
—0.001
0.88
— .624
2.95
— .269
3.55 .424
October .
0.45
.426
1.11
—0.146
2.86
— .129
1.57
— .185
3.37 .616
November
1.24
.374
5.44
.997
6.31
1.121
2.51
—0.113
3 . 87 1 . 268
December
4.19
.794
4.31
.680
1.78
0.702
2.24
.441
3.75 1.718
TOTALS
40.06
19.085
41.17
15.670
42.29
19.158
32.70
7.372
44.22 19.941
316
P.D. 34
Nashua River
The average annual yield of the south branch of the Nashua River at the outlet
of the Wachusett Reservoir in Clinton during the past nine years has varied from
549,000 gallons per day per square mile in 1941 to 1,215,000 gallons per day per
square mile in 1945. The following table gives the record of the yield of the Nashua
River in million gallons per day per square mile for each of the past nine years and
the mean for the past 53 years; the drainage area at the point of measurement is
107 . 69 square miles.
Yield of the Nashua River Darinage Area in Million Gallons
Per Day Per Square Mile
Mean for
53 years
Month
1941
1942
1943
1944
1945
1946
1947
1948
1949
1897-1949
January
0.789
0.814
0.988
0.386
1.112
1.949
1.107
0.571
1.482
1.209
February .
1.193
0.706
1.599
0.712
1.146
1.369
1.285
0.982
1.790
1.270
March
1.138
3.546
2.675
1.699
3.214
2.684
2.090
3.402
1.459
2.556
April
1.361
1.261
1.759
2.105
1.623
1.163
1.907
1.603
1.594
2.251
May
0.697
0.919
2.267
0.886
2.180
1.713
1.592
2.314
.968
1.338
June
0.404
1.034
0.765
1.176
1.399
1.279
0.727
2.404
.344
.879
July
0.307
0.747
0.434
0.057
0.489
0.364
0.173
0.947
— .004
.476
August
0.304
0.410
—0.153
0.066
0.588
0.720
0.254
0.067
.213
.384
September
—0.012
0.322
0.107
0.312
0.128
0.455
0.282
0.156
.037
.434
October
—0.312
0.445
0.529
0.330
0.350
0.661
0.067
0.014
— .017
.451
November
0.306
0.975
1.131
0.716
.809
0.367
0.596
0.920
.271
.808
December
0.476
1.417
0.553
1.026
1.510
0.716
0.521
0.680
.366
1.095
Average
for year
0.549
1.054
1.051
0. ,87
1.215
1.121
0.880
1.172
.701
1.095
Average for
driest 6 mos.
0.165
0.646
0.4*.
0.417
0.625
0.548
0.314
0.463
.140
.570
The rainfall en" he Nashua River drainage'area and the total yield expressed in
inches in depth (inches of rainfall collected) for each of the past nine years 1941-
1949, inclusive, together with the average for 53 years are shown in the following
table :
Rainfall in Inches, Received and Collected on the Nashua River Drainage Area
Column (1) Rainfall — Column (2) Rainfall Collected
Month
1941
1942
1943
1944
1945
(1)
(2)
(1)
(2)
(1)
(2)
(1)
(2)
(1)
(2)
January .
3.65
1.408
4.46
1.451
3.78
1.762
1.62
0.689
3.84
1.984
February
2.55
1.923
2.94
1.137
1.85
2.575
2.64
1.188
4.50
1.846
March
2.63
2.029
7.91
6.325
3.59
4.771
4.65
3.031
2.47
5.734
April
0.86
2.349
1.55
2.177
3.93
3.037
4.24
3.635
4.21
2.802
May
2.24
1.243
3.84
1.639
5.70
4.044
1.25
1.581
5.39
3.889
June
2.97
0.698
5.55
1.785
1.96
1.320
7.46
2.029
6.17
2.414
July
3.71
0.547
5.80
1.333
4.31
0.774
1.13
0.101
5.12
0.872
August .
3.02
0.542
2.20
0.730
2.23
— 0 . 273
0.95
0.117
3.72
1.049
September
0.71
—0.021
2.52
0.556
1.44
0.185
6.79
0.538
2.33
0.221
October .
2.44
—0.556
3.39
0.793
5.67
0.944
2.17
0.588
2.15
0.624
November
3.09
0.527
5.41
1.683
5.26
1.954
4.64
1.235
5.49
1.396
December
3.55
0.850
6.00
2.528
0.77
0.986
4.07
1.831
6.22
2.694
TOTALS .
31.42
11.539
51.57
22.137
40.49
22.079
41.61
16.563
51.61
25.525
Mean for
53 Years
Month
194(
1947
1948
1949
1897
-1949
(1)
(2)
(1)
(2)
(1)
(2)
(1)
(2)
(1)
(2)
January .
3.86
3.477
3.38
1.975
4.25
1.018
4.40
2.643
3.84
2.156
February
4.26
2.205
2.72
2.070
2.98
1.639
3.42
2.884
3.64
2.063
March
1.76
4.788
3.77
3.729
3.87
6.069
1.89
2.602
4.06
4.559
April
2.77
2.008
5.31
3.292
3.05
2.767
4.55
2.752
3.87
3.885
May
6.33
3.055
3.64
2.840
7.39
4.128
3.75
1.726
3.53
2.387
June
3.23
2.208
3.20
1.254
6.06
4.150
.60
.594
3.93
1.517
July
4.36
0.649
4.18
0.308
5.84
1.689
2.21
— .007
3.96
.850
August .
6.54
1.284
1.91
0.453
1.89
0.119
3.42
.380
3.77
.686
September
5.52
0.785
3.68
0.487
0.81
0.269
2.53
.064
3.88
.749
October .
1.03
1.179
1.22
0.121
3.11
0.025
2.22
— .031
3.13
.805
November
1.47
0.633
5.91
1.029
7.15
1.588
2.54
.467
3.88
1.395
December
4.12
1.278
3.60
0.929
2.86
1.212
3.38
.652
3.87
1.952
TOTALS
45.25
23.549
42.52
18.487
49.26
24.673
34.91
14.726
45.36
23.004
P.D. 34
317
Merrimack River
The Merrimack River, which is the second largest stream in Massachusetts, has
a total drainage above its mouth at Newburyport of 5000 square miles, of which
1250 square miles are within the limits of Massachusetts. The records of flow of the
Merrimack River have been kept continuously in the office of the Essex Company
since 1880. The net watershed above the point of measurement is considered to be
4,463 square miles.
The following table gives the records of the flow of the Merrimack River at
Lawrence for each of the past nine years and the mean for the past 70 years — the
amounts being expressed in cubic feet per second per square mile of drainage area :
Flow of the Merrimack River at Lawrence in Cubic Feet Per
Second Per Square Mile
Mean for
70 Years
Month
1941
1942
1943
1944
1945
1946
1947
1948
1949
1880-1949
January
1.571
.911
1.364
.757
1.573
2.138
1.060
.682
2.262
1.333
February
1.874
.733
1.472
.876
1.254
1.784
2.014
.983
1.829
1.372
March
1.441
3.189
2.754
1.808
4.5 5
4.296
2.834
3.732
2 . 339
2.804
April .
2.356
3.297
2 . 959
4.120
3.248
2.289
3.749
3.113
2.648
3.619
May
.952
1.607
3.804
2.341
4.105
2.659
3.085
3.211
1.742
2.324
June
.539
1.610
1.467
2.147
2.583
1 . 934
2.361
2.404
.693
1.341
July
.536
.877
.630
1.085
1.380
.571
.959
1.065
.329
.782
August
.294
.665
1.038
.429
.726
.893
.550
.511
.272
.644
September
.267
.452
.561
.843
.566
.624
.496
.297
.394
.676
October
.326
.513
.764
.736
.876
1.112
.259
.290
.352
.775
November
.529
1.210
2.151
.762
1.309
.841
.955
.924
.618
1.147
December
.594
1.725
1.201
1.386
2.400
.827
.810
.634
.797
1.165
Average
for year
.940
1.399
1.680
1.441
2.044
1.664
1.594
1.487
1.190
1.498
Average for
6 driest mos.
.415
.888
1.058
.873
1.210
.811
.672
.620
.443
.865
Examination of Rivers
Under the provisions of the General Laws, the Department maintains general
oversight over the surface waters of the state. Massachusetts is especially fortunate
in that sources of water supply are obtained from unpolluted sources with the ex-
ception of that of the city of Lawrence which uses the Merrimack River as its source
of supply. The river systems of the State are such that it is possible to obtain water
supplies in the upland regions of these streams and to discharge waste materials be-
low the cities and towns without endangering other sources of water supply.
Many of the larger cities of the' Commonwealth are located along the coast, or on
large streams, and it was originally possible to dispose of sewage without treatment
by means of sea outfalls or direct river discharge without creating a nuisance in
many instances. However, with the growth of cities and towns and certain indus-
tries it has been necessary to provide sewage treatment to maintain satisfactory
conditions in our rivers. The natural recuperative powers of Massachusetts streams
are very great, and thus the streams do quickly recover, even after serious pollu-
tional loads are added.
Most of the small streams of the Commonwealth are not polluted, but the main
threads of the streams receive sewage and industrial waste either directly or after
treatment. Certain streams, such as the Nashua River below Fitchburg, the Rum-
ford River in Mansfield and Norton, the French River at Webster, the Quinebaug
River below Southbridge, the Housatonic River below Dalton and in Lee, portions
of the Hoosic River, and the Merrimack River below Haverhill, have on several oc-
casions been found to be devoid of dissolved oxygen and nuisance conditions have
prevailed. Much of the Division's efforts have been directed to eliminating sources
of pollution which have caused these nuisance conditions. Special legislation was
enacted in 1949 providing for an investigation of the sanitary condition of the
Housatonic River. Legislation was also requested for an investigation of the Sud-
bury River by a Joint Board to consist of the State Planning Board, the Depart-
ment of Agriculture, the Department of Conservation, and the Department of
318 P.D. 34
Public Health. It will be necessary to request similar legislation for the investiga-
tion of the sanitary condition of other rivers as the funds and permanent staff avail-
able to the Department are not adequate to do this work.
River Sampling
River sampling stations have been maintained by the Department for a great
number of years. The schedule was revised and enlarged prior to the 1949 season
to include all of the interstate rivers in order to have information available on which
to base the future classifications of streams in connection with the work of the New
England Interstate Water Pollution Control Commission. During the year 1949
the Department maintained 255 river sampling stations on the various rivers of the
Commonwealth. Samples were collected from June through November at most of
these stations for dissolved oxygen content and chemical analysis. In addition,
samples were collected on several occasions for bacterial examination. The number
of sampling stations on each river were as follows :
Aberjona (12), Ipswich (7), Merrimack (19), North (Salem-5), Shawsheen (2),
Assabet and Sudbury (17), Charles (18), Neponset (16), Taunton (17), Ten Mile
(4), Rumford (17), Blackstone (16), Nashua (15), Otter (2), Quinebaug & French
(14), Ware & Quaboag (13), Connecticut & Chicopee (14), Green (2), Millers (5),
Mill, Manhan, Deerfield (8), North (Colrain-2), Scantic (1), Westfield (5), Farming-
ton (2), Hoosick (8), Housatonic (14).
New England Interstate Water Pollution Control Commission
Under date of November 20, 1940, Mr. Victor M. Cutter, Chairman of the Na-
tional Resources Planning Board, Region One, appointed a committee "to set up
criteria for classification of pollution in New England streams and to investigate the
possibilities of actually making such a classification." This committee consisted of
the following members :
Lt. Col. J. S. Bragdon, District Engineer, U. S. Engineer Office, Providence,
Rhode Island.
E. W. Campbell, Director, Division of Sanitary Engineering, Maine Depart-
ment of Health, Augusta, Maine
Edward L. Bike, State Supervisor, Recreation Study, U. S. National Park Serv-
ice
W. C. Herrington, U. S. Fish and Wildlife Service, Department of the Interior
C. D. Howard, Chief, Division of Chemistry and Sanitation, New Hampshire
State Board of Health, Concord, New Hampshire
Eskil C. Johnson, Sanitary Engineer, Sewage & Shellfish Section, Rhode Island,
State Department of Health, Providence, Rhode Island
Dr. C. C. Pierce, U. S. Public Health Service, Wall, Nassau & Pine Streets, New
York City.
Philip Shutler, Director, Vermont State Planning Board
Edward L. Tracy, Sanitary Engineer, Vermont State Board of Health, Burling-
ton, Vermont
Herbert E. Warfel, Biologist, New Hampshire Fish and Game Commission,
Concord, New Hampshire
Arthur D. Weston, Chief Sanitary Engineer, Massachusetts Department of
Public Health, Boston, Massachusetts
Warren J. Scott, Director, Bureau of Sanitary Engineering, State Department
of Health, Hartford, Connecticut, Chairman
The committee arranged for Gordon M. Fair, Professor of Sanitary Engineering,
Harvard University, to act as consultant for the committee. This committee which
became known as the Special Committee of Clsssification of New England Waters,
made its report to the National Resources Planning Board, setting forth a system of
classification of waters according to highest use.
Class A — Waters as source of drinking water or for the cultivation of market
shellfish.
Class B — Waters used for bathing
P.D. 34 319
Class C — Waters used for recreational boating, fishing, cultivation of seed oy-
sters, or industrial supply with treatment
Class D — Waters used primarily for transporting of waste without uses.
Standards were set for each of these classifications to cover the physical appear-
ance, dissolved oxygen content, and bacterial quality.
In order to promote cooperative programs for cleaning up interstate streams the
Special Committee recommended, in part, that the National Resources Planning
Board request the governor of each New England state to appoint a State committee
for classification of the State's waters in accordance with the classifications prepared
in its report, such committees to include official representatives of the State agencies
supervising (1) health, (2) water pollution or water conservation, (3) fish and game,
and ^4) planning; together with a representative of industry. Under date of Feb-
ruary 5, 1941, Victor M. Cutter, Chairman of the National Resources Planning
Board, made such request to the Honorable Leverett Saltonstall, Governor of
Massachusetts. The Governor appointed to such a committee Raymond J. Kenney,
Commissioner of Conservation, Otis D. Fellows, Chief Engineer of the State Plan-
ning Board, and Richard K. Hale, Director of the Division of Waterways, Depart-
ment of Public Works, with Arthur D. Weston, Chief Sanitary Engineer, Depart-
ment of Public Health, as Chairman. Massachusetts was the first State to appoint
such a committee. Similar committees were appointed by the governors of each
New England State with the exception of one. Subsequently, the chief engineers
of the various regulatory agencies of the New England States met frequently and
prepared tentative classifications of the various interstate streams in accordance
with the standards prepared by the Special Committee of the National Resources
Planning Board.
This informal cooperation between the states in the matter of stream pollution
control ultimately led to a recommendation that a compact be established to set up
a permanent organization to coordinate the work of the various New England
states in this matter.
Under the provisions of Chapter 421 of the Acts of 1947 the State Planning Board
was authorized to enter into a compact with the other New England States to es-
tablish a New England Interstate Water Pollution Control Commission. The Pre-
amble of this Compact reads as follows :
"Whereas, The growth of population and the development of the territory
of the New England States has resulted in serious pollution of certain interstate
streams, ponds and lakes, and of tidal waters ebbing and flowing past the
boundaries of two or more states; and
Whereas, Such pollution constitutes a menace to the health, welfare and
economic prosperity of the people living in such area ; and
Whereas, The abatement of existing pollution and the control of future pol-
lution in the interstate waters of New England area are of prime importance
to the people and can best be accomplished through the co-operation of the
New England States in the establishment of an interstate agency to work with
the States in the field of pollution abatement :
Now, therefore, the states of Connecticut, Maine, Massachusetts, New-
Hampshire, Rhode Island and Vermont do agree and are bound as follows:"
The Compact recognizes such variable factors as location, size, character, and
flow, and the many varied uses of the waters of New England, and that no single
standard of sewage and waste treatment was practicable. The Commission was di-
rected to establish reasonable physical, chemical, and bacterial standards of water
quality satisfactory for various classifications of us.e, and each signatory State agreed
to prepare a classification of its interstate waters according to the present and pro-
posed highest use of these waters. The signatory States pledged to provide for the
abatement of existing pollution and for the control of future pollution of interstate,
inland, and tidal waters of New England, and to protect and maintain the waters in
a satisfactory condition consistent with the highest classified use of each body of
water.
320 P.D. 34
Rhode Island was the first State to ratify this compact. To date, Rhode Island,
Connecticut, Massachusetts and New York, insofar as it lies within the New Eng-
land Drainage Basin Watershed, have ratified the Compact. The Compact, after
ratification by the States, was submitted to the Congress of the United States and
was approved by that body.
The Governor of Massachusetts appointed the following to the Commission :
Dr. Vlado A. Getting,
Commissioner of Public Health
Lewis R. Hovey
Leo Marceau
Lawrence F. Miller and
Robert H. Russell
The Compact Commission has held five meetings, Dr. Vlado A. Getting, Com-
missioner of Public Health, was elected Chairman, Walter J. Shea, Temporary
Secretary, and Leo Marceau, Treasurer. The first meeting was held in Boston on
November 25, 1947. The Commission established a Technical Advisory Board
consisting of the chief engineers of the various regulatory agencies of each State.
Other New England States have been invited to be represented at each meeting of
the Commission and at each meeting of the Technical Advisory Board, in order that
all of the New England States might be acquainted with the work of the Commission
and advise the Commission relative to matters pertaining to the States which they
represent.
Tentative standards for water classification were adopted February 11, 1949.
The State of Vermont has passed enabling legislation to join the Commission but
formal execution of the Compact has been delayed pending the need of further
classification. The Department is continuing to cooperate with the other New
England States and the Commission to establish effective controls of the pollution
of the various streams. Plans are now under way for the establishment of a perma-
nent office in Boston and the appointment of a permanent engineering secretary to
represent the Commission.
Cooperation with U. S. Public Health Service
Beginning with the Fifty-fifth Congress in 1897, there have been federal water
pollution control measures before all but six Congresses. Separate bills were passed
by the House and Senate in 1936 and in 1940, but agreement was not reached on any
single bill. The Eightieth Congress, Second Session, enacted Public Law 845 and
set the policy of Congress in matters of water pollution control. This policy is to:
(a) recognize, preserve, and protect the primary responsibilities and rights of
the States in controlling water pollution.
(b) support and aid technical research to devise and perfect methods of treat-
ment of industrial wastes not susceptible to known effective methods of
treatment.
(c) provide Federal technical services to State and interstate agencies and to in-
dustries.
(d) provide financial aid to State and interstate agencies and to municipalities.
(e) place the responsibilities of the program with the Surgeon General of the
U. S. Public Health Service and the Federal Works Administrator.
Under the provisions of this Act, the U. S. Public Health Service has divided the
country into 14 regional river basin districts. The New England district, with head-
quarters in Boston, embraces all of New England and that portion of New York
which is included in the New England Interstate Water Pollution Control Compact.
No Federal funds were made available for grants for planning or as aids to States
or interstate agencies for investigation during the fiscal year 1949. However, it is
anticipated that certain limited funds will be made available to the various State
and interstate regulatory agencies for investigations or studies of industrial wastes
relative to the control of pollution from industrial sources.
Rules and Regulations for Prevention of Stream Pollution
During the period covered by this report, Chapter 388 of the Acts of 1941 was
adopted giving this Department limited authority on new sources of pollution but
it gave the Department no authority to control on sewer systems existing on Jan-
P.D. 34
321
uary 1, 1941, nor on industrial wastes from plants existing on that date. During the
war it seemed impracticable to obtain more satisfactory legislation, but in 1945 the
condition of various rivers became so objectionable, particularly the North River in
Salem and Peabody and the Taunton River in Taunton and Berkley, that the mat-
ter was again agitated. The Legislative Committee on Public Health made various
inspections and held hearings in Taunton, Salem and Lee.
The first comprehensive stream pollution control law for the Commonwealth was
enacted by the Legislature with an emergency preamble in 1945 and is known as
Chapter 615 of the Acts of that year. The act provides that the Department of
Public Health shall prescribe and establish rules and regulations to prevent pollu-
tion or contamination of any or all of the lakes, ponds, streams tidal waters, and
flats within the Commonwealth. Such rules and regulations were prescribed and
established by the Department of Public Health at the meeting of its Public Health
Council on Tuesday, August 14, 1945, and were approved by the Governor and
Council on September 19, 1945. In general these rules and regulations provide that
no sewage, human excrement, house slops or sink wastes, garbage, manure or put-
rescible matter, manufacturing refuse, waste product or any polluting liquid poison-
ous or injurious to humans or animals, shall be discharged into any waterway within
the Commonwealth except as it may be approved by the Department of Public
Health when in its opinion the best practicable and reasonably available means to
render the same harmless have been provided in accordance with plans approved by
the Department.
This legislation has been of material assistance to the Department in preventing
the continued pollution of various lakes, ponds, streams and tidal waters and flats.
Under the provisions of the law it is necessary to publish these rules and regulations
in a newspaper of the town where such rule or regulation is to take effect, or, if no
newspaper is published in such town, to post a copy of such rules and regulations in
a public place in the town. The towns in which these Rules and Regulations have
been published up to June 30, 1949, are as follows:
City
or Town
1.
Taunton .
2.
Worcester
3.
Auburn
4.
Salem
5.
Peabody .
6.
Woburn .
7.
Fitchburg
8.
Attleboro
9.
Foxborough
10.
Mansfield
11.
Framingham
12.
Provincetown
13.
Middleborough
14.
Falmouth
15.
Sunderland
16.
Bridgewater
17.
Swansea .
18.
Norton
19.
Weymouth
20.
Dudley
21.
Webster .
22.
Ayer
23.
Nahant
24.
North Adams
25.
North Brookfield
26.
North Attleborough
27.
Edgartown
28.
Gay Head
29.
West Tisbury
Date
Nov.
14,
1945
Nov.
14,
1945
Nov.
14,
1945
Nov.
16,
1945
Nov.
16,
1945
Mar.
22,
1946
Apr.
25,
1946
July
25,
1946
June
28,
1946
June
28,
1946
July
22,
1946
Jan.
6,
1947
Jan.
15,
1947
Feb.
19,
1947
Jan.
2,
1947
Jan.
22,
1947
Apr.
23,
1947
Apr.
25,
1947
May
27,
1947
June
11,
1947
July
29,
1947
Aug.
27,
1947
Mar.
16,
1948
June
9,
1948
July
28,
1948
Oct.
21,
1948
May
13,
1949
May
12,
1949
May
12,
1949
322 P.D. 34
City or Town Date
30. Chilmark .... May 12, 1949
31. Oak Bluffs .... May 12, 1949
32. Tisbury May 13, 1949
33. Scituate . . . . . June 13, 1949
It has been necessary to use this legislation in court only in connection with the con-
struction of sewage treatment works at Taunton and the improvement of one of the
main sewers of the city of Woburn and in connection with three sources of industrial
wastes in Taunton. Court cases have been prepared against North Brookfield and
Peabody but litigation was not necessary. The act has been referred to by the De-
partment in numerous letters where certain municipalities and industries continue
to violate the rules and regulations prescribed by the Department under the provi-
sions of Chapter 615 of the Acts of 1945. Cases are now pending against the towns
of Rockland and Nahant and certain individuals in Provincetown.
Only one of the cases brought by the Department under the provisions of Chap-
ter 615 of the Acts of 1945 entailed any very extensive litigation, viz., Attorney
General v. City of Woburn. This case was tried during a period covering several
days before Judge Hanify of the Superior Court, and it was ordered, adjudged and
decreed :
"That the city of Woburn, a municipal corporation, its officers, servants,
agents and employees be, and they hereby are, enjoined from discharging any
sewage or waste containing any putrescible organic matter or other deleterious
substances into the Aberjona River or any tributary thereof."
This decree was entered on April 8, 1947, and the city of Woburn appealed to the
Supreme Court. The case was brought not only under Chapter 615 of the Acts of
1945, an amendment of Section 5 of the General Laws, Chapter 111, but also under
the provisions of the special act relating to the Aberjona River, Chapter 291 of the
Acts of 1911. The Supreme Judicial Court in 322 Mass. 634 stated that the decree
of the Superior Court was amply supported by the evidence and the decree was
affirmed with costs.
Municipal Sewage Treatment Works
The Division of Sanitary Engineering, as required by Chapter 111 of the Gen-
eral Laws, has from time to time examined the various municipal sewage treatment
works in this Commonwealth and the main outlets of municipal sewers and has in-
vestigated the effect of the sewage disposal. Examinations have also been made of
the sewage treatment works of the state, county and other institutions and indus-
trial plants. Regular periodic samples have been collected of the sewage and ef-
fluent of the municipal sewage treatment works.
Of the 351 cities and towns in this Commonwealth, 135 municipalities are now
served by public sewerage systems. While no accurate figure is available at this
time as to the population actually served by these sewers, the total population of
the above municipalities, according to the 1945 census, is 3,997,638. Sewage from
90 of the above 135 municipalities is disposed of by discharge into inland or tidal
waters. Sewage from the remaining 45 municipalities representing a total popula-
tion of 902,873 persons is discharged to sewage treatment works. 216 Massachu-
setts municipalities have no recognized public sewerage systems; these towns rep-
resent a total of 495,643 persons or 11% of the total Massachusetts population of
4,493,281.
New Municipal Sewerage Systems
During this period public sewers have been introduced in four municipalities,
namely, Ayer, East Longmeadow, Ludlow, and Weymouth. Of these four, the first
three towns also have treatment works ; sewage from Weymouth is discharged tothe
mains of the South Metropolitan Sewerage System.
P.D. 34
City or Town
Ayer .
East Longmeadow
Ludlow
City or Town
Brockton
Framingham
Franklin
Gardner
New Municipal Sewage Treatment Works
323
Sewage or
Effluent Dis-
charged Into
Nonacoicus
Brook
Pecoosic
Brook
Chicopee
River
Year Treatment
1943 Comminutor, Imhoff tank, trickling filter,
secondary sedimentation, sludge beds.
1941 Bar rack, grit chamber, Imhoff tank, high
rate trickling filter, secondary sedimen-
tation, chlorination, glass covered sludge
bed.
1941 Bar rack, comminutor, grit chamber, aera-
tion, mechanically equipped settling
tank, sludge digestion, glass covered
sludge beds.
Major Additions to Sewage Treatment Works
Year Improvement
1941 Primary settling, sand filters.
1946 Chlorination.
1948 Settling tanks, trickling filters rotary distributors.
1949 Primary sedimentation, trickling filter, secondary sedi-
mentation, sludge digestion. (Replacing two old
plants).
1949 Imhoff tank, trickling filter, secondary sedimentation.
1948 Grit chambers, comminutors, Imhoff tanks, high rate
trickling filters, final settling tanks.
1946 Chlorination.
1948 High rate trickling filters, mechanically equipped tanks,
sludge digestion, open sludge beds.
1949 Chlorination, sand filters.
1948 Trickling filters rotary distributors.
Hopedale
Marlborough
Natick
North Attleborough
North Brookfield
Worcester .
Acquisition of Land for Sewage Treatment Works
Under the provisions of General Laws, Chapter 83, Section 6, the Department
is required to hold a public hearing when a town proposes to purchase land or take
the same by eminent domain for the treatment, purification and disposal of sewage.
During this period hearings have been held relative to the taking of land by nine
municipalities. In the instance of Ayer, land was acquired under the provisions of
Chapter 255 of the Acts of 1941, and by Bridge water, under the provisions of Chap-
ter 472 of the Acts of 1948.
The takings are shown on the following table :
Areas of Land in
Proposed Taking
Municipality (Acres)
Ayer
Bridge water
Fall River .
Grafton
Ipswich
Middleborough
North Brookfield
Taunton
Westfield .
6.0
16.9
10.0
3.0
4.0
2.1
58.0
6.0
Analytical Results and Record of Operation
Due to the large volume of work assigned to the Division of Sanitary Engineering,
it has become necessary to request the operators of the various sewage treatment
works in the Commonwealth to collect samples for chemical analysis at their plants
and to submit the same to the Department for analysis. Sample bottles for this
purpose are sent to the various operators four times each year. The tables below
contain data relative to the analyses for the samples collected during the year 1949.
Only a limited amount of data is presented; however, detailed analyses are available
in the office of the Division of Sanitary Engineering to any who are interested in such
information.
324
P.D. 34
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Fitchburg
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Framingham /
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Greenfield
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P.D. 34
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Northbridge
328 P.D. 34
Examination of Sewer Outlets Discharging Into the Sea
Since the war the Department has attempted to make annual examinations of all
of the main sewer outlets including those discharged into the sea as required by law.
The most important outlets discharging into the sea are those of the Metropolitan
Sewerage Districts at Nut Island in the southerly part of the harbor and Deer Is-
land in the northerly part of the harbor. Sewage treatment works for the treatment
of the sewage of the South Metropolitan Sewerage District at Nut Island are now
being completed by the Metropolitan District Commission at a cost of some
$6,750,000, and it is hoped that when these works are put into operation it may be
practicable for the Department to approve certain additional areas for bathing and
to remove the restrictions on the taking of shellfish from certain areas in the souther-
ly part of the harbor. Works are now being designed for the treatment of the sew-
age collected in the North Metropolitan Sewerage System. Funds for conveying the
sewage to the sewage treatment works are available, and it is expected that the pre-
liminary plans for the treatment works will shortly be completed. The treatment
works at Nut Island and Deer Island will consist primarily of sedimentation and
chlorination with the digested sludge being discharged on" the ebb tide in deep water
in or near President Roads. The city of Boston has prepared complete contract
drawings for treatment works at the Calf Pasture. These plans have been approved
by the Department, and under the provisions of Chapter 598 of the Acts of 1949 the
city is required to construct these and appurtenant works before July 1, 1955. The
city is authorized to borrow funds outside the debt limit not exceeding $12,000,000.
In regard to the smaller sewer outfalls into the sea the town of Rockport has con-
structed an outfall through which a considerable quantity of its sewage is being dis-
charged into tide water having a depth of 34 feet at low tide. The outfall sewer of
the South Essex Sewerage District has been cleaned on one or more occasions in the
period covered by this report and, in addition, a substantial grit and grease chamber
has been constructed for the removal of grit and grease from the sewage of the city
of Peabody. A new outfall sewer has been constructed for the removal of the sewage
of the town of Swampscott to take the place of the existing outfall constructed
nearly 50 years ago which was found to be in an unsatisfactory condition. Late in
the period covered by this report the town of Plymouth authorized an engineering
study to be made for the discharge of sewage after primary treatment into Plymouth
Harbor or into the sea through an outfall off Rocky Point. The town of Province-
town has given consideration to an outfall into tide water but as the cost was very
considerable the town has elected to postpone any sewage treatment works other
than to provide for the construction of a large number of local cesspools. The town
of Falmouth has completed the first step of the outfall sewer at Woods Hole. The
town of Fairhaven has completed its studies for sewage disposal and rather than to
discharge the sewage after treatment into valuable shellfish areas has decided to
treat the sewage at an isolated point and discharge it after sedimentation and chlori-
nation into the Acushnet River. At New Bedford the city is completing new inter-
cepting sewers along the waterfront with a view to preventing the continued dis-
charge of sewage into the Acushnet River. The city of Fall River is completing its
sewage treatment works providing for sedimentation, chlorination and the discharge
of the effluent through a submerged outlet into Mount Hope Bay. It is hoped that
during the coming year the city will finance the construction of an intercepting
sewer to remove all of the sewage now being discharged into the Taunton River and
Mount Hope Bay to the sewage treatment works.
Shellfish
The period covered by this report has seen considerable activity in connection
with the sanitary control of shellfish. No extensive changes have been made in the
shellfish from contaminated areas. It has been necessary since the adoption of
Chapter 463 of the Acts of 1948 to examine annually all of the contaminated areas.
This has been an arduous task for the Division of Sanitary Engineering as it is felt
that as the approval or disapproval of shellfish harvesting areas is based largely on
sanitary surveys with limited reliance on the analyses of overlying waters and the
shellfish. Furthermore the annual advertising and posting is a problem which if
continued must result in the recmest for a very substantial addition to the funds
available for shellfish control. Three reports '(H. 1475-1946, H. 1850-1947, H.
P.D. 34
329
1770-1948 and H. 2275-1949) have been prepared with the assistance of the De-
partment relative to general questions on the sanitary control of shellfish with
particular reference to a development of a more adequate means of treating shell-
fish from moderately polluted areas. The results of these studies have been an ap-
propriation of $120,000 for the construction of a new plant by the Division of Ma-
rine Fisheries for the treatment of shellfish. The only plant now in operation for
the treatment of shellfish is that operated by the city of Newburyport. The follow-
ing is a table showing the number of barrels handled at that plant beginning in the
year 1941:
Deliveries made to chlorinating Plant at Newburyport of Clams taken from Con-
taminated Areas
Year
1941
1942
1943
1943
1943
1944
1944
1945
1945
1946
1946
1947
1947
1948
1948
1949
No. of Barrels
17,831 97/100
Dec. 1, 1942 to June 30, 1943
July 1, 1943 to Dec. 31, 1943
July 1, 1943 to June 30, 1944
July 1, 1944 to June 30, 1945
July 1, 1945 to June 30, 1946
July 1, 1946 to June 30, 1947
July 1, 1947 to June 30, 1948
July 1, 1948 to June 30, 1949
19,412
9,093
9,110
17,324
15,298
14,884
12,123
9,391
12,910
127/180
13/18
7/12
V5
In addition to annual examinations of shellfish areas, many areas have been
re-examined for approval by the Department for the taking of shellfish for puri-
fication at a plant approved in writing by the Department. Of this, there are some
15 areas in Boston Harbor which have been approved as suitable for the taking of
shellfish for treatment purposes.
The following table shows the number of out-of-state shellfish certificates which
were approved during the last nine years:
1941
1942
1943
1944
1945
374
1946
344
1947
166
1948
288
1949
255
. 587
. 378
. 229
. 224
Cross Connections
The Department has continued the enforcement of its rules and regulations per-
taining to cross connections as adopted February 9, 1937, under authority of Sec-
tion 160, Chapter 111 of the General Laws of the State. Full time by one engineer
and part time by from one to two others has been devoted to the protection of the
public water supplies against contamination through cross connection with second-
ary water supplies.
On May 12, 1912, the rules and regulations were amended so as to continue to
safeguard the public water supplies, yet fit any possible emergency, and facilitate
the successful prosecution of the war production program. On February 8, 1949,
the rules and regulations were readopted in the original form. The original rules
and regulations of the Department provide that where a physical cross connection
between a pipe containing a municipal water supply and a pipe containing a second-
ary water existed on December 1, 1937, the date of discontinuance of that cross
connection could be temporarily extended with the permission of the Department,
provided the public water supply service was equipped with a set of approved
double check valves installed in accordance with the Department's specifications
330
P.D. 34
and requirements so that the valves could be readily tested for tightness or be
opened for overhauling and repairs. The rules and regulations further provided
that after December 31, 1937, no physical connection between the distribution
system of a public water supply and that of any other water supply would be per-
mitted. The secondary water classification is interpreted to include reused or re-
circulated municipal water, sewage and industrial solutions.
The following table shows the distribution and number of approved double-check
valve installations v/hich have been permitted in accordance with these rules and
regulations :
Number of
Municipalities
Number of
Number of
having Industrial
Industrial
Sets of Active
Plants with Double
Plants having
Double Check
Check Valve
Double Check
Valve |
(Period Ending) Installations
Valve Installations
Installations in State
Dec. 31, 1941 .... 125
589
901
Dec. 31, 1942
126
626
956
Dec. 31, 1943
131
639
991
Dec. 31, 1944
133
647
1006
Dec. 31, 1945
133
660
1020
Dec. 31, 1946
133
664
1014
Dec. 31, 1947
134
665
1020
Dec. 31, 1948
134
657
998
June 30, 1949
134
658
1002
In continuing permission to maintain such approved cross connection installa-
tions, the Department requires the company owning the installation to test the
same for tightness once each month. The Department has made arrangements with
the local water works officials whereby one of their employees will test the check
valves with the representative of the company once every three months, reporting
the results to this Department on forms furnished them. Once a year an experienced
engineer from this Department tests each set of check valves, sees that the bonnets
are removed and the interiors thoroughly cleaned out, that the rubber facings are
replaced when necessary, that moving parts are lubricated, that all gauges and
valves are in good working order, that drains are clear and that, on again placing
the installation in service, it tests satisfactorily for tightness. Thus, he endeavors
to leave the installation mechanically perfect for the ensuing jrear.
The following table shows the number of such annual inspections made by the
Department engineer and records how satisfactorily the check valves met the test
prescribed by the Department:
No. of sets of
Double Check
No. of sets of
No. of sets of
Date
Valves receiving
Double Check
Percentage
Double Check
Annual Inspection
Valves testing
testing
Valves testing
Percentage
by State
satisfactorily be-
satisfactorily
satisfactorily after
testing
(Period)
Engineer
fore overhauling
overhauling
satisfactorily
Ending)
Dec. 31, 1941
796
605
76.0
788
99.0*
Dec. 31, 1942
902
704
78.0
902
100.0
Dec. 31, 1943
946
760
80.3
946
100.0
Dec. 31, 1944
941
747
79.4
941
100.0
Dec. 31, 1945
881
731
83.0
881
100.0
Dec. 31, 1946
910
761
83.6
910
100.0
Dec. 31, 1947
786
645
82.0
786
100.0
Dec. 31, 1948
878
718
81.8
878
100.0
June 30, 1949
447
366
81.9
447
100.0
♦Necessitated through lack of necessary rubber facings, repair parts, etc. Each set was repaired by the
company and reinspected by the Department's engineer after a few days. During the interval one check
valve protected the public water supply.
From the above table it will be noted that each year approximately twenty per
cent of the double check valve installations failed at first to entirely meet the re-
quirements of the Department. The Department's test for tightness is rather strin-
gent inasmuch as it is performed with municipal water pressure entrapped between
the inside and outside tightly-closed gate valves and no back pressure is used against
the inside check valve. Experience has shown that where the check valves are fre-
P.D. 34 331
quently tested and are properly cared for they usually meet this rigid test but in any
case the check valves are overhauled and made to meet this test before the Depart-
ment's engineer leaves the premises. Our engineer has found that the smaller the
size of the check valve, the more likely it is to fail to meet this test for tightness and
that in only extremely rare instances is a check valve ever found in such a poor me-
chanical condition that it is valueless. While the above table does not mean that
twenty per cent of the check valve installations would permit contamination of the
public water supply, should conditions be right for such failure, it does show that
due to neglect the swing-type check valves did not work fast enough to meet the
requirements of the Department and further that it is necessary for each check
valve installation to be inspected regularly by an experienced man because the De-
partment relies upon the quick and complete closing of these valves in order to pro-
tect the public water supply and at the same time protect the drinking water used
by plant employees. Since 1937, when the double-check valve method of protection
came under control of this Department, there has been no known contamination of
a water supply which involved the failure of an approved check valve installation.
Reckeational Camps, Overnight Camps or Cabins and Tourist Camps
Chapter 140 of the General Laws was amended by Chapter 416 of the Acts of
1939 to require annual licensing by the local boards of health of all recreational
camps, overnight camps or cabins and trailer camps. This law specifies that the
Department shall be notified of the granting of such licenses and that the Depart-
ment shall have jurisdiction to examine the water supply and methods of sewage
disposal. Said Chapter 140 was further amended by Chapter 396 of the Acts of
1941 and Chapter 153 of the Acts of 1945. Chapter 396 provided that the owner
of the camp should be advised by registered mail relative to the examination of the
water supply and sewage disposal while Chapter 153 authorized local boards of
health to issue renewal licenses without a notice and hearing. The following table
shows the number of camps licensed annually since 1941 :
Overnight and Recreational
Year Trailer Camps Camps Total "*?
471
184
655
326
156
482
154
109
263
168
152
320
211
126
351
269
151
420
470
208
678
542
203
745
544
208
752
The effect of the war on the number of camps in operation is readily seen from the
above tabulation.
The camp licensing law has resulted in providing safe sources of water supply and
sanitary works for the disposal of sewage in connection with these camps.
Fluoridation of Water Supplies
Under the provisions of Chapter 38 of the Resolves of 1945, the Division of Sani-
tary Engineering assisted in the preparation of special legislative reports of the De-
partment of Public Health relative to the decay of teeth resulting from a lack of
fluorine (House Document 1608-1945) and a further study and report under the
provisions of Chapter 51 of the Resolves of 1946 (House Document 1786).
Fluoride determinations made by the Division of Sanitary Engineering in 1936
and 1937 failed to show fluorine present in any sample in excess of 0 . 15 of a part per
million. Further analyses were made, starting in the years 1944 and 1945, which
confirmed the earlier results, except that fluorine in the amount of 1 . 2 parts per
million was found in the water supply in Farnumsville, Grafton ; 1 . 0 part per mil-
lion in the deep well water supply of Lyonsville at Colrain ; 0 . 7 of a part per million
in the deep well at Fisherville in Grafton. Of the 368 sources of water supply ana-
lyzed, 97.5% contained 0.20 of a part per million or less of fluorides; 62.2% con-
tained 0 . 10 of a part per million or less ; and the average of all samples was 0.11 of a
part per million. The fluoride content of all public water supplies as determined in
1944-45 was published in House Document 1608-1945.
332 P.D. 34
The possibility of relationship between mottled enamel and fluoride content of
water consumed was first brought to light in 1931. Studies by public health of-
ficials have indicated that the use of water containing excessive amounts of fluorine
may result in mottled enamel. Experiments are being carried on in various states
as to the effect of the addition of fluorine to drinking water supplies for the reduction
in the number of dental caries in children. There has been considerable interest in
Massachusetts in the possibility of treating public water supplies with fluorine.
The Division of Sanitary Engineering has assisted the Dental Health Unit in
starting certain experimental treatment of two of the institutions' water supply
systems with sodium fluoride, using the third institution as a control. It is antici-
pated that this experimental treatment of water with fluorine will be carried on for
a period of two years. Because of the varying qualifications of the public water sup-
plies in the Commonwealth, the Division feels that treatment of public water sup-
plies should be undertaken only with the provision that the hydrological and me-
chanical set-ups and also the laboratory and dental control are adequate.
Radioactive Isotopes
Radioactive isotopes have become available for distribution through the Isotopes
Division of the Atomic Energy Commission and are being used for research pur-
poses at various institutions and for therapeutic purposes at several hospitals in
Massachusetts. In order to obtain radioactive isotopes for these purposes it is
necessary to satisfy the Atomic Energy Commission that the user is familiar with
their handling and use. Only very little supervision of the use of these materials is
provided by the Atomic Energy Commission. Monitoring services are available in
this State through private groups whereby the users of radioactive isotopes are ad-
vised relative to the exposure of individuals. There has been no supervision of the
use or disposal of radioactive materials by the State.
It is anticipated that the Division of Sanitary Engineering soon will make a sur-
vey of all users of radioactive materials in order to ascertain the safeguards used to
protect the workers and the public health and to determine the methods used for
the disposal of these materials. Following the survey the need of regulations will be
considered.
The Division has assisted the Division of Sanitary Engineering of Harvard Uni-
versity in a short study of the use of radioactive materials for determining the ve-
locity and quantity of water flowing in streams by variation of the so-called salt
dilution method. A similar cooperative study is now being made to determine the
rate of dispersion of radioactive iodine in ponds and sewage settling tanks. Reports
on these subjects are not available as yet.
Bathing Places
While under the Massachusetts laws the Department of Public Health has no
specific authority with regard to bathing places, it is the Department's policy upon
request from local boards of health, other public authorities, organizations, and, in
special cases, individuals to examine indoor and outdoor bathing places.
In advising relative to the construction and operation of swimming pools and
other bathing places, it is the practice of this Division to follow the recommenda-
tions of the Joint Committee on Bathing Places of the Conference of State Sani-
tary Engineers and the Engineering Section of the American Public Health Associa-
tion. In accordance with the recommendations of that committee this Division in
passing on the suitability for public bathing of any outdoor bathing water is guided
by three considerations: (1) information obtained by a sanitary survey of sources of
pollution, consideration of flow currents, etc.; (2) the results of bacteriological
analyses of the water ; and, (3) the results of chemical analyses of the water. _ Fur-
thermore, it is the policy not to approve any outdoor bathing places unless suitable
and adequate bathhouse, drinking water, and toilet facilities have been provided.
As with various other activities of this Division, the demand for the advice of this
Division with regard to the suitability of bathing places, particularly outdoor
beaches, has greatly increased, particularly in the past three years. This is shown
by the following table:
P.D. 34
333
Year
1941
1942
1943
1944
1945
1946
1947
1948
1949
Bathing
places examined
54
47
35
60
66
68
126
120
248
Of the 248 bathing places examined during the year 1949, the Department found
100 to be satisfactory; the other 148 were found to be unsatisfactory. A large pro-
portion of the unsatisfactory bathing places were determined to be such, not be-
cause of the bacteriological quality of the bathing water, but because suitable fa-
cilities had not been provided.
Wobk at Institutions
During the war years very little work was done in connection with sanitary facili-
ties at State Institutions, both because of the high price and scarcity of materials
and the scarcity of labor. The following is a summary of the work done in each of
the fiscal years since July 1, 1946:
July 1, 1946 to June 30, 1947
Lakeville State Sanatoeium
Installation of sprinkler alarm switches
Preparation of specifications for fire alarm system
Painting of inside of domestic water supply tank ) Preparation of
Painting of fire tank inside and out j specifications
North Reading State Sanatorium
Repairs and painting boiler feed tank
Preparation of specifications for centrifugal pump
Preparation of specifications for installation of Hersey detector meter on do-
mestic water supply line
Pondville Hospital
Preparation of specifications and repiping certain buildings
Improvement in refrigerating system
Painting of fire service tank
Rutland State Sanatorium
Sewer connections to the "Farm House" and bungalow
Contract let for new water storage tank and pipe line
Contract for fire alarm system
Preparation and specifications for installing water main to the farm buildings
Westfield State Sanatorium
Preparation and specifications for painting new water tank
Replacing of piping in the Girls' Building
Resurfacing of roads on institution property
Bussey Institute
Installation of oil-burning equipment
Installation of piping in laboratory equipment
July 1, 1947 to June 30, 1948
Lakeville State Sanatorium
Painting of fire and domestic water supply tanks
Preparation of new specifications for fire alarm system
334 P.D. 34
North Reading State Sanatorium
Preparation and specifications for renewal of piping in certain buildings
Purchase of Hersey meter for domestic water supply system
Rutland State Sanatorium
Completion of fire alarm system
Installation of fire alarm system
Installation of water pipe line to farm buildings and resetting of hydrants
Replacement of interior piping in attendants' building.
Pondville Hospital
Replacement of water pipe line in Cottage B
Westfield State Sanatorium
Preparation of specifications for replacements to old domestic water tank
Replacing of piping in the Girls' Building
Painting of old and new water supply tanks
Repairs to old water supply tank
Preparation of plans and specifications for improvements to sewage disposal
system from Dairy and Farm Buildings
Bussey Institute
Installation of electrical circuits oil-burning equipment
Installation of piping in laboratory equipment
Interior painting third floor
Calling for bids for outdoor incinerator
Calling for bids for installation of storeroom
Calling for bids on replacement of hot water heater and piping
July 1, 1948 to June SO, 1949
Lakeville State Sanatorium
Letting of contract for fire alarm system
Pondville Hospital
Replacement of hot and cold water piping in Cottages A, C, D, and part of
the "White House"
North Reading State Sanatorium
Replacement of hot and cold water piping in the Administration Building
and in the Nurses' Hall
Installation of Hersey water meter
Purchase of centrifugal pump
Retouching of painting on water tanks done the previous year
Survey of steam piping
Rutland State Sanatorium
Installation of water storage tank and pipe line
Installation of fire alarm system
Installation of 6-inch water main to farm buildings
Replacement of water piping in the men attendant's building
Installation of heater for new fire tank
Westfield State Sanatorium
Repairs of old domestic water tank
Preparation of plans and specifications for improvements to sewage disposal
system and installation of chlorinator
Bussey Institute
Installation of outdoor incinerator
Installation of storage room
Installation of hot water heater and piping
Preparation of designs for installation of freight elevator
P.D. 34 335
Housing
The effect of poor housing conditions upon public health has been a problem con-
fronting local and State authorities for many years. Adequate control of housing
from the viewpoint of public health requires the adoption and enforcement of regu-
lations establishing basic minimum standards for the maintenance of housing sani-
tation.
Legislation adopted under Chapter 631 of the Acts of 1947 authorized the De-
partment of Public Health to draw up regulations to establish minimum require-
ments of fitness for dwellings and also provided for the Board of Standards in the
Department of Public Safety to draw up minimum requirements for the construc-
tion, alteration, repair and use of buildings with the assistance of the Commissioner
of Public Health.
This Department adopted regulations under date of December 6, 1949. These
regulations, however, do not become effective unless they are accepted by a city or
town. Two towns have accepted these regulations at this time.
Veterans' housing and numerous sub-division developments have presented a
problem to local health authorities who in turn have requested the assistance of
this Division with regard to water supply and sewage disposal.
Fish Dehydrating Plants
This subject, ordinarily covered under offensive or noisome trades, General Laws,
Chapter 111, Section 152, has raised many questions before the Division during the
last few years largely because of the fact that fish byproducts from trash fish and
waste from edible fillets have offered a good market when converted into fish meal,
fish concentrates and. other similar products. At the beginning of the period covered
by this report, there was a fish dehydrating plant as a part of the works of LePage's
Inc., in Gloucester, two in Boston, one on the waterfront of Gloucester Harbor and
still another in North Woburn. As the market for fish products improved, two new
large dehydrating plants were constructed on the State Fish Pier in Gloucester, a
new one in New Bedford and, at the time of writing this report, one additional one
is under construction at Wareham and a second one is contemplated in New Bed-
ford. The processes consist of pressing cooked fish for the removal of certain liquid
products and for drying the solid matter, grinding it and producing fish meal for
animal feed.
Serious complaints have been made relative to the plant at LePage's, Inc., in
Gloucester, the Woburn plant and, more recently, the New Bedford plant. These
complaints and petitions required the holding of hearings under the said Section
152. Very extensive odor-control devices were installed at the North Woburn plant
and at the New Bedford plant which consist quite largely of burning the more ob-
jectionable drier gases and scrubbing with water the condensable and soluble gases
from other portions of the processes. The situation has been corrected in North
Woburn and the petition against this plant was dismissed under date of February
11, 1947. No complaints have been made relative to this plant since the petition
was dismissed. The Department is holding on the table the petition on the New
Bedford plant. The two new plants on the State Fish Pier, Gloucester, have thus
far resulted in no substantial complaint to the Department.
The aggregate capacity of the eight fish dehydrating plants in Massachusetts is
approximately 1100 tons per day. It is understood that additional plants are being
contemplated.
The experience of this Division shows that the handling of fish, especially trash
fish that is not too fresh and has not been iced, is an odor-control problem of the
greatest magnitude. At least one of the plants has solved the problem and it is
hoped that the others will shortly be under control.
The statutes on noisome trades, General Laws, Chapter 111, sections 143 through
154, are some of the oldest in the laws of this Commonwealth, the first act relative
thereto having been adopted in 1692. Many changes have, of course, been made but
the odor situation in relation to the operation of fish dehydrating plants was such
in 1948 as to result in a further amendment of the statutes by Chapter 480 of the
Acts of 1948, which provides that this Department, may advise the board of health
of a city or town previous to the assignment of a place for the exercise of a noisome
336 P.D. 34
trade and that any person aggrieved by the action of the board of health in assigning
such a location, may, within 60 days, appeal from such assignment to this Depart-
ment, following which the Department may, after a hearing, rescind, modify or
amend such an assignment.
WATER AND SEWAGE LABORATORY
During the period from January 1, 1941, to June 30, 1949, inclusive, the work of
the Water and Sewage Laboratory in the State House was devoted chiefly to the
chemical analysis and microscopical examination of samples from public water sup-
plies and rivers, while chemical analyses were made of samples collected from semi-
public water supplies, bathing beaches, municipal and institutional sewage treat-
ment plants. The following table summarizes the analytical work performed in the
State House Water and Sewage Laboratory for the above period:
1941
1942
1943
1944
*1945
1946
1947
1948
1949
Samples from public water supplies
Surface waters
1487
1539
1402
1436
-
1546
1394
961
1004
Ground waters
1275
1303
1083
1152
-
1084
1224
949
996
Special samples
Surface waters
286
257
271
259
-
351
452
390
409
Ground waters
1725
1282
737
897
-
1455
1649
1819
1002
Samples from rivers
1243
1277
1148
1082
-
1279
1672
1634
1388
Samples from sewerage systems and
sewage disposal works .
898
949
1027
924
-
1190
1119
1015
1096
Samples of wastes and effluents from
factories
80
84
64
128
—
79
282
139
116
Samples in connection with Military
Surveys . . .
1428
542
52
-
-
-
-
-
-
Miscellaneous samples (Partial
analyses) ....
979
262
318
241
-
352
74
70
Ill
Total ....
9401
7495
6102
6119
*6257
7336
7866
6977
6122
Microscopical Examinations
2208
2066
1737
1906
1825
1961
2153
1773
1791
*Not classified as to type of sample.
A considerable amount of field work was done by members of the laboratory staff,
principally in connection with problems of corrosion control which occurred in public
water supply systems.
In addition to routine work this laboratory undertook a great variety of work
often involving complex analytical procedures. Considerable work was done in re-
gard to improving the methods of analysis, especially in connection with fluorides,
phosphates, phenols, zinc, cyanides, sulfides, fats, the insecticide DDT, and ro-
denticides ANTU and 1080. Because of limited budget and laboratory space, the
routine work has been curtailed to a minimum in spite of increased demand for
laboratory services from the general public. It has been necessary to devote a
greater portion of the staff's time to research and special analytical work.
Corrosion Control
Corrosion has been one of the outstanding problems in connection with public
water supplies as the waters of this State are seemingly soft with a pH below neu-
tral. The Department has studied these problems extensively both in the labora-
tory and in the field. Advice has been given to a large number of municipalities
where corrosion problems have occurred. Optimum pH has been determined for-
mally of the public water supplies by the use of Langelier Saturation Index and
recommendations made relative to the required dosages of lime or soda ash. The
Department has made a great effort to impress on the water supply officials that
it is very important in corrosion control that the treatment be adequate and unin-
terrupted if consumer complaints are to be avoided. Inadequate dosages or periods
of no dosages at all due to breakdown or clogging of equipment or lack of chemical
will entirely nullify any beneficial efforts from the periods of adequate treatment.
P.D. 34 337
The Effects of the Use of Hexametaphosphate Compounds
on the Corrosion of Metallic Piping
The use of various polyphosphates, especially hexametaphosphate, to reduce the
corrosive properties of potable water supplies began in Massachusetts about 1941.
The effectiveness of such treatment has been studied in the laboratory both by
laboratory experiments and actual field observations since that time. The following
is a brief summary of the results of these observations to date :
Iron and Steel Pipe — The use of hexametaphosphate in connection with the cor-
rosion of iron and steel pipe to reduce "red water" trouble resulting therefrom has
been quite successful. If properly applied, threshold treatment with dosages of
0 . 5 to 2 . 0 parts per million over a long period of time has resulted in a marked re-
duction of "red water" conditions.
Copper and Brass Pipe — The use of these chemicals to inhibit corrosion of either
brass or copper piping has met with only indifferent success. We have met no in-
stances of any marked reduction in the corrosion of either brass or copper by the
use of this type of treatment. We do have some instances where no effect or even a
slightly adverse effect on the corrosiveness of the water toward copper and brass
has resulted from the treatment with this chemical.
Lead — The laboratory has carried out a large number of experiments with both
old and new lead service pipe under controlled laboratory conditions over a period
of more than a year. In addition, analyses have been made in connection with this
type of treatment where installed in municipalities that had lead service lines in use.
In general, we have found that in case of lead pipe the effect of the addition of this
chemical on the corrosiveness of the water toward lead pipe depended on the pH of
the water. Experiments carried out at pH values of about 6 . 0 indicated that there
is no increase in the corrosive properties of the water and that there are even indi-
cations of a slight decrease of such corrosiveness. With waters having a pH of 6 . 5
to 7.0 there seems to be no marked effect on the corrosion of lead. For instance,
numerous samples collected over a period of one year from certain taps in a munici-
pality using this type of treatment and having a^surface water with a pH of 6 . 5 to
6 . 8 showed no evidence of any marked change of lead content after such treatment
was undertaken. However, experiments carried out with waters having a pH of 8.0
to 8.4 showed a very marked increase in the corrosion of both old and new lead serv-
ice pipe when treatment with hexametaphosphate was undertaken. It would seem
that the use of hexametaphosphate with waters having a pH much over 7.0 may re-
sult in an increase in the corrosion of any lead service pipe which is present and an
increase in the lead content of such waters.
Additional Properties of Hexametaphosphate — In view of the fact that sodium
hexametaphosphate has the property of forming soluble complexes with insoluble
calcium salts, some question arose as to its possible effect on cement-lined or as-
bestos-cement pipe. Experiments conducted in the laboratory with two 12-inch
sections of 4-inch asbestos cement pipe showed that dosages of 10 parts per million
of this compound added to water stored in the pipe had no effect on the solvent
action of the water in the pipe. In addition, studies were made in one of our mu-
nicipalities where this compound was being added to the water at the rate of 2 parts
per million. Samples collected over a period of five months from a tap located at the
end of a 1600-foot asbestos-cement main showed no increase in the solvent action
of the water on this pipe.
Another experiment had to do with the question as to whether the presence of
hexametaphosphate in a water would interfere with the ion exchange that takes
place in zeolite treatment. It was found that in dosages up to 10 parts per million
no such interference took place but in higher dosages zeolite treatment was unsatis-
factory.
Inhibitors
The laboratory has had occasion to analyze many commercial compounds sold
for the treatment of both potable water supplies and water used in air-conditioning
systems. The large majority of these compounds were found to consist of aqueous
solutions of sodium silicate with occasional small amounts of compounds such as
338 P.D. 34
chromates, and organic materials. On the other hand, a compound composed of a
35 per cent solution of phosphoric acid together with a small amount of organic
matter has also been sold for this purpose. The use of commercial inhibitors in con-
nection with potable water supplies should be avoided.
The Use of Anti-Freeze Materials in Water Supply Lines
Recent developments in the use of such devices as hot water and steam lines em-
bedded in sidewalks and roads for thawing during freezing weather have resulted in
the use of various anti-freeze materials introduced into water lines which in many
instances are cross-connected with potable water supplies. Requests for advice as
to suitable compounds for use in such instances led to a study of the problem and a
survey of the field of anti-freeze materials.
It was found that there were over 230 brands of anti-freeze compounds on the
market. These generally fall into one of the following categories:
1. Alcohols — The alcohols commonly used as bases for anti-freeze are methanol,
ethanol, isopropanol, and mixtures of these.
2. Glycols — Ethylene glycol and propylene glycol are widely used. Diethylene
glycol also has been used.
3. Salt-Base — Calcium, magnesium, and sodium chlorides are most commonly
used.
4. Petroleum Base Compounds — Highly refined petroleum fractions containing
no aromatics or olefins. Oils and kerosene also have been used.
5. Miscellaneous Substances — Monoethanolamine chloride or other suitable salt
of an aliphatic amino base and a strong acid have been used. Honey, sugars, gly-
cerine, trimethylene glycol and diacetone alcohol also have been used.
In addition to the anti-freeze material there are frequently present in the anti-
freeze compounds an inhibitor to prevent corrosion as well as other miscellaneous
compounds.
A number of these anti-freeze compounds were analyzed in the laboratory. It
would appear from these data as well as the data mentioned above that the large
majority of anti-freeze compounds available at the present time are entirely un-
suitable for use where cross-connections with a potable water supply may exist.
Some of the materials such as methanol, denatured ethanol and ethylene glycol are
undesirable because of their toxicity. Other compounds in themselves not harmful
such as calcium chloride, contain added ingredients in the form of corrosion in-
hibitors which are quite toxic in character — for instance, chromates.
Corrosion of Lead Pipe
As a result of a complaint of possible lead poisoning due to the consumption of
the water of a municipal supply drawn through a long, lead service pipe, a study was
made of the corrosion of lead in one of the municipalities having several small ponds
as sources of water supply. In this particular municipality lead pipe had been regu-
larly used for service lines up to 1934 or 1935 although since that time no lead has
been used for service lines. There are three reservoirs which feed various sections
of the town and samples from unusually long, lead service lines on each of these
reservoirs were collected for analysis.
It was found that several samples, both running and standing, collected from
services supplied by one such reservoir gave amounts of lead far in excess of those
specified by the U. S. Public Health Service. Samples collected from the other two
gave quantities less than those indicated by the U. S. Public Health Service. Chem-
ical analyses of the three waters are as follows :
Color
Chlorides
Hardness
Alkalinity
pH
(Parts per Million)
Pond A
(High lead results)
23
4.3
22
18
6.8
PondB
(Low lead results)
20
4.5
26
25
6.8
PondC
(Low lead results)
15
3.9
15
14
6.6
P.D. 34 339
There is little difference in the corrosive properties of these waters as indicated
by chemical analysis to account for the difference in the corrosiveness of these three
waters toward lead pipe.
Effect of High Chlorine Residuals on the Corrosion of Lead Pipe
In connection with certain studies on the desirability of using high chlorine resi-
duals to reduce gas-forming bacteria in a large surface water supply, the laboratory
was requested to carry out experiments on the effects of water carrying high chlorine
residuals as high as 10 to 15 parts per million on the corrosion of lead pipe.
It was decided to study these effects by measuring the solubility of metallic lead
and certain lead salts in water carrying these high residuals. The experiments were
carried out using a surface water and determining the solubility of lead filings, lead
carbonate, lead sulphate and the incrustant material removed from an old lead serv-
ice and composed of lead carbonates, sulphates, small amounts of iron hydroxide
and organic matter.
From experiments carried out in previous years on the effect of small dosages of
chlorine on the corrosion of lead pipe, it was felt that the pH of the chlorinated water
was of prime importance in determining the corrosiveness of the water with respect
to lead pipe.
Where chlorine is added to the water in the form of calcium hypochlorite there is
an increase in the pH due to an increase in the hydroxyl ions, but when gaseous
chlorine is used there will be a decrease in the pH due to the formation of small
amounts of hydrochloric acid by hydrolysis of the chlorine.
The variations in pH are illustrated by the following experiment using Metro-
politan water:
Using Chlorine Gas Using High Test Hypochlorite
Chlorine Chlorine
Residual Residual
(Parts per Million) pH (Parts per Million) pH
0
6.6
0
6.6
15
4.1
15
7.3
25
3.6
25
8.0
The effect of chlorinated water on the solubility of lead and lead salts, using both
waters treated with chlorine gas and with calcium hypochlorite and a contact period
of 30 minutes is as follows :
Lead Content After 30 Minutes' Contact
With Chlorine Residual of-
0 p.p.m. 15 p. p.m.
Using CI
Gas
15 p.p.m.
Using HTH
pH = 6.6
pH = 4 . 1
pH = 7.5
Lead metal (filings) .
Lead sulphate .
Lead carbonate
Lead lining from old lead
pipe
.60
2.9
1.05
1.8
15.5
23.5
16.0
19.0
.65
2.9
.80
1.6
In addition, the following tables give the results obtained where the contact period
was 24 hours :
340 P.D. 34
Using Chlorine Gas
Lead Content After 2^ Hours' Contact with Water
With Chlorine Residual of
0 p.p.m.
10 p.p.m.
15
p.p.
m.
pH = 6.6
pH = 5.7
pH
= 4
.1
Lead metal (filings) . . 5.0 8.0 23.5
Lead sulphate . . . 13.5 18.0 28.5
Lead carbonate . . 1.7 7.5 15.5
Lead lining from old lead pipe - 16.0 21.0
Using High Test Hypochlorite
pH = 6.6 pH = 7.0 pH = 7 . 5
Lead metal (filings) . 5.0 6.0 6.5
Lead sulphate . . . 13.5 10.0 9.0
Lead carbonate . . 1.7 1.5 1.2
Lead lining from old lead pipe - 3.5 4.
From these data it is evident that the solvent action of water carrying a high resi-
dual free chlorine content is dependent on the pH of such a water. Where chlorine
gas has been used the small amount of hydrochloric acid formed has a solvent action
on both metallic lead and lead salts, especially the carbonates, and waters so treated
will therefore be more corrosive to both new and old lead pipes. Where hypochlor-
ites are used and there is no marked change in the pH, the solvent action of waters so
treated is not markedly affected.
Corrosion of Aluminum
From time to time the Department has investigated complaints of corrosion of
aluminum- ware attributed to the use of the public water supply. It has been found
that most of these complaints have to do with the pitting of aluminum utensils in
which water is allowed to stand for a considerable period of time as, for instance,
aluminum pans filled with water and placed on a radiator for purposes of humidifica-
tion. This type of corrosion is ordinarily to be attributed to galvanic action, the
corrosion of the aluminum being due to the presence in the metal of minute amounts
of other metals as impurities. Particles of these metals set up minute electrolytic
cells with the aluminum, and corrosion takes place. In general, waters in the pH
range from 6.5 to 7.0, which constitute a majority of the waters in Massachusetts,
are not apt to cause corrosion of aluminum utensils under ordinary conditions of use.
Experiments on Iron and Manganese Removal
Experiments were carried out on a ground water supply for the removal of iron and
manganese by chlorination, followed by the addition of lime or soda ash to raise the
pH, and subsequent filtration. Coagulation was by mechanical stirring at either 60
or 90 r.p.m. The following tables summarize the results of these experiments:
Effect of the Addition of Soda Ash
Total
Solids
(p.p.m.)
pH
Alkalinity
Hardness Iron
Manganese
Phenol-
phthalein
Total
Chlorine
Demand
(Part:
5 per Million)
Well Raw Water
Test No. 1 .
100 p.p.m.
60 r.p.m.
Test No. 5
225 p.p.m.
60 r.p.m.
112
212
330
6.0
9.4
10.1
20
80
22
110
228
35 1.0
33 .52
.62
.70
.46
.36
1.23
P.D. 34 341
Effect of the Addition of Hydrated Lime
Well Raw Water
112
6.0
Test No. 2
128
9.4
35 p. p.m.
60 r.p.m.
Test No. 8 .
140
10.2
55 p. p.m.
90 r.p.m.
22 35 1.0 .70 1.23
55 61 .53 .46
80 - .12 .08
These data would indicate that the most effective removal of iron and manganese
by this method of treatment can be obtained by chlorination, the addition of lime
to a rather high pH, followed by flocculation, sedimentation and filtration.
Phosphorus in Surface Water
Considerable data have been accumulated to show that phosphorus is one of the
chief elements in determining the extent of biological activity in surface waters.
Occurrence of excessive microscopic growths is limited by the phosphorus content
of the water. Ponds having quantities of phosphorus and nitrogen in excess of cer-
tain minimum values are far more likely to have frequent occurrences of excessive
microscopic growths and consequent difficulties with odors and tastes. For this
reason the laboratory has undertaken to determine the phosphorus content of the
various surface waters used for public water supplies.
It has been found that in general it can be expected that excessive growths of
microscopic organisms will take place when the inorganic phosphorus content ex-
ceeds 0.01 of a part per million. Several hundred such determinations made thus
far show that all of our public water supply sources so far examined have a phos-
phorus content less than this critical amount. However, some ponds not used for
public water supply and having difficulty with excessive microscopic growths were
found to have amounts of phosphorus in excess of this amount.
Use of Marble Chips in Treatment of Acid Wastes
The laboratory has carried out considerable experimental work on the neutraliza-
tion of acid wastes by flow through beds of marble chips. Both downflow and up-
flow types of treatment were tried. The following table summarizes the results of
treatment of various wastes with the downflow type of bed :
Neutralization of Acid Wastes by Downflow Through Bed of Marble Chips
(3-5 mm.)
Acidity after 5 pH after 5
Initial Acidity minutes' contact minutes' contact
4,100 240 4.0
1,720 100 3.8
1,500 70alk. 5.6
400 42alk. 5.7
340 39alk. 5.7
250 52alk. 5.8
150 40alk. 6.2
70 30alk. 6.3
45 36alk. 6.4
_ Using the upward flow type of treatment bed, it was found that effective reduc-
tion of the acid content could be obtained with certain size marble chips and at cer-
tain rates of flow. The reduction in acidity also was found to vary with the depth
of the bed of marble chips. This table gives data on the change in pH and acidity
of an acid waste with different depths of marble chips. The following table illus-
trates the effects of variation in the rate of upward flow:
Acidity of
Effluent
pHof
Effluent
2,800
700
1.8
2.0
500
2.2
300
2.35
170
2.5
78
2.8
24
3.45
2
4.1
342 P.D. 34
Depth of Marble Chip Bed
(in feet) size 1.5-3.0 (mms)
0
1
2
3
4
5
6
7
The rate of upward flow and acidity of effluent are shown in the following table :
Rate of Upward Flow Acidity of
gal. per sq. ft. per min. Effluent
60. 245.*
36.6 182.
20. 41.
10. 0.
The effect of variation in the size of the marble chips, using the same rate of flow,
is shown below:
Size of Marble Chips Acidity of pH of
(mms.) Effluent Effluent
0 5-2 0 212** 2.4
1.5-3.0 310** 2.3
^Initial Acidity 516
**Initial Acidity 590; initial pH 2.0
Treatment of Fish Stick Water
A question arose as to the relative effectiveness of two methods of processing
"stick water" obtained at fish-processing plants. The process as ordinarily carried
out at local plants consists of passing the liquid through a 90-mesh shaker screen,
settling in a tank for about 23^ hours and then skimming off the oil. The remaining
liquid then goes to evaporators where it is evaporated to 50 per cent solids content.
A newer method consists of more mechanical equipment including screens, de-
canters and centrifuges. It was claimed that this latter method resulted in a more
efficient removal of suspended solids and therefore a reduction in possible carry-
over during subsequent evaporations and a consequent improvement in the quality
of the condensing water.
A comparison of the two methods of treatment was carried out on a laboratory
scale using a sample of untreated "stick water" freshly obtained from a local plant.
Portions of the sample were screened through an 80-mesh screen, allowed to settle
for one hour and 2}/2 hours, the oil skimmed off, and then analyzed. Two other por-
tions were similarly treated except that at the end of the settling period the material
after skimming off the oil was centrifuged for 15 minutes at 2,000 r.p.m. The fol-
lowing is a summary of the data obtained:
P.D. 34
343
"Stick Water"
Solids
(Parts per Million)
Aibuminoid Ammonia
B.O.D.
o
3
03
ai
O
a
(Parts per Million)
Untreated
After screening and settling one hour
After screening and settling 2}4 hours
After screening, settling one hour,
followed by centrifuging for 15
minutes .....
After screening, settling 2V2 hours,
followed by centrifuging for 15
minutes .....
Total
Volatile
Fixed
Total
Volatile
Fixed
Total
Volatile
Fixed
Total
Volatile
Fixed
.Total
Volatile
Fixed
69,200
51,700
17,500
_
2,600
2,300
300
41,000
56,900
40,000
16,900
-
12,300
11,700
600
57,800
51,700
6,100
65.1
45,500
40,000
5,500
67.4
12,300
11,700
600
-
55,600
51,000
4,600
73.7
43,400
39,400
4,000
76.3
12,200
11,600
600
—
51,400
49,900
1,500
91.4
39,700
38,600
1,100
93.5
11,700
11,300
400
-
50,600
49,700
900
94.9
38,700
38,200
500
97.1
11,900
11,500
400
"
25,600
Treatment of Combined Municipal and Industrial Wastes
The laboratory has carried out certain experiments in connection with the pro-
posed sewage treatment plant in one of the towns of the State. It was expected that
the sewage here would be difficult to treat due to the presence of relatively large
volumes of alkaline paper wastes. For instance, a sample of the sewage composited
according to the expected flows had a pH of 12.4, a B.O.D. of 1,150 ppm and a sus-
pended solids content of 713 ppm. Samples of the wastes from the various indus-
tries in the town, which were to be discharged to the sewage treatment plant, were
collected and a composite sample representing the sewage was prepared by mixing
industrial waste and domestic sewage in proportions based on flow figures.
In the proposed plant there were plans to use the carbon dioxide gas present in the
flue gases for the purpose of reducing the pH of the sewage. Samples of the com-
posite sewage were treated with carbon dioxide gas to reduce the pH to about 9.0,
8.5, 8.0, 7.5, and 7.0. The amount of carbon dioxide gas was measured and, after
the pH had been adjusted, the sample was flocculated for 30 minutes and then
samples were collected at the end of the following sedimentation periods : 3, 4, 6, 8,
and 10 minutes.
The proposed plans also contemplated the use of ferric salts, preferably ferric sul-
phate. Preliminary experiments with various dosages of this chemical were not
very encouraging. Other experiments were then carried out involving the addition
of a mineral acid to further reduce the pH.
In addition to these forms of chemical treatment which were those contemplated
in the plans drawn up for the sewage treatment plant, the laboratory tried out
briefly the use of other chemicals; namely, calcium hydroxide, calcium chloride,
ferrous sulphate, and alum, to reduce especially the B.O.D. of the composite sewage.
It was found that none of these chemicals in reasonable dosage would give a satis-
factory reduction. The best results as far as B.O.D. reduction went were obtained
by lowering the pH of the sewage to 4.0 or less by the use of mineral acid and allow-
ing a sedimentation period after flocculation of at least 30 minutes. Under these
conditions, a B.O.D. reduction of about 40 per cent was obtained.
Treatment of Wool Scouring Wastes
The laboratory undertook a series of experiments on methods of treatment of
wool scouring wastes. These wastes are characterized by a high B.O.D. content
(7,000 ppm in a recent sample), a high grease content (average 4,500 to 5,000 ppm),
large amounts of suspended solids (average about 6,000 ppm) and are usually quite
alkaline (pH 10.0-12.0). Satisfactory treatment requires a marked reduction of all
these ingredients. Having in mind a treatment process involving the use of calcium
hypochlorite which has been carried out on similar wastes in certain mills, these ex-
periments were intended to compare that method with other possible methods of
treatment.
344
P.D. 34
Using Calcium Hypochlorite
Using calcium hypochlorite, it was found that quantities up to 2,500 ppm fol-
lowed by one hour's settling had only a slight effect on the wastes. Using 5,000 ppm
there was a marked separation with a clear liquid on the bottom of the cylinder and
scum on the surface about two inches thick. The original B.O.D. of the waste used
was 1,900 ppm; with 2,500 ppm of calcium hypochlorite the residual chlorine of the
clear liquid was 97.5 ppm and the B.O.D. of the clear liquid was 1,900 ppm; with
5,000 ppm of calcium hypochlorite the residual chlorine was 452 ppm and the
B.O.D. of the clear liquid was somewhat over 800 ppm. Samples treated with
quantities up to 50,000 ppm all gave similar separation of grease which floated on
the surface and underlying this was a clear straw-colored liquid. Samples of waste,
which had been treated at the mill with calcium hypochlorite in the process men-,
tioned above and which have been analyzed in the laboratory in recent years, have
in general given similar results ; that is, the clear effluent has been very low in sus-
pended solids and grease content but has a B.O.D. of about 800 ppm.
Using Calcium Chloride
Experiments were run with calcium chloride in dosages up to 30,000 ppm. All
dosages over 2,500 ppm resulted in a marked separation of the grease and a clear
supernatant liquor. The following table gives the data on the results of samples
treated with various amounts of calcium chloride :
Table Showing the Effect of the Addition of Calcium Chloride to Wool Scouring Wastes
Analysis of Effluent after 2 Hours' Settling
Sus. Solids
Fats
B. O. D.
Vol. of Sludge
Calcium
a
ft
ft
£ >
8 o
S
a
a
s >
B
a
a
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1 ° O
Chloride
Added
P. P.M.
I
PhPh
3 g
X 100
Total Volume
Remarks
0
5,900
_
4,500
_
4,900
_
_
2,500
400
93.
"
~
1,900
_
33.
supernatant liquid
somewhat turbid
5,000
115
98.
320
93.
1,230
75.
51.
supernatant
fairly clear
10,000
-
-
-
-
850
83.
57.
supernatant clear
20,000
-
-
-
-
-
-
53.
supernatant clear
30,000
14
99.8
63
98.5
750
85.
43.
supernatant clear
50,000
"
"
'
"
-
—
32.
—
In addition, the following chemicals were tried: sodium hypochlorite, calcium
hydroxide, and calcium hydroxide, followed by the addition of carbon dioxide. These
experiments indicate that satisfactory removal of fats and suspended solids and
marked reduction of B.O.D. content can be obtained using proper dosages of cal-
cium hypochlorite, calcium chloride or calcium hydroxide. The results obtained
with calcium chloride are in general about as good as those obtained with similar
dosages of calcium hypochlorite, with the exception that the B.O.D. of the effluent
is somewhat higher, the difference in B.O.D. of course being due to oxidation by the
large amounts of chlorine in the hypochlorite. Calcium chloride treatment has the
advantage in that the sludge carrying the fats is precipitated to the bottom of the
tank, whereas with calcium hypochlorite the sludge rises as a scum to the surface
and a portion tends to settle to the bottom. Calcium chloride is of course consider-
ably cheaper to use than calcium hypochlorite. Calcium hydroxide also can be used
but only in very large dosages. Where the effluent from this treatment process is
to be subsequently treated by biological filtration processes it would seem that the
treatment with calcium chloride is by far the preferable method because the ef-
fluent contains no bactericidal substances such as free chlorine or caustic alkalinity
which must be neutralized before biological treatment. Dilution of the waste with
water before treatment with calcium chloride seems to help in rapid settling of the
sludge. Quantities of calcium chloride in excess of 2,500 ppm can be used possibly
with aeration of the treated waste before settling. The settled waste will then be
quite satisfactory for use on any biological filter.
P.D. 34 345
Treatment of Cyanide Wastes
The laboratory has carried on experiments on the treatment of cj^anide wastes
by chlorination for some time and the data obtained agree in general with the vo-
luminous literature since published on the subject. The following practical applica-
tions of this method are illustrative of the results which can be obtained and prac-
ticed.
Three samples of plating wastes, namely, a sample of nickel-plating waste, silver-
plating waste, and plating wastes from the findings department, were used in these
experiments. The original cyanide content of these wastes was found to be as fol-
lows:
Waste Sodium Cyanide Content
(Parts per million)
Nickel-plating 3,800
Silver-plating 11,260
Findings department . . , . 20,520
It was found that satisfactory reductions of the cyanide content of such wastes
should be obtained by the use of sodium hypochlorite solution. The following table
indicates the amounts of commercial sodium hypochlorite solution required for this
purpose :
Amount of Commercial Sodium
Waste Hypochlorite Solution Required
(Gallons per gallon of cyanide waste)
Nickel-plating .08
Silver-plating . . . . • '. • . .25
Findings department ...... .40
With sodium cyanide concentrations of 4,000 parts per million or less, the treat-
ment process consists merely of adding the correct volume of hypochlorite to the
original vat, stirring for about 15 minutes to one-half hour, and then disposing of
the wastes. The cyanide concentration of the treated waste is negligible. With
sodium cyanide concentrations of over 4,000 parts per million, treatment with sodi-
um hypochlorite results in a marked increase in temperature and the evolution of a
certain amount of gases such as ammonia and carbon dioxide. Such wastes which
in addition require larger volumes of hypochlorite solution should preferably be
treated not in the original vat but drained into a separate tank located in a well-
ventilated space. The contact period, however, is about the same, one-half hour.
The use of bleaching powder in place of sodium hypochlorite is unsatisfactory, but
a combination of bleaching powder and caustic soda can be used.
Effect of Storage on Distillery Wastes
In connection with the study of the treatment of wastes at a large distillery in one
of the cities of the State, the question arose as to the effect of 48 to 72 hours' storage
of the waste materials, consisting of thick slops, thin slop and syrup, on the quality
of these substances to be used as feed materials. Half-gallon, glass-stoppered bottles
partly filled with samples of these wastes were kept in the laboratory at room tem-
perature of about 75 °F. The samples were tested daily to determine any change in
the odor of the material or the change in pH. The following table summarizes the
results :
346
P.D. 34
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P.D. 34
347
Treatment of Tannery Wastes
A. Removal of Sulfides from Tannery Wastes: — Experiments were carried out on
the effectiveness of various iron salts including ferrous and ferric sulfate and ferric
chloride in removing soluble sulfides from dilute and concentrated tannery wastes.
In using ferric chloride on dilute sulfide wastes (265 parts per million of sulfides as
hydrogen sulfide) and concentrated wastes (2,000 parts per million hydrogen sul-
fide) it was found that the amount of soluble sulfides removed was approximately
proportional to the amount of ferric chloride added. For complete removal of the
sulfides an amount of iron salts about 10 per cent in excess of the theoretical must
be added. In the laboratory, satisfactory sedimentation, when using this dosage,
was obtained in less than one hour. Likewise, using ferrous sulfate, it was found
that a dosage similar to that of ferric chloride gave satisfactory removal of the sol-
uble sulfides.
B. Experiments on the Treatment of a Municipal Sewage and Tannery Wastes: —
In connection with studies of a proposed municipal treatment plant, experiments
were carried out to determine the effect of the addition of certain quantities of tan-
nery wastes to the municipal sewage.
Experiments also were carried out on effects of plain sedimentation of this mu-
nicipal sewage and on mixtures of this sewage with various amounts of the wastes
from the tannery. The proportions of sewage to waste used were those indicated by
the rates of flow determined on the day the samples were collected. Experiments
also were carried out on the treatment of composite wastes from the tannery by
plain sedimentation and by chemical treatment followed by sedimentation. The
chemicals used included alum, ferric sulfate, carbon dioxide gas, mineral acid, ferrous
sulfate, and ferric chloride. The results obtained from the use of the latter two are
not reported since they were quite similar to those obtained with the other coagu-
lants. The data obtained are summarized in the following tables:
Results of Treatment of Municipal Sewage and Tannery Wastes
Period of
Sedimentation
Table No. 1 — Municipal Sewage
Suspended Solids B.O.D.
(Hours)
p.p.m.
Per Cent
Removal
p.p.m.
Per Cent
Removal
pH
Municipal Sewage — Treatment: Plain Sedimentation
0 244 - 200
1 64 74 106
2 40 84 92
47
54
6.7
Municipal Sewage + Tannery Wastes. — Treatment: Plain Sedimentation
(Combined in the proportions 1.6 m.g.d. : 314,000 g/d)
0 330 - 250
1 137 58.5 165 33.
2 92 72. 155 37.5
9.2
Municipal Sewage + Tannery Wastes. — Treatment: Plain Sedimentation
(Combined in the proportions 3.4 m.g.d. : 314,000 g/d)
0 301 - 210 - 8.6
1 121 60. 115 45
2 88 71. 110 48
348 P.D. 34
Results of Treatment of Municipal Sewage and Tannery Wastes
Table No. 2 — Tannery Wastes
Period of
Sedimentation
Suspended Solids
B.O.D.
(Hours)
p. p.m.
Per Cent
Ptemoval
p.p.m.
Per Cent
Removal
pH
Treatment:
0
1
2
Treatment:
0
1
2
Treatment:
0
1
2
Treatment:
0
1
2
Treatment:
0
1
2
Treatment:
0
1
2
Plain Sedimentation
750
288
190
62
75
540
370
300
11.7
31.5
45.
Addition of Alum (100 p.p.m.) followed by Sedimentation
750 - 540 - 11.4
270 64 240 55
260 65 230 57
Addition of Ferric Sulphate (300 p.p.m.) followed by Sedimentation
750
48
46
93.6
93.9
540
200
180
Addition of COi followed by Sedimentation
750 -* 540
363 52* 295
172 77* 285
63
66.5
45
47
Addition of H2SOt (900 p.p.m.) followed by Sedimentation
750 - 540
172 77 280 48
170 77 270 50
Addition of H2S04 (1000 p.p.m.) followed by Sedimentation
750 - 540
18 97.6 250 54
15 98.0 250 54
10.8
8.1
6.1
4.5
*A large proportion of the suspended solids consisted of a fine precipitate of calcium carbonate.
Miscellaneous Research
In addition, the laboratory engaged in many activities. For instance, a good deal
of time was devoted by the laboratory force to investigations of complaints of of-
fensive odors emanating from industrial operations, pollution of streams, dumps,
and other sources. Interesting work has been carried on in recent years on the
chemical treatment of aquatic plants. Successful results have been obtained on the
treatment of Lemna and Elodea with certain esters of 2, 4-D. During the war, es-
pecially, work was done on the use of replacement oil instead of linseed oil in paint
formulas for red lead paint for painting the interior of stand pipes. It appeared that
such paints, while inferior in lasting quality, were satisfactory for the purpose.
Experiments were carried out on a smaller scale on paper and many other types of
industrial waste.
THE LAWRENCE EXPERIMENT STATION
During the nine-year period, 1941-1949, the research work of the Experiment
Station in connection with the filtration and other purification of water and the dis-
posal of domestic sewage has steadily expanded : meanwhile the participation of the
Station in the engineering work of the Division, beginning in the early war years
has very greatly increased, and in the past year and a half a sanitary engineer has
P.D. 34
349
been assigned as a member of the staff at Lawrence. This work involves not only
the collection of samples but assistance and instruction to operators of water and
sewage plants in both laboratory and engineering fields in general and in specific
problems and difficulties, the supervision of shellfish treatment plants, and par-
ticularly the construction and operation of experimental treatment plants which
were in most cases adaptation of experimental work at the Station. A great deal of
the work has been in latter years in connection with stream pollution and the treat-
ment or disposal of industrial wastes.
The following table summarizes the samples examined at the Station during the
period :
1941
1942
1943
1944
1945 1946
1947
1948 1949
Total
Chemical samples in connection
with the investigation of the dis-
posal of domestic sewage, filtra-
tion of water and of rivers and
bathing places
2,120
2,186
2,740
2,584
3,344
3,232
3,208
3,023
3,799
26,236
Chemical samples in connection
with the investigation of indus-
trial wastes ....
196
329
145
223
217
381
390
645
817
3,343
Chemical and mechanical samples
of sand and other filtering ma-
terials .....
249
386
183
106
260
225
281
164
325
2,179
Total Chemical
2,565
2,901
3,068
2,913
3,821
3,838
3,879
3,832
4,941
31,758
Bacterial samples in connection
with water supplies, bathing
places, stream pollution, and all
other regular work of the De-
partment ....
19,526
16,783
17,010
17,542
13,600
14,416
15,583
15,588
16,156
146,204
Bacterial samples in connection
with military camps and adja-
cent areas ....
1,379
1,274
471
182
30
-
-
-
• -
3,336
Bacterial shellfish samples
768
768
723
1,111
963
687
1,200
577
913
7,710
Total Bacterial
21,673
18,825
18,204
18,835
14,593
15,103
16,783
16,165
17,069
157,250
Grand Total
24,238
21,726
21,272
21,748
18,414
18,941
20,662
19,997
22,010
189,008
The collection and examination of samples in or near military areas was only part
of the cooperation given the Armed Forces during the war years; in addition to these
analyses much other assistance was given in the form of loans of apparatus and sup-
plies, participation in water and sewage problems, and particularly work on certain
industrial waste problems.
In connection with public water supplies, work involving more than collection and
analysis of samples has been carried on in cooperation with fifty-two water depart-
ments and the Metropolitan Water Supply. This work has included especially as-
sistance in filtration and coagulation problems, chlorination and other disinfection,
colors, odors and tastes, cooperation in laboratory control work, including the train-
ing of personnel and the installation of new or enlarged laboratories, control of cor-
rosion and especially assistance in regard to new and emergency supplies. The Sta-
tion also has taken an active part in the expanding stream pollution program and
the stream classification work in connection with the New England Interstate
Water Pollution Control Commission. There has also been a large amount of work
on private and semi-private supplies and on bathing beaches and swimming pools.
In field work in connection with the disposal of sewage, the results of the general
research work of the Station have been applied to the usual problems of sewage
treatment and in addition in many cases specific investigations have been conducted
both at Lawrence and in the community under study. Many of the older treatment
plants have been given assistance in operation and in laboratory control and in
special problems, especially those relative to sedimentation and filtration of sewage
and digestion of sludge. In most of the newer plants, the plans have been largely
influenced by the work of the Station, and in every case plans submitted have been
examined in light of our previous experimental work, and in several cases additional
specific work has been done, frequently resulting in modification of quantities or of
350 P.D. 34
procedure. Analyses of filtering material and especially assistance in furnishing
specifications for such material have been given, not only for municipal and large
private plants, but very frequently for home disposal areas especially in housing de-
velopments.
Shellfish Reseakch
In the field of shellfish sanitation, the Station has continued through the entire
period to exercise supervision over the Newburyport Shellfish Treatment Plant by
means of frequent visits, check bacterial examinations and other obsez'vations as
well as assembling and averaging records of plant operation. Throughout the period
experiments have been carried on for improvement of the cleansing process, and be-
ginning in 1947 very intensive studies were made as part of the shellfish investiga-
tion which resulted in the Reports of the Special Commission from 1947 on and plans
drawn up from time to time as a result of that work.
In 1943 it seemed possible that a certain type of disease known as mussel poisoning
which had been prevalent on the Pacific coast and in Europe for many years had ap-
peared among the shellfish on the eastern coast, and this threat seemed so serious
that the U. S. Public Health Service had forbidden the taking of any shellfish. To
investigate the possibilities of this infection the Experiment Station, together with
the Biological Laboratories, investigated the shellfish from every area in Massa-
chusetts and also performed a very considerable amount of similar work on samples
from adjacent states. As a result of these investigations it was shown that the pos-
sibility of danger from mussel poisoning was extremely slight.
Ever since 1904 research in methods of analysis and preparation of shellfish for
analysis have been studied at the Station. As a result of the report of the *APHA
Shellfish Committees in 1941 and later and the adoption of the maceration methods
suggested by that Committee, the Experiment Station began an intensive study of
such methods; it was shown that maceration methods were far from being stand-
ardized and that the correlation with the older method of scoring of shell liquor
was extremely poor. Correspondence with the U. S. Public Health Service and the
representatives of other states led eventually to a very complete study in which
the Station participated, not only on methods of preparation and of analyses but in
regard to the relatively low importance of shellfish analysis as compared to sanitary
surveys of areas and bacterial analyses of overlying waters. The U. S. Public
Health Service at that time proposed that a maximum MPN of 230 should be set
for all shellfish, and the investigations of the Experiment Station showed that this
would practically prohibit the digging of any clams from Massachusetts beds.
Further negotiations with the U. S. Public Health Service resulted in an immediate
modification of the proposed standards with the eventual result that no final
mathematical limit was set but that the responsibility for proper sanitary values of
shellfish was continued with the individual states. In 1944 the work was incorpo-
rated in an extensive report which covered the items named above and included
important epidemiological studies by the Department biologists and observations
on the sanitary surveys and their significance by the engineers of the Division. In
the meanwhile the Station has participated in the work of many national commit-
tees studying shellfish problems and has been given representation on the Commit-
tee of Shellfish Consultants of the TJ. S. Public Health Service.
Beginning in 1946 consideration was given to the possible role of aquatic birds
in the contamination of shellfish. As a result, cooperative studies were begun with
the U. S. Public Health Service and the Federal Fish and Wildlife Service on this
problem.
During this period investigations were made of the sterilizing effect of cooking
on various types of shellfish, both in the home and in commercial establishments.
It was definitely established that many methods of cooking did not completely
sterilize shellfish.
In 1949 investigation was made in a field closely allied to shellfish, that is in
the sanitary quality of crab meat and lobster meat. Experiments showed that if
these meats were prepared as a result of proper cooking complete sterility would
result but that many commercial practices fall far short of this result.
♦American Public Health Association
P.D. 34 351
Water Bacteriology Research
In the field of research in water bacteriology, the State has made many investi-
gations in the past 9 years. Throughout this period, studies have been made on
the performance of many discriminatory media, proposed by others or developed by
the Station for the purpose of differentiating various members of the coliform group
bacteria. Several times it has been reported that in general most discriminatory
media either tend to reduce the numbers of coliform bacteria found or fail to give
the proper differentiation. In the study of the ordinary Imvic reactions, many con-
tinuous studies have shown that temperature of 30 °C. rather than the old standard
37 °C. gives much more satisfactory results. The 9th Edition of Standard Methods
set up confirmation on Brilliant Green Bile medium as a practical equivalent of the
normal completed test and many thousands of cultures have been examined at the
Station by means of the two methods ; the general results indicate sharp differences
between the two proposed methods, especially in that many organisms which pro-
perly should not be considered as coliform bacteria with sanitary significance may
be so reported if BGB is the only criterion, and further that many false fermenters
may be reported as significant organisms.
Another important step in regard to false fermentation showed that these were
occurring practically throughout the entire State but were particularly prevalent
in the Metropolitan water supply. Study of thousands of cultures eventually led
to the discovery that in a great measure this fermentation was due to the symbiotic
action in which one or more organisms reduced the lactose of the standard culture
tube to dextrose and that other organisms were then able to produce gas in the
dextrose thus formed. Those organisms were found to be particularly resistant to
chlorine. The general conclusion to be drawn from the study was that the occur-
rence of these organisms apparently had no sanitary significance. During the war,
in connection with civilian defense it seemed wise to make arrangements for emer-
gency control and examination of public water supplies both in connection with
possible contamination by war gases and in connection with possible breakdowns of
pumps, power lines and other facilities. A method of emergency bacterial examina-
tion was developed and taught to 200 men and women participating in civilian de-
fence. A valuable by-product of these courses of instruction was the training of
many volunteer assistants who were at least able to collect proper representative
samples in case of emergency.
From time to time the Station has conducted investigations into bacteriostatic
and bactericidal agents not only of standard disinfectants prepared for the purpose,
but of many other chemicals which are not primarily intended for action on bac-
teria. These works included an extensive study on the bacterial effects of DDT
which might be sprayed into reservoirs and public streams which might be used for
public water supply and included also the effect of these chemicals on odors and
tastes. It was found in general that DDT in the quantities commonly used had no
significant effect on the bacterial content of water supplies and that in general
neither odors nor tastes on a significant level were caused. Another interesting study
was on the possible effect of the 2-4D weed killers developed for the purpose of re-
straining or killing broad leaf weeds; it was shown that if any reasonable concen-
tration was used in or around sand filters that the weed killers had no deleterious
effect on the biological action of the filter.
During the early part of the war the Station was asked to study Halazone tablets
which were composed of a chlorine-bearing substance dispensed in such a size as to
give adequate disinfection to a canteen of water and expected to be applied by the
members of the armed forces in the field. Our investigation showed that the tablets
were far from uniform in size and in chlorine content and that they were very dif-
ficult to dissolve. Furthermore, even when complete solution had been obtained,
the available chlorine was not sufficient to disinfect satisfactorily water containing
any considerable amount of organic matter.
The bacterial laboratory of the Experiment Station has carried on a very consider-
able amount of work in connection with the new Stream Pollution Programs and has
been particularly valuable in preparing material for stream classification. Part of
this work at least had been directly connected with the incidental effect of many
industrial wastes on the bacterial content of water.
352 P.D. 34
The Station has participated in an intensive study on degradation of water in dis-
tribution systems conducted under the auspices of the American Water Works As-
sociation. Similar work has been done from time to time in connection with chlorine
troubles and particularly with the presence of tastes and odors in distribution sys-
tems. It seems from this work that with many of our soft New England waters
large numbers of bacteria are always present in the bacterial slime deposit in the
pipes. Some of these studies have shown that active oxidizing agents such as chlorine
dioxide in the presence of chlorine may give very satisfactory reduction in the num-
bers of these bacteria present. Information has also been gained in the probable
role of some of these bacteria in the chemical degradation of water.
For the past year the Experiment Station has been participating in research work
in connection with the bacterial sections of the forthcoming Standard Methods for
Examination of Water and Sewage, particularly in regard to discriminatory media
and to the effect of time and temperature on stored bacterial samples. Similar work
had previously been conducted by the Station in connection with the 6000 samples
from public water supplies which are received each year. During the summer of
1949, preliminary studies on the effect of ultrasonic waves on bacteria were con-
ducted at the Experiment Station.
Water Treatment Research
Investigation of methods of water purification during this period included the
continuation of the long-time storage studies in which Merrimack River water is
stored in the dark for approximately 30 days. Analysis of the raw and stored water
has shown that the bacterial content of the water may be reduced as much as 99%
and also that significant reductions in the chemical suspended matter are obtained.
Because the storage basins are covered there is very little reduction in color. A
series of sand filters which receive both stored and unstored water have shown that
the bacteria remaining after storage are more difficult to remove by sand filtration
than those in the original water. However, the final result of storage and filtration
gives a water extremely satisfactory in bacterial content as well as in chemical
characteristics.
Two large size coagulation and filtration systems were operated with special
studies on optimum coagulation and also on secondary filtration at low rates of
water previously treated at rapid rates. It was found that when the filter operating
at rapid rates was properly operated that very nearly complete reductions in bac-
teria could be obtained and that further filtration gave relatively insignificant re-
moval. However it was possible by careful operation of both steps of the process to
obtain almost completely sterile water. A considerable amount of work was done
on both these filter systems, repeating work previously done at the Station in re-
gard to the precipitation of mats of coagulant on the upper surface of the filter
which it was hoped might result in the need for less rigorous control of coagulation
and possible operating economies. However, these experiments as well as the ones
conducted earlier indicate that satisfactory results could not be obtained. _
The appearance of very high numbers of bacteria in water supplies in which
various phosphates were used as part of the treatment process led to an intensive
study of the part played by phosphates, especially the polyphosphates, in water.
A series of papers written on the subject showed that in both ground water and
surface water enormous increases in the total number of bacteria and in the number
of coliform organisms as well as considerable increases in pathogenic organisms such
as E. typhi took place. These things occurred in the presence of polyphosphates in
fairly high concentration but in the concentrations finally used in treatment of
water supplies, the effect was relatively small. It was also found that certain phos-
phates might have valuable application as bacteriostatic agents in experiments
where it is desired to maintain a constant number of bacteria. It was also shown
that phosphates resulting from the partial decomposition of hexametaphosphates
likewise stimulated bacteria and that the presence of certain inorganic acids might
also stimulate the effect of phosphates. Various other investigations showed that
there was little difference resulting from the presence of sodium or potassium iron
and that nitrogen in various forms had a slight inhibiting effect for a short time but
later on resulted in further increases in the effect of the phosphates. As a result of
P.D. 34 353
these papers the manufacturers of stock phosphates advised water supplies using
these materials to add chlorine or other sterilizing agents to the stock solutions.
During the war the shortage of alum made it desirable to study the effects of other
coagulants in water treatment and in several plants the results of experiments on
various iron salts were applied with considerable success. Likewise, wartime short-
ages of chlorine led to investigations of the possible use of bromine and later on
chlorine dioxide as water disinfectants. In a series of papers on this subject it was
reported that disinfection by bromine was possible although at greater expense as
compared to chlorine; that organic matter in water affected the bromine to a much
greater degree than it did chlorine and that while against pure cultures in sterile tap
water or in sterile distilled water bromine was practically as effective milliliter for
milliliter as chlorine, in water containing any particular amount of organic chlorine
or bromine demand, bromine became progressively less valuable as compared to
chlorine. It was also reported that bromine had a very considerable flash effect but
that the residual effect of bromine was very considerably less than that of chlorine.
In regard to chlorine dioxide, it was reported that this material can be used very
successfully as a bactericide but that, very much like bromine, its action was con-
siderably less in the presence of even small amounts of organic matter as compared
to the action of chlorine. It was likewise found that chlorine dioxide had some-
what less residual effect than equivalent amounts of chlorine, and that the bacteridi-
cal value of dioxide is not nearly as much affected by change in pH as is that of
chlorine. It was also found that chlorine dioxide generally did not produce the disa-
greeable chloro phenol tastes which result from treatment by chlorine alone.
As a result of these studies and the work of others, chlorine dioxide and chlorine
were used successfully in the water supply of the city of Chicopee where very disa-
greeable odors and tastes had for a long time been encountered. In another paper
it was reported that provided proper doses of chlorine were used as the main dis-
infecting agent, appropriate doses of chlorine and chlorine dioxide gave very satis-
factory results in the reduction of odors and tastes and had a very important action
in reducing the numbers of bacteria present in the distribution system. Further
studies with chlorine dioxide showed that in many cases this agent was very valuable
in reducing tastes and odors resulting from such diverse causes as iron, manganese,
oils, detergents and other dispersing agents and organic tastes produced by turnover
in reservoirs.
The Station has studied continuously the effect of chlorine on bacterial removal
and on the causing or prevention of tastes in water. It was been found for instance
that extremely small amounts of certain new chemicals either resulted in the ap-
pearance of very small amounts of phenol in the water which when chlorinated gave
disagreeable chlorophenol tastes and it was found that in many cases, especially in
the softer waters, that super-chlorine or the so-called "breakpoint" did not result in
complete removal of these tastes and odors. In many other places, however, super-
chlorination was found to give completely satisfactory results. As a result of these
contradictory findings, it was recommended that individual studies of each water
be made in regard to disinfection by chlorination. It was also found, especially in
the water supply of the city of Lawrence which had as its source a river containing
considerable amounts of organic matter and of industrial wastes, that treatment
with activated carbon was satisfactory at certain periods only when extremely high
concentrations were used. Other studies in regard to disinfection and removal of
odors and tastes indicated that step addition of chlorine produced more satisfactory
results and frequently resulted in more economical operation than when the indi-
cated amount of chlorine was applied at one time. Many experiments were conducted
on the treatment of water by such agents as activated clays, but most of these in-
dicated that in most of our waters such agents are generally not satisfactory.
The general softness of Massachusetts waters brought many problems in regard to
corrosion, and in about 25 communities assistance was given in the field in the ad-
dition of suitable alkaline materials to overcome or reduce this corrosion. This work
necessitated the conducting of many experiments particularly in regard to the ap-
plication of the Langelier Index and similar formulas to the New England waters
which are generally very low in dissolved solids content. The general use of cement-
lined pipe in Massachusetts is a valuable aid in the reduction of corrosion but in
many cases the pipe when first in use yields a water very high in pH which fre-
354 P.D. 34
quently results in disagreeable tastes. In several communities assistance has been
given in regard to early curing of this pipe and removal of the tastes and odors.
The Station has been increasingly active in the study of tastes and odors produced
by algae and similar organisms and likewise has been of assistance to several water
departments in regard to filtration problems resulting from large growths from such
organisms.
Chemical treatment for the correction of corrosion was applied at the North
Reading State Sanatorium where it was particularly important to present a water
as low in metals as possible for the children who are patients at the institution, and
where it was also necessary to restrict as far as possible the use of chemicals in treat-
ment in order to avoid intestinal disturbances in the children involved. At the
Tewskbury State Hospital peculiar circumstances in connection with large amounts
of iron and manganese caused serious deposits in the transite pipe used to carry
the water supply to the institution; development of a method of penetrating this
coating by chlorine and detergents resulted in removal of the deposits and a large
increase in the capacity of the pipe. This treatment has been employed several
times with very satisfactory results.
In connection with the growing interest in the use of fluorides in water to reduce
dental caries, this Station has conducted a considerable amount of experimental
work and has analyzed many of the water supplies of the State, practically none of
which contains any significant amount of fluorides. Determinations of total and of
available fluoride of various foods, especially seafoods, were also made. In order to
facilitate field work, a short method of analysis of fluorides was developed and we
were able to put this in such a form that field determinations could be readily made.
In connection with the sanitation of bathing places, the Station has made very
many bacterial analyses. In addition, instruction has been given to personnel in
various cities and towns so that they might control bathing places, and simple
methods of application of chlorine and determination of available chlorine have
been shown to much of this personnel. In connection with bathing beaches and
swimming pools where filters are used, the staff at the Station has conducted many
field experiments and has likewise given instruction to operators. The Station has
been particularly interested in the use of diatomaceous earth filters for swimming
pool treatment, and extensive experiments have been operated both at the Station
and at indoor and outdoor pools. As a result of these experiments, it has been con-
cluded that diatomaceous filters properly operated at safe rates can furnish very
satisfactory treatment for swimming pools.
Sewage Treatment Research
The work in connection with the sewage research of the Station has included
studies of sedimentation, including the operation of an Imhoff tank, six septic tanks
with subsurface disposal areas, activated sludge tanks, over 50 trickling filters, and
secondary sand filters.
The sewage used in experiments is pumped from one of the main sewage lines of
the city of Lawrence, selected because it is almost completely free of industrial
wastes, to holding tanks so arranged as to reduce sedimentation to a minimum, and
thence by automatically controlled pump to an elevated settling tank, which has an
average detention period of less than two hours. From this tank a uniform settled
sewage is distributed by gravity to all the experimental filters. During the nine
years the average B.O.D. of the raw sewage was 384 ppm, and that of the settled
sewage 311 ppm, a reduction of 19%. In individual years the percentage reduction
has been as low as 10% and as high as 33%. The reduction in suspended solids has
ranged from 60 to 35%, with an overall average of 43%, from 212 ppm in the raw
sewage to 122 ppm in the settled.
The Imhoff tank in use does not have sufficient capacity to furnish all the sewage
required for experiments, and therefore only a small portion of the sewage receives
treatment in this tank, resulting in a detention period much longer than normal.
The average suspended solids in the effluent have been 70 ppm, a reduction of 67%,
and the B.O.D. 177 ppm, a reduction of 54% from the raw sewage.
Two activated sludge tanks were operated during the nine year period. One of
the tanks consisted of three compartments in series, each about 75 inches deep with
P.D. 34 355
an overall capacity of 700 gallons. This tank had all the necessary settling tanks,
surplus sludge storage and aeration tanks and apparatus for returning the sludge
to any of the three compartments. The other tank consisted of three rectangular
tanks in series with a water depth adjustable to 12 to 40 inches. This tank was also
provided with all the necessary facilities for activated sludge operation. The aver-
age detention period in the first tank was about 33^ hours and the amount of air was
varied from time to time with quantities as low as 0.6 of a cubic foot per gallon of
sewage treated to as high as 1.5 cubic feet. The overall removal of B.O.D. from the
settled sewage applied to the effluent of the final settling tank was 85% and the re-
moval of suspended solids was 47%. There were no significant differences in per-
formance which could be attributed to the amount of air being applied. The second
tank was continuously operated with one cubic foot of air per gallon of sewage
treated. The average reduction of B.O.D. in this tank was 83% but the removal of
suspended solids was 59% which is significantly higher than the results obtained in
the first tank. Experiments indicated that the shallower tank and the relatively
stable amount of air used gave a final floe which settled more rapidly than the
deeper tank. In both of these tanks, air enriched with an additional 20% of oxygen,
and for a period of about two weeks pure oxygen, was used in place of normal at-
mospheric air and the results of these experiments indicated that neither enriched
air nor pure oxygen gave results as good as those normally obtained with atmos-
pheric air.
Septic Tanks
During the nine years a series of septic tanks have been operated to study par-
ticularly the effect of detention time and to furnish material for flooding subsurface
disposal areas. Four tanks were operated throughout the nine years; two others,
Nos. 719 and 720, for seven years. All of the tanks are simple concrete boxes, with
each compartment twice as long as its width; all have a water depth of 40 inches
with an air space of 3 to 4 inches; the inlets and outlets are submerged tees. The
compartments of the two-compartment tanks are built side-by-side with the com-
mon wall between the tank cut off so as to provide an end-around baffle. Tank No.
507 has received the fresh sewage of the Station; all the other tanks have received
the settled Lawrence sewage used in other experiments. The following table de-
scribes the tanks and the method of operation :
No. of
Capacity
Detention
Tank No.
Compartments
Cu. ft.
Receives
Period, days
719
1
23.3
Settled sewage
H
691
2
53.3
Settled sewage
V2
720
2
46.7
Settled sewage
1
508
2
53.3
Settled sewage
2
690
2
53.3
Settled sewage
4 (1946-1949)
690
2
53.3
Settled sewage
6 (1941-1945)
507
1
26.7
Fresh station
sewage
2
All the tanks are opened once each year for sludge measurement and analysis,
and any sludge in excess of 4 to 6 inches in depth is removed before the tanks are
again put into operation. The average accumulation of sludge in Tank No. 507,
which has received fresh Station sewage has been 7.4 inches; the greatest average
accumulation in any of the other tanks has been 2.6 inches in the first compartment
of No. 691.
It has been found that the destruction of material deposited was much greater in
the tanks with short detention periods as compared to those with longer detention ;
for instance, Tank No. 719 destroyed 74, 88 and 87% respectively of the solids, nitro-
gen and fats deposited in the tank, while for No. 508, the percentages were 48, 58
and 54, and for No. 690, during the time when its detention period was six days, the
percentages were 43, 43 and 48.
356
P.D. 34
The removal of total B.O.D. is roughly proportional to the length of the detention
period, with 29% of the total B.O.D. deposited being destroyed in Tank No. 719, as
against 56% in No. 690 ; but in removal of suspended B.O.D. the difference was much
less, with percentages of 53 in No. 719 and 65 in No. 690. The effect of detention
period of destruction of material is shown in the following table in terms of pounds
per year per cubic foot of tank space. It is noticeable in most respects that Tank
No. 507, which has received very fresh sewage, shows greater removals than any of
the tanks which have received settled sewage, which is relatively less fresh and of
course also contains relatively less suspended matter.
Pounds of Material Destroyed
per Year per Cubic Foot of
Days
Tank Space
Tank No.
Detention
Solids
Fats
Nitrogen
719
H
1.90
.54
.137
691
H
1.74
.36
.072
720
l
.65
.24
.054
508
2
.54
.08
.022
690
4
.23
.09
.016
690
6
.27
.03
.007
507 (fresh
2
2.35
.46
.087
sewage)
Total B.O.D.
Suspended B.O.D.
Lb. per
Lb. per
Days
Percent
Cu. Ft.
Percent
Cu. Ft.
Tank No.
Detention
Destroyed
per Yr.
Destroyed
per Yr.
719
Yz
29
3.08
53
1.71
691
V*
23
1.75
50
.94
720
1
33
1.62
48
.37
508
2
45
1.05
60
.27
690
4
52
.56
55
.13
690
6
56
.22
65
.06
507 (fresh
2
78
2.90
94
2.14
sewage)
Since generally the main usefulness of septic tanks is in the preparation of sewage
for further treatment by removal of suspended matter especially in subsurface dis-
posal areas, the amount of suspended solids remaining in a septic tank effluent is
very important. It has been found that the tanks with longer detention show a
slightly greater percentage of removal of suspended solids, but Tank No. 719 which
had the highest suspended solids remaining snowed 67 ppm as against 50 ppm in No.
508. In fixed suspended solids which have a very significant effect on the clogging
of subsurface areas, there never has been shown any real difference in the amount
remaining.
Subsurface Disposal Areas
Several subsurface disposal fields have been operated continuously at the Sta-
tion for many years receiving effluents from the septic tanks. Two areas have been
operated for nearly 13 years; both are in very fine soil. One unit with sand with an
effective size of 0.034 mm has received an average does of nearly 2.5 gallons of septic
tank effluent per square foot of trench per day without any great reduction in per-
meability. The sand in the other unit is slightly coarser, with an effective size of
0.041 mm. Although these units are similarly dosed with the same effluent, and are
located in exactly similar locations, this unit has progressively declined in ability
to receive effluent from almost 5 gallons per square foot per day to a present figure
of less than one gallon. Observation of these units and of larger areas at roadside
P.D. 34 357
stands, etc. indicates the difficulty in estimating the long-time capacity of any given
field; but it also seems to be indicated that in well-constructed fields, septic tanks
can be dosed at a rate of about one gallon per square foot of trench per day.
Trickling Filters
Over fifty trickling filters have been operated during the past nine years, most of
them at high rates. Since study of trickling filters since 1890 has indicated that six
feet of stone is the optimum depth for filtration of Lawrence sewage, most of the
filters are of this depth, but others have been operated with four, eight, and ten feet
of stone. In addition to single-pass filters, many recirculating units have been op-
erated, and several secondary filters, receiving effluents from other units have been
run.
The B.O.D. loading has varied from 500 to 700 pounds per acre foot, the typical
low-rate loading to a maximum of nearly 20,000 lbs. The accompanying figure shows
the B.O.D. removal from all of these filters, together with that of averaged groups of
filters receiving approximately the same load. It appears from the results shown
that with loadings of 500 to 700 pounds per acre foot, B.O.D. reduction in the
settled effluent of about 90% may be expected ; that as loadings increase, the reduc-
tion in B.O.D. will drop sharply to about 7500 pounds and that with loadings in ex-
cess of that figure, comparatively little loss in efficiency will be found.
It has been found that with loadings up to about 1200 pounds per acre foot, con-
siderable quantities of nitrates will be produced, and the effluents will have relative
stabilities of 50% or higher, and significant reductions in organic nitrogen will be
obtained. From this range up to about 2500 pounds per acre foot some slight degree
of nitrification and removal of organic nitrogen will be found, and the effluents will
show some degree of relative stability. With loadings beyond this figure there is
little or no effect on organic nitrogen and the effluents will remain stable for not
much longer than one day. It has been found that with loadings up to about 1500
pounds per acre foot, settled effluents have shown removals in suspended solids on
the order of 80% or more from the settled sewage applied. With loadings from
about 2000 pounds to 10,000 pounds, the removal of suspended solids has been
about 50%, and with heavier loadings the percentage of reduction drops gradually
to about 33%, but figures of about that magnitude were still obtained with the maxi-
mum loading of nearly 20,000 pounds. Since some reduction of B.O.D. is also ob-
tained with this high loading, it may be assumed that even with this extremely
great amount of B.O.D. applied, which was obtained by using a liquid rate of 40
million gallons per acre per day, a trickling filter still gives a considerable degree of
treatment.
As far as possible, each of the recirculating filters operated has been paired with a
single-pass filter receiving the same B.O.D. loading as that in the primary sewage
applied to the recirculator. Several recirculating ratios have been studied, from 1 :1
to 9:1, and in general our conclusions have been that a ratio of 3 of recirculated
effluent to 1 of new sewage furnishes adequately the dissolved oxygen and high con-
tent of active oxidizing bacteria which seem to be the agents responsible for satis-
actory recirculation performance. A pair of filters operated quite similarly except
in recirculation rates showed some slight degree of improvement in reduction of
B.O.D. with a ratio or 5:1 as compared to 3:1 but it is questionable if the improve-
ment obtained would warrant the additional pumping cost.
The recirculating filters with primary B.O.D. loads of from 1200 to 9000 pounds
per acre foot showed about twice as high a percentage of B.O.D. removal as the
single-pass filters with similar loads, and somewhat better performance in removal
of suspended solids, but nitrification to any degree and removal of organic nitro-
gen, as well as reasonably high relative stability was found only in filters with pri-
mary loadings of 2500 pounds or less.
Experiments in regard to intermediate settling of recirculated effluent indicated
that sedimentation periods as low as 15 minutes were satisfactory. In one experi-
ment the intermediate settling tank was gently agitated by air; the filter for several
months seemed to show improved performance, but eventually it began to show de-
posits of sludge on the top layers of stone, indicating that a complete lack of settling
would be unwise.
358 P.D. 34
Secondary single-pass filters which received settled effluents from high-rate re-
circulating filters gave very satisfactory performance. Two such two-filter units,
in one case with the secondary filter operating at 15 million gallons per acre, per day,
and the other at 20 million gallons per acre per day, gave overall removals of B.O.D.
at times in excess of 85%. The combined loading of such systems was between
3500 and 5000 pounds and the settled effluents of the final filter in each case was
as good as those from single-pass filters receiving only one-quarter as great a load.
Secondary sand filters receiving settled effluent from trickling filters also showed
very excellent performance. Previous experiments with sand filters indicated that
when settled sewage was applied, the maximum rate of application was about
100,000 gallons per acre per day, with a B.O.D. loading not much in excess of 100
pounds per acre. On several units containing 4 feet of sand, it was found possible
to obtain effluents low in color and containing 10 ppm or less of B.O.D. with load-
ings up to 75 pounds per acre foot or a total of as much as 400 pounds per acre. It
was found possible also to run these sand filters at loadings 50% greater than the
amounts given above for several months before marked deterioration of the ef-
fluents was shown.
It was found also that such secondary sand filters gave much more satisfactory
results when the effluent applied came from a recirculating filter rather than from a
single-pass unit, and that in multiple systems, shallow primary filters were not as
satisfactory as those with 6 feet or more of rock.
Industrial Wastes Research
During the period 1941 to 1949 something over 40 different wastes were investi-
gated; in some cases simple sedimentation or coagulation was the only method in-
volved. In many cases however a long study of an individual problem was con-
ducted, including the methods used above and biological treatment as well.
In 1940 work on laundry waste was begun and in 1941 extensive studies on treat-
ment of laundry wastes by coagulation and by trickling filter treatment were carried
out. A complete report on this study was made a part of the report of the Division
for 1941. It was shown that chemical coagulation of these wastes resulted in a very
satisfactory supernatant; the report showed that slow stirring with the addition of
acid could neutralize about two-thirds of the total alkalinity of the waste, followed
by addition of alum or iron salts which was the most economical and most expedi-
tious manner and that economies in the use of chemicals were thus obtained. Trick-
ling filter studies showed that although the raw laundry waste frequently had a pH
as high as 11, direct application to rates up to 1.5 million gallons per acre per day
gave very satisfactory removal of B.O.D. and good clarification. With recirculation
it was possible to increase this loading somewhat. At rates much higher than this,
adequate treatment was obtained for a short while but accumulation of grease and
the deleterious effect of the caustic alkalinity on the bacteria of the filter inhibited
satisfactory treatment. Filtration of neutralized waste which resulted in removal
of the grease made it possible to obtain satisfactory biological treatment with loads
at least equal to those given by similar amounts of domestic sewage. Since that
time laundry wastes from several other sources including two Army installations
have been worked on and it has been found possible by partial treatment to utilize
trickling filters for a very satisfactory complete treatment.
In connection with the wastes of one laundry it was found that intermittent dis-
charges of starch into a stream had led to enormous growths of bacteria on the order
of at least one billion bacteria per milliliter. It was found possible to coagulate these
wastes and to effect almost complete removal of starch.
In several instances wastes from wood working plants were studied; in many cases
simple sedimentation was sufficient treatment of these wastes but it was also found
that certain materials were extracted from these wastes which later on served as
food for bacteria and which also led to very great difficulties from tastes and odors
when waters containing these extracts were chlorinated. The studies involved co-
agulation which was shown to require very high amounts of coagulant for complete
treatment, biological filtration which offered a relatively complete answer and also
studies of oxidation of the material in the stream, especially by chlorine dioxide
which almost completely eliminated the tastes.
P.D. 34 359
Many different kinds of wastes from paper mills were studied. Experiments were
conducted both at Lawrence and in the field in regard to the treatment of flax cook-
ing wastes resulting from the manufacture of cigarette paper. It was shown in both
experiments that any reasonable amounts of mixture of such wastes with domestic
sewage definitely inhibited coagulation and sedimentation. Attempts at chemical
coagulation resulted in removal of 50 to 70% of the B.O.D. and a considerable
amount of the color but the material remaining was still much too strong to be dis-
charged into any reasonable sized stream. Dilution followed by coagulation es-
pecially with calcium chloride gave a high percentage of removal but the cost of
this treatment was practically prohibitive. It was found that evaporation of these
wastes followed by combustion gave a theoretically satisfactory yield of soda
which would probably pay for all or most of the cost of treatment. Later studies on
chemical coagulation followed by flotation of light paper mill wastes indicated this
method would remove very satisfactorily suspended matter from white water
wastes and if certain amounts of coagulant were used, deinking wastes or mixtures
of deinking and coagulation wastes could be treated with reasonable certainty of
satisfactory improvement. At the present time other investigators are making large
scale studies of these processes.
Many different varieties of wastes from chemical plants were studied. Some of
these wastes are high in content of both organic and inorganic acids and one waste
in particular had a pH as low as 2. Extensive studies on trickling filters showed that
this waste after some degree of neutralization responded very satisfactorily to treat-
ment on trickling filters and a large scale pilot plant is now in operation for further
confirmation of this study. It was interesting to note that by gradually reducing the
pH of the mixed wastes fed to a trickling filter that the filter gradually became ac-
customed to lower and lower pH's and further studies in regard to trickling filter op-
eration with wastes having a pH as low as 3 are now in operation. A study of wastes
containing considerable amounts of zinc indicated that although a trickling filter
could be accustomed to amounts of zinc as high as 50 ppm it was generally prefer-
able to remove the zinc wholly or partially before trickling filter operations were
used.
Another particularly important study of biological treatment of waste from a
chemical plant was conducted in cooperation with engineers from the parent plant.
It was found by proper adjustment and gradual building up of proper bacterial
growth that it was eventually possible by the use of a trickling filter recirculated
with a high ratio to effect satisfactory biological treatment of a waste containing
formaldehydes in concentrations up to 1000 ppm.
In a similar fashion, wastes from three different manufactories producing various
kinds of plastic wastes showed that trickling filters would operate satisfactorily if
gradually accustomed to amounts of phenols and other organic materials up to ap-
proximately 100 parts per million although initially these wastes were shown to be
quite bactericidal in action. Work on other manufacturing wastes of this type in-
cluded a study of the effect of cyanides on sand beds and trickling filters and it was
found possible by gradually increasing the dose of cyanides to have either type of
filter work satisfactorily with doses of cyanides on the order of 50 ppm. It was
found that once the growth accomplishing this work was established that removal
of the cyanides caused a deterioration in the performance of the filter.
Much field work and a very considerable amount of experimental work was con-
ducted on tannery wastes. In several cases studies were made of specific wastes to
determine the probable effect of such wastes when mixed with domestic sewage
which was being treated either by sand filters or by trickling filters. It was found
that if the proportion of tannery wastes, especially if grease content was high, ex-
ceeded 10% of the total that operation of municipal filters received considerable
damage. In such cases sedimentation, preferably assisted by coagulation with iron
salts or with calcium chloride, sufficiently reduced the B.O.D. and suspended matter
and the grease in the wastes so that the effluent of such treatment could then be satis-
factorily handled by a normal municipal treatment plant. In three instances, ex-
perimental work of this nature at the Station and a subsequent operation of trickling
niters receiving the partially or wholly coagulated waste indicated that trickling
filters especially with recirculation could satisfactorily handle loadings of tannery
360 P.D. 34
waste up to 1500 pounds per acre foot and that a pH acceptable to the filter might
rate as high as 9.0.
Very extensive work was carried on in connection with wool scouring wastes. Very
great quantities of these wastes are produced in Massachusetts in many cases on
relatively small streams. The wastes are very high in grease and frequently have a
B.O.D. as high as 30,000 ppm. For many years various methods of coagulation of
these wastes had been studied and in 1947 it was demonstrated that the use of car-
bon dioxide to neutralize the high caustic alkalinity of the waste followed by or ac-
companying the use of calcium chloride as a coagulant made it possible to reduce
grease content in some cases as much as 99% to effect removal of suspended ma-
terial well in excess of 90% and to remove all of the suspended B.O.D. as well as
small parts of the B.O.D. in solution. Complete reports of this work have been
published in scientific journals. Large scale pilot operations have been conducted
at several wool scouring plants throughout the State and in one such plant full
scale operation is now showing a high degree of success.
In many cases the amount of organic matter and particularly the amount of
B.O.D. remaining after even successful coagulation is so high that further treatment
is necessary. Dilute trickling filters operated at three different commercial plants
and at the Experiment Station have indicated that such filters will operate satis-
factorily at loadings in the order of 1200 to 1500 pounds per acre foot and that al-
most any desired degree of removal of B.O.D. can be obtained. This work is being
continued especially Avith a view to recovery of some or all of the valuable grease con-
tent in the wool. Laboratory experiments have shown that this wool grease can be
removed in satisfactory condition to the extent of at least 50% of that remaining
after treatment by centrifuge and that the wastes remaining after this removal may
still be satisfactorily treated by biological means.
Another important textile waste which has received a considerable amount of
attention at Lawrence are the wastes from various dyeing operations. In 1948 and
1949 through the cooperation of several mills, extensive study was made on both
acid and alkaline dye wastes and on mixtures of the two. It was found that sedi-
mentation even when assisted by chemical coagulation had relatively little effect on
such wastes although it was generally desirable to install equalizer tanks because of
the uncertain discharge of volumes and types of wastes particularly with respect to
color. It was then shown that trickling filters had B.O.D. loads approximately
equal to those giving satisfactory results with domestic sewage produced from satis-
factory effluents and that with recirculation filters it was possible to obtain loadings
of at least 1500 pounds per acre foot, obtain effluents which show removals of B.O.D.
down to 20 or 30 ppm. freedom from suspended solids and complete removal of color.
It was shown further that considerable amounts of such dye waste could be treated
together with domestic sewage with any of the methods normally employed. These
results have also been published in one of the scientific journals.
Other textile wastes receiving attention during the period included several types
of cotton bleaching wastes and it was likewise shown that by proper adjustment and
especially by fortification of these highly carbonaceous wastes with proper amounts
of ammonia and phosphates that successful biological treatment could be obtained.
In several individual problems, assistance was given to the manufacturers in obtain-
ing the most effective and most economical methods of coagulation.
Studies were made also of many kinds of wastes resulting from the processing or
manufacture of food. Fish wastes almost always involve odorous materials, con-
siderable amounts of grease and fairly heavy B.O.D. loads. Assistance was given to
one processor in attempts at biological treatment of mixed wastes from fish handling
and the studies indicate that satisfactory treatment could be obtained only with
very small loadings. It was also shown that very small amounts of such wastes when
mixed with domestic sewage caused considerable difficulties from odors and that
relatively small amounts of fish scales clogged and otherwise interfered with ma-
chinery for disposing of sewage and waste. In connection with odors from treatment
of fish and especially from the manufacture of fish meal, extensive studies on chlori-
nation indicated that in many cases chlorine alone even in very heavy doses did not
completely eliminate such odors but that chlorination followed by burning at rela-
tively high temperatures resulted in complete destruction of the odors.
P.D. 34 361
Several different types of waste from distilleries and breweries were studied. In
most cases it was found that the most successful preliminary treatment for such
wastes was the complete removal of grains by screening, sometimes followed by sedi-
mentation. Following such treatment biological filters were shown to operate with
satisfaction provided the pH of the applied wastes was maintained at any given
point. It was also shown that considerable amounts of such waste could be mixed
with domestic sewage and treated in municipal plants provided that the input of
such wastes was maintained at practically the same relative proportion of the mix-
ture; in other words, if these wastes were discharged uniformly over a day, there was
little or no interference with satisfactory biological treatment. Several kinds of
dairy waste including those from the manufacture of ice cream were also studied.
It was found that generally speaking, long storage of waste containing milk or milk
products to the point of spasticity gave very satisfactory coagulation and separation
of casein and other material and that the supernatant liquor responded well to bio-
logical treatment. The treatment of the remaining sludge, however, was rather dif-
ficult. At two or three industrial plants, assistance was given in the determination
of the most economical method of coagulation and it was found that careful use of
iron salts resulted in the production of the smallest amounts of sludge which was
relatively stable and handled more easily than the sludge produced by any other
coagulant. It was found in general that milk wastes, like many other wastes from
food processing could be treated with very limited hope of success in septic tanks
and that frequently such treatment gave effluents which were treated with difficulty
on sand filters either subsurface or open to the air. Two different types of waste
were very difficult to treat because of the high content of inorganic matter and of
very stable organic materials. Wastes from potato chip manufacturing were found
to contain very high amounts of fine inorganic matter which was very difficult to
settle and which unless removed clogged very rapidly sand beds and even coated
trickling filters in such a manner as to interfere with successful operation. Corn
huffing wastes as ordinarily discharged were found to contain extremely high
amounts of inert cellulose which interfered with the operation of septic tanks, sand
beds and trickling filters. However, addition of small amounts of coagulant and
careful screening resulted in a waste which did respond satisfactorily to biological
treatment. Wastes from plants canning citrus fruits were found to be easily treated
once the organic acids had been neutralized and the suspended matter removed by
screening or careful coagulation. Such wastes after preliminary treatment had no
serious effect when mixed with domestic sewage.
In general these experiments indicated that practically every variety of indus-
trial wastes produced in the State could by careful study and especially by careful
evaluation of the materials involved be satisfactorily treated and that in many cases
interesting methods of biological treatment could be used provided the strength and
the other characteristics of the waste were brought into line with similar character-
istics of domestic sewage.
362
P.D. 34
OPERATION OF TRICKLING FILTERS
REMOVAL OF BOD
194t— 1949
o— O — 0 S1N6LE-PA3S
• — • — • RECIRCULATION
3
1
0
o
|
1
8|
I
•T.
1
i
0
•
•
0
1
I
•
0
0
1
••
, t
>
r
4
•
./
•
o
3 / *
7
•
y
>
L .
S o
/
■
*/
•
Z^
/
° **
0 0 8 JO 1»A0«3» %
P.D. 34
363
Purification of Merrimack River Water by Storage and Filtration
Average Chemical Analyses
(Parts per Million)
Ammonia
Nitrogen as
Albuminoid
T3
>>
S
3 _
a
a a
•p|
a
u
o
O
o
"3
o
3|
13
03
m 3
M o
OO
a
o
J?
3
a
c3
W
W
a
Filter No. 576:
Raw river water applied
40
.508
.301
.203
.146
.003
8.8
.65
19
27
6.6
Effluent ....
26
.262
.140
-
.097
.000
6.5
.44
26
29
6.6
Per cent removal
35
48
53
-
-
-
26
32
-
-
-
Filter No. 577:
Stored river water applied
44
.201
.195
.170
.326
.001
8.5
.47
35
39
7.3
Per cent removal by storage
-
60
35
16
-
-
4
28
-
-
-
Effluent ....
37
.073
.128
-
.357
.001
7.3
.28
37
43
7.0
Per cent removal from applied
16
64
34
-
-
-
14
40
-
-
-
Per cent removal by storage
and nitration
8
86
58
"
—
17
57
-
_
—
(Average 1943-1948: 5 years, 3 months operation, representative of whole period 1941-49)
Secondary Sand Filtration of Trickling Filter Effluent
Average Chemical Analyses
-o
i-i
(Parts
per Million)
Ammonia
0)
>>
a
a
< .
&5
Nitrogen as
a
3
™ o
Albuminoid
ftV
<l
Ou
n a
r^3 CJ
T3 O
£3
o
o
c
a
to
O
d
"o
O
a>
J3_
a
Q
CO
O
H
13
_o
M^3
o
02
5
03
$
CO
CD
_>
Settled Sewage as Applied to Trickling Filters
24 4.1 3.0 8.7 - - 47 255
Settled Effluent from Trickling Filter No. 704 as Applied to Sand Filter No. 711
4 10 5,300 - - - 5.7 35 120 - 11
63
Effluent from Sand Filter No. 711
1.4 0.62 - - 24.6 .036
34
99
Per cent Removal from Trickling Filter Effluent
- - - 74 93
Per cent Removal from Settled Sewage
94 85 - - - - 81
97
Settled Effluent from Trickling Filter No. 735 as Applied to Sand Filter No. 712
6 20 7,100 - - - 5.8 - - 30 109 13
Effluent from Sand Filter No. 712
4 0.25 57 1.1 0.64 - - 23.9 .027 8 6 39 99
Per cent Removal from Trickling Filter Effluent
- ____--73 95__
Per cent Removal from Settled Sewage
- - 95 84 - - - - 83 98. -
Settled Effluent from Trickling Filter No. 742 as Applied to Sand Filter No. 718
6 15 5,300 - - - 6.4 - - 38 195 - 11
Effluent from Sand Filter No. 718
0.25 102 0.91 0.53 - - 24.2 .018 7- 7
Per cent Removal from Trickling Filter Effluent
- - - - 82 96
35
99
Per cent Removal from Settled Sewage
96 87 85
97
(Average 1943-1948, 5 years, 3 months operation, representative of whole period 1941-49)
364 P.D. 34
Average Solids in Samples Collected in Connection with the Lawrence Supply
(Parts per Million)
Dissolved Solids
Suspended Solids
Total
Loss on 1
Ignition | Fixed
Total
Loss on
Ignition
Fixed
Raw Merrimack River Water . 79
Coagulated and Settled Water as
Applied to Filters . . .75
Effluent from Filters . . .107
Outlet from Distributing Reservoir 92
Tap at Water Department Shop . 92
Tap at Experiment Station . | 88
29
23
28
24
27
21
50
52
79
68
65
67
7
4
3
(Average 1943-1948, 5 years, 3 months operation representative of whole period 1941-49.)
Purification of Merrimack River Water by Storage and Filtration
Average Bacterial Analyses
Bacteria per Milliliter
Coliform
Bacteria
4 Days
24 Hrs.
20° C.
37° C.
in 100 ml.
Filter No. 576:
Raw river water applied ......
51,400
1,700
5,300
Effluent
2,700
280
460
Per cent removal ......
95.0
83.6
91.3
Filter No. 577:
Stored river water applied .....
900
110
35
Per cent removal by storage .....
98.2
93.5
99.3
Effluent
730
15
24
Per cent removal from applied ....
18.9
86.5
31.4
Per cent removal by storage and filtration
98.6
99.1
99.5
(Average 1943-1948 5 years, 3 months operation — representative of whole period 1941-49)
Average Suspended Solids
(Parts per Million)
Loss on
Total
Ignition
Fixed
Regular Sewage ........
197
162
35
Settled Sewage ........
86
70
16
Per cent Removal in Settling .....
56
57
54
Imhoff Tank No. 545
44
34
10
Per cent Removal by Imhoff Tank ....
78
79
71
(Average 1943-1948 — 5 years, 3 months operation — representative of whole period 1941-49)
Septic Tanks — Data on Operation
Detention period, days
Solids in tank, Jan. 1948, lb
Solids deposited during 1948, lb
Total solids, lb.
Solids in tank, .Tan. 1949, lb.
Solids destroyed, lb.
Solids destroyed, per cent
Solids accumulated, lb.
Fats in tank, Jan. 1948, lb.
Fats deposited during 1948, lb.
Total fats, lb.
Fats in tank, Jan. 1949, lb.
Fats destroyed, lb. .
Fats destroyed, per cent .
Fats accumulated, lb.
Nitrogen in tank, Jan. 1948, lb
Nitrogen deposited during 1948, lb.
Total nitrogen, lb. .
Nitrogen in tank, Jan. 1949, lb
Nitrogen destroyed, lb.
Nitrogen destroyed, per cent
Nitrogen accumulated, lb.
719
H
34.4
44.3
11.7
32.6
74
1.8
2.2
17.2
19.4
2.4
17.0
87
0.2
.35
83
.18
.37
.81
!21
691
720
508
507
690
y%
1
2
2
4
23.1
13.9
18.5
7.6
15.1
52.7
21.2
16.7
70.8
17.8
75.8
35.1
35.2
78.4
32.9
25.2
12.6
25.1
11.4
12.5
50.6
22.5
10.1
67.0
20.4
67
64
29
86
62
2.1
0
6.6
3.8
0
5.1
3.4
4.8
2.1
4.0
26.8
9.7
5.3
18.2
4.8
31.9
13.1
10.1
20.3
8.8
5.1
3.2
5.9
2.1
2.6
26.8
9.9
4.2
18.2
6.2
84
76
42
90
70
0
0
1.1
0
0
.74
.48
.52
.24
.49
3.75
2.06
1.46
3.80
.73
4.49
2.54
1.98
4.04
1.22
.75
.44
.76
.48
.38
3.74
2.10
1.22
3.56
.84
83
83
61
88
69
.01
.00
.24
.24
.00
(Average 1943-1948 — 5 years, 3 months operation — representative of whole period 1941-49)
P.D. 34
Operation of Septic Tanks
Biochemical Oxygen Demand
365
719
691
720
508
507
690
Detention period, days
B.O.D. applied, lb. ...
B.O.D. destroyed, lb. .
B.O.D. destroyed, per cent
Suspended B.O.D. applied, lb. .
Suspended B.O.D. destroyed, lb.
Suspended B.O.D. destroyed, per cent
X
246
56.1
23
41.1
18.0
44
H
1
2
2
340
148
87.0
76.0
46
40.6
35.5
58.5
13
27
41
77
57.0
24.8
14.5
45.4
13.8
8.5
57
42.0
24
34
39
93
4
42.4
22.0
52
7.1
3.6
51
(Average 1943-1948 — 5 years, 3 months operation — representative of whole period 1941-49)
Secondary Sand Filtration of Trickling Filter Effluents
Average Suspended Solids
(Parts per Million)
Total
Loss
on
Ignition
Fixed
Sewage applied to Trickling Filters
Settled 704 Effluent as applied to Sand Filter 711
Effluent from Sand Filter 711
Per cent removal from Trickling Filter Effluent
Per cent removal from Settled Sewage
Settled 735 Effluent as applied to Sand Filter 712
Effluent from Sand Filter 712
Per cent removal from Trickling Filter Effluent
Per cent removal from Settled Sewage
Settled 742 Effluent as Applied to Sand Filter 713
Effluent from Sand Filter 713
Per cent removal from Trickling Filter Effluent
Per cent removal from Settled Sewage
86
46
11
76
87
47
11
77
87
58
10
83
70
39
7
39
7
49
7
16
7
4
(Average 1943-1948, 5 years, 3 months operation representative of whole period 1941-49)
Operation of Septic Tanks
Average Suspended Solids
(Parts per Million)
Loss
on
Total Ignition Fixed
Tank No. 719 (J^ day detention) applied .
effluent .
per cent removal
Tank No. 691 (J4 day detention) applied
effluent
per cent removal
Tank No. 720 (1-day detention) applied .
effluent
per cent removal
Tank No. 508 (2-days detention) applied .
effluent
per cent removal
Tank No. 690 (4-days detention) applied
effluent
per cent removal
applied .
Tank No. 507 (2-days detention) effluent .
per cent removal
99
79
20
65
49
16
36
35
20
99
79
20
61
49
12
38
38
40
99
79
20
64
47
17
35
40
15
99
79
20
52
37
15
47
53
25
99
79
20
54
39
15
45
51
25
452
377
75
44
30
14
90
92
81
(Average 1943-1948, 5 years, 3 months operation, representative of whole period 1941-49)
366
P.D. 34
Average Chemical Analyses of Samples Collected in Connection with the
Lawrence Supply
(Parts per Million)
jo
"o
O
Ammonia
a
03 o
+3 u
_o
o
<u
aB
M O
oo
c
0
O
a
S3
bO
C
03
>>
'3
"3
<
<u
a
■a
u
03
a
Albuminoid
3
o
fj
a
Raw Merrimack River Water .
44
.302
.325
.219
.135
7.7
9.2
.46
.058
18
27
6.6
Coagulated and settled water as
applied to filters
13
.298
.126
-
.186
8.9
4.8
.21
—
8
33
5.8
Per cent removal
70
1
61
-
-
-
48
54
-
-
-
-
Effluent from filters
9
.291
.107
-
.129
10
3.1
.12
.047
38
50
8.6
Per cent removal
80
3
67
-
-
-
"66
74
19
-
-
-
Outlet from Distributing Reser-
voir ....
7
.250
.106
-
.156
11
3.0
.11
.038
20
41
7.0
Tap in Water Department Shop
13
.184
.107
-
.179
11
2.9
.33
-
20
41
7.0
Tapjat Experiment Station
9
.202
.090
"
.177
11
2.9
.32
.033
20
41
7.01
(Average 1943-1948, 5 years, 3 months operation, representative of whole period 1941-49)
Average Chemical Anlayses
(Parts per Million)
Ammonia
Kjedlahl Nitrogen
XI
o
O
o
aB
as
x o
OO
03
d
Albuminoid
"3
o
a
o
"o
CO
a
"3
o
c
_o
"o
03
w
a
35
24
31
26
26
7.2
4.1
4.3
3.0
20
8.7
Regular Sewage
13 45
Settled Sewage
5.9 43
64
47
43
2.7
63
30
Per cent Removal by Settling
57 55 - 27
38
27
291
255
Sewage after Passing through Imhoff Tank No. 545
1.9 4.8 3.6 - 28 24
7.3
6.8
7.1
56
Per cent Removal by Imhoff Tank
76 72 - 56
.55
(Average 1943-48, 5 years, 3 months operation, representative of whole period 1941-49)
Average Results of Bacterial Analyses of Samples Collected in Connection
with the Lawrence Supply
Bacteria per
Per cent of
Milliliter
Bacteria Removed
Bacteria
4 Days
24 Hrs.
4 Days 24 Hrs.
In
20° C.
37° C.
20° C.
37c C.
100 ml.
Raw Merrimack River Water
98,000
6,300
-
-
18,900
Coagulated Wrater at Mixing Tank, Pre-
chlorinated ......
33
26
99.9 +
99.6
Coagulated and Settled Water as applied to
Filters
12
6
99.9 +
99.9
0
Effluent from Filters .....
65
4
99.9 +
99.9 +
Effluent after Postchlorination
4
2
99.9 +
99.9 +
0
Outlet from Distributing Reservoir
300
2
99.7
99.9 +
Tap on Low Service System
700
4
99.3
99.9 +
Tap on High Service System . . .
1,000
3
99.0
99.9 +
*Less than 1
(Average 1943-1948, 5 years, 3 months operation representative of whole period 1941-49)
P.D. 34
27
Operation of Septic Tanks
Average Chemical Analyses
367
{Parts per Million)
Ammonia
Kjeldahl Nitrogen
B.O.D.
Albuminoid
a
a
a
o
a
o
05
o
dE
o
CO
CO
u
03
O
fljs
d <D
"3
o
Ala
0 »
P-H 0,
03
t£ 03
X o
03
"3
o
>sl
CO
d a,
I— t 03
ffl
pq
H
02
02
H
OQ
03
OO
PE|
H
02
02
ft
Seated Sewage Applied to Septic Tanks Nos. 719, 691, 720, 508, and
5.2 3.7 1.5 9.6 7.2 2.4 55 48 245 204 41
690
6.8
24
3.8
11 27
Effluent from Septic Tank No. 719 i}A-day detention)
2.8 1.0 6.8 4.9 1.9 38 34 189 166
29
Per cent Removal
32 21 31 29
23
23
6.9
22
19 27
Effluent from Septic Tank No. 691 (j^-day detention)
2.8 1.0 6.9 5.2 1.7 39 28 212 181
24
33
28
Per cent Removal
28 29 29
42
13
11
31
24
25
35
Effluent from Septic Tank No. 720 {1-day detention)
2.5 0.9 6.2 4.6 1.6 35 32 178 151
.'53
Per cent Removal
39 33 36
33
27
26
27
34
6.9
27
0 42
Effluent from Septic Tank No. 508 (2-days detention)
2.3 0.7 5.5 4.3 1.2 30 33 145 120
38
.".7
43
Per cent Removal
40 50 36
31
39
7.0
25
3.0
Effluent from Septic Tank No. 690 (4-day s detention)
2.0 1.0 5.4 3.8 1.6 28 20 118 97
46
33
Per cent Removal
47 33 50
58
53
21
7.1
45 15
Fresh Sewage Applied to Septic Tank No. 507
6.4 8.6 27 12 15 161 125 439 177
7.1
40
2.8
Effluent from Septic Tank No. 507 (2-days detention)
2.0 0.8 5.1 3.7 1.4 29 20 101 82
69
91
82
Per cent Removal
69 91 82
84
77
19
93
(Average 1943-1948, 5 years, 3 months operation, representative of whole period 1941-49)
368
P.D. 34
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P.D. 34
369
AMHERST LABORATORY REPORT
The laboratory for the western district was located at the Westfield State Sana-
torium in 1941. In December 1942, this laboratory was moved to the University of
Massachusetts at Amherst. This facilitated cooperative arrangements with the
University of Massachusetts by members of the laboratory staff. At first, only
special chemical, microscopical and bacterial examinations were analyzed and ex-
amined at this laboratory, but after September 1944 all the regular monthly bac-
terial examinations of samples submitted from water departments in the two west-
ern districts have been sent to the Amherst laboratory instead of to the Lawrence
Experiment Station.
The work of cooperation with the University of Massachusetts has consisted of
student instruction by lectures and by laboratory instruction of students. In the
last fiscal year the lectures have consisted of about 40 hours; laboratory instruction
159 hours; and 7 hours have been devoted to examinations.
The following numbers and types of samples were analyzed at the Westfield or
Amherst laboratory during the period from January 1, 1941, to June 30, 1949:
Calendar
Year
Bacterial
Samples
Chemical
Samples
Microscopic
Samples
Special
Examinations
1941
1942
1943
1944
1945
January-June, Inclusive, 1946
Fiscal Years Ending
June 30, 1947 .
June 30, 1948 .
June 30, 1949 .
2692
135
245
13
1702
113
249
8
730
153
58
83
1132
322
57
22
2011
344
26
245
808
195
6
159
1708
331
12
196
1759
607
2
284
1811
552
34
65
k-
Public Document
No. 34
-L- %%z Commoutoealtfr of illagtfacfjusettg
CONSOLIDATED REPORT
OF THE
Department of Public Health
FOR THE
Fiscal Years 1950 Through 1956
Volume I
%%t Commontoealtti of jUlassacijuseUs
CONSOLIDATED REPORT
OF THE
Department of Public Health
FOR THE
Fiscal Years 1950 Through 1956
Volume I
m
Publication or this Document Approved by George J. Cronin, State Purchasing Agent
1M-6-57-920570
P.D. 34 Hi
CONTENTS
Report of the Public Health Council
Personnel 3
Meetings 4
General Duties 5
Hearings 6
Hospital Survey and Construction 6
Regulations 6
Report of the Commissioner of Public Health
Office of the Commissioner 7
Reorganization of the Department 7
Staff Conferences 8
Department Headquarters 8
Approving Authority for Medical Schools 8
Medical Panels 9
Rating Board 9
Milk Regulation Board 9
Council for the Aging 10
State Planning Board 10
Regulations 10
Legislation 13
Future Possibilities in the Department 14
Bureau of Administration
Division of Administration 17
Division of Training and Research 18
Medical Social Training Project 19
Division of Health Information 20
Personnel 20
Services 20
Bureau of Health Services
Division of Local Health Services 22
Northeastern District 23
Southeastern District 24
Central District 25
Western District 26
Nursing Section 27
Social Work Section 27
Nutrition Section 28
Civil Defense Section 31
Division of Maternal and Child Health Services 32
Maternity Care 32
Infant Care 32
Preschool Care 33
Conservation of Hearing and Vision 34
School Health 36
Services for Crippled Children 36
Statistical Services 38
Legislation 38
Special Projects 38
Publications 39
Bureau of Preventive Disease Control
Division of Cancer and Chronic Disease 40
Thirtieth Anniversary 40
Epidemiology and Biometrics 41
Services 44
Education 44
Registration 45
Heart Program 47
Geriatric Program 48
In Memoriam 49
Statistical Report 50
iv P.D. 34
Division of Alcoholism 62
Administration 62
Treatment 64
Education 65
Division of Communicable Diseases 66
Prevalence of Communicable Diseases . 66
Reorganization 68
Epidemiology 68
Special Projects and Studies 68
Interstate Problems 69
Pakistan Program 69
Residency Training 69
Revision of Regulations 69
Communicable Disease Information 70
Publications 70
Division of Dental Health 71
Fluoridation 71
Other Preventive Measures 71
Professional Resources 71
Disease Prevalence and Treatment Effectiveness 71
Community Dental Health Programs 72
Division of Venereal Diseases 73
Budget 73
Modus Operandi 73
Resume of Activities 74
State Cooperating Venereal Disease Clinics 76
Premarital Examination Law 77
Prenatal Syphilis Study 77
Education 77
Publications 79
Bureau of Institute of Laboratories
Division of Biologic Laboratories 80
Antitoxin and Vaccine Laboratory 80
Blood Laboratory 81
Special Services 82
National Institutes of Health 82
Division of Diagnostic Laboratories 85
Diagnostic Laboratory 85
Bacteriological Laboratory 85
Wassermann Laboratory 86
Bureau of Hospital Facilities
Division of Hospital Facilities 88
Licensure 88
Hospital Survey and Construction 92
Bureau of Tuberculosis and Institutions
Division of Sanatoria and Tuberculosis 97
Departmental Institutions 98
Bureau of Environmental Sanitation
Division of Sanitary Engineering
Routine Work Ill
Special Activities 112
Legislative Investigations 112
Water Resources Board 112
State Reclamation Board 1 12
Civil Defense 113
Water Supply Section 115
Special Activities 115
Water Shortages 115
Public Water Supplies 115
Consumption of Water 118
Fluoridation of Public Water Supplies 120
Climatological Data: Precipitation 121
Cross Connections 122
P.D. 34 v
Community Sanitation 123
Camp Sanitation 123
Housing 123
Refuse and Garbage 124
Lockups ! 124
Nuisances 125
Cemeteries 125
Local and State In-Service Training 125
Insect and Rodent Control 125
Home Accident Prevention 126
Atmospheric Pollution Control and Radiological Health Section 126
Division of Smoke Inspection 128
Water Pollution Control 130
Examination of Rivers 130
Cooperation with the Public Health Service 131
Prevention of Stream Pollution 131
Municipal Sewage Treatment Plants 132
Shellfish 132
Lawrence Experiment Station 134
Chemical Research 137
Bacterial Research 138
Shellfish Research 140
Sewage Treatment Research 142
Industrial Wastes 145
Training Activities 148
Radiological Studies 148
Plumbing Laboratory 148
Division of Food and Drugs 150
Emergency Duties 152
New Developments in the Food Industry 153
Frozen and Pre-Cooked Foods 153
Slaughtering 153
Slaughterhouses 153
Poultry Slaughtering 154
Registration of Food Processors 154
Drug Abuses 154
Harmful Drugs 154
Harmful Drug Law Revamped 155
Law Enforcement 155
Chemicals in Food 156
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH
July 1, 1956
Commissioner of Public Health, Samuel B. Kirkwood, M.D.
Public Health Council
Samuel B, Kikkwood, M.D., Chairman
Gordon M. Faik, B.S., Dr. Ing., 1956-62 Raymond L. Mutter, 1947-59
William H. Griffin, D.M.D., 1945-57 Conrad Wesselhoeft, M.D., 1953-60
Paul J. Jakmauh, M.D., 1949-61 Charles F. Wilinsky, M.D., 1946-58
Florence L. Wall, Secretary
Bureau of Administration
Leon A. Bradley, Ph.D., Bureau Chief
Division of Administration . Leon A. Bradley, Ph.D., Director
Division of Health Information . Louis Cohen, M.D., Dr.P.H., Director
Bureau of Health Services
Robert E. Archibald, M.D., M.P.H., Bureau Chief
Division of Local Health Services Robert E. Archibald, M.D., M.P.H.,
Director and Deputy Commissioner
Division of Maternal and Child
Health Services . . . . R. Gerald Rice, M.D., M.P.H., Director
Bureau of Hospital Facilities
A. Daniel Rubenstein, M.D., M.P.H., Bureau Chief
Division of Hospital Facilities . A. Daniel Rubenstein, M.D., M.P.H.,
Director
, Bureau of Preventive Disease Control
Herbert L. Lombard, M.D., M.P.H., Bureau Chief
Division of Cancer and Chronic
Disease Herbert L. Lombard, M.D., M.P.H., Director
Division of Communicable Diseases Roy F. Feemster, M.D., Dr.P.H., Director
Division of Venereal Diseases . Nicholas J. Fiumara, M.D., M.P.H.,
Director
Division of Dental Health . . William D. Wellock, D.M.D., M.P.H.,
Director
Division of Alcoholism . . James B. Maloney, M.D., Director
Bureau of Environmental Sanitation
Clarence I. Sterling, Jr., C.E., Bureau Chief
Division of Sanitary Engineering Clarence I. Sterling, Jr., C.E., Director
Division of Food and Drugs . George A. Michael, Director
Bureau of Tuberculosis Control
William H. Weidman, M.D., Bureau Chief
Division of Sanatoria and
Tuberculosis .... William H. Weidman, M.D., Director
P.D. 34
Bureau of Institute of Laboratories
Johannes Ipsen, M.D., M.P.H., Bureau Chief
Division of Biologic Laboratories James A. McComb, D.V.M., Director
Division of Diagnostic Laboratories Robert A. MacCready, M.D., Director
District Health Officers under Division of Local Health Services
Southeastern District .
Lakeville State Sanatorium
Middleboro
Northeastern District .
North Reading State Sanatorium
North Wilmington
Central District ....
Rutland State Sanatorium
Rutland
Western District ....
University of Massachusetts
Amherst and
246 North Street, Pittsfield
Grace E. Lutman, M.D.
Frederick A. Dunham, M.D.
Arthur E. Burke, M.D.
Walter W. Lee, M.D.
Institutions under Division of Sanatoria and Tuberculosis
Lakeville State Sanatorium
North Reading State Sanatorium
Rutland State Sanatorium .
Westfield State Sanatorium
Pondville Hospital
Lemuel Shattuck Hospital .
Massachusetts Hospital School
Harry A. Clark, M.D., Superintendent
Clair W. Twinam, M.D., Superintendent
Paul Dufault, M.D., Superintendent
Wilson W. Knowlton, M.D., M.P.H., Supt.
George L. Parker, M.D., Superintendent
William H. H. Turville, M.D., Supt.
John J. Carroll, M.D., Superintendent
Wbt Commontoealtf) of ifflas&acfjusiette
CONSOLIDATED REPORT
of the
DEPARTMENT OF PUBLIC HEALTH
for the
FISCAL YEARS 1950 THROUGH 1956
REPORT OF THE PUBLIC HEALTH COUNCIL
Personnel
On July 1, 1949, the Public Health Council was constituted as follows:
William H. Griffin, D.M.D., Boston '
Gordon Hutchins, Concord
Paul J. Jakmauh, M.D., Milton
Francis H. Lally, M.D., Milford
Raymond L. Mutter, Holyoke
Charles F. Wilinsky, M.D., Brookline
It is with deep regret that we record the death on August 4, 1953, of Dr. Francis
H. Lally, who served the Commonwealth faithfully as a member of the Public
Health Council since 1924. At a meeting on August 25, 1953, the Council adopted
the following resolution expressing the loss to the Department in Dr. Lally 's death:
In Memoriam
Whereas, God in His Infinite Wisdom has called from our midst to his
eternal rest our good friend for many years and fellow member of the Public
Health Council, Francis H. Lally, M.D., and
Whereas, his friends and associates feel a deep sense of personal loss in
the death of one who did so much to help further the health and welfare of
the people of the Commonwealth by his service on the Public Health Council
for twenty-nine years, and
Whereas, in our many contacts with him we were privileged to have an
insight into his qualities of tact, integrity, and devotion to high ideals, and
Whereas, he gave of himself and his time unselfishly and willingly in order
that the people of this Commonwealth might benefit from his wisdom;
Therefore, Be It Resolved: That this expression of great loss be
written on the records of the Department of Public Health in the minutes of
August 25, 1953, and that a copy of this resolution as well as a message of
deep sympathy be forwarded to his family.
Dr. Conrad Wesselhoeft of Boston was appointed in December, 1953, to fill Dr.
Lally's unexpired term, and in May, 1954 Dr. Wesselhoeft was reappointed for a
complete six-year term.
Dr. Griffin, Dr. Wilinsky, Mr. Mutter, and Dr. Jakmauh were reappointed for
six-year terms in 1951, 1952, 1953, and 1955, respectively.
In May, 1950 Mr. Paul F. Flaherty of Boston was appointed as a member of the
Public Health Council in place of Mr. Gordon Hutchins, whose term had expired.
Professor Gordon M. Fair of Cambridge was appointed in May, 1956 in place of Mr.
Flaherty, whose term expired.
Under General Laws, Chapter 17, Section 3, the Commissioner of Public Health
is ex officio a member of the Public Health Council and serves as Chairman.
4 P.D. 34
In February, 1956 Miss Florence L. Wall completed twenty years' service as
Secretary to the Public Health Council. Miss Wall continues in her position, but in
view of the distinction of having served in this capacity under four commissioners
the Public Health Council at its meeting on February 14, 1956 gave suitable rec-
ognition to this service.
On June 30, 1956 the membership of the Public Health Council was as follows :
William H. Griffin, D.M.D., Boston, 1945-57
Charles F. Wilinsky, M.D., Brookline, 1946-58
Raymond L. Mutter, Holyoke, 1947-59
Conrad Wesselhoeft, M.D., Boston, 1953-60
Paul J. Jakmauh, M.D., Milton, 1949-61
Gordon M. Fair, B.S., Dr. Ing., Cambridge, 1956-62
Meetings
Regular monthly meetings of the Public Health Council were held in accordance
with General Laws, Chapter 17, Section 3, usually at the State House, Boston.
Some meetings were held at the institutions under the jurisdiction of the Depart-
ment. Such visits are planned in rotation, so that each institution is visited about
once every three years. This practice allows the Council members to familiarize
themselves with the individual programs of each hospital and to inspect the physical
facilities for the care of the patients and for maintenance and housekeeping. During
the period of this report, Council meetings were held at North Reading State Sana-
torium in 1949 and 1952; at Lakeville State Sanatorium in 1950, 1952 and 1953; at
Westfield State Sanatorium in 1950, 1952, and 1953; at Rutland State Sanatorium
in 1952; at Pondville Hospital in 1951 and 1954; at Lemuel Shattuck Hospital in
1955; and at Massachusetts Hospital School in 1956. When visiting the institutions,
the Council gave particular attention to preparations for civil defense, including
facilities for storage of litters, auxiliary pumps, generators and other supplies, and
emergency accommodations should an evacuation of patients and staff become
necessary.
In addition to its regular monthly meetings, it was necessary for the Council to
meet to hold public hearings, to meet jointly with the State Advisory Council on
the Administration of the Hospital and Medical Facilities Survey and Construction
Act, or to consider new activities and responsibilities added to the Department from
time to time, usually by legislative act. A special meeting was held in March, 1953
to join with the Special Commission on the Structure of State Government in a
public hearing to consider the recommendations of that Commission relative to the
Department of Public Health.
Because of the desire of the Council members to become as familiar as possible
with all public health activities in the Commonwealth, the Council continued the
practice established several years ago of holding certain meetings each year in
sections of the State away from Boston to consult with local health officials or to
view public health installations of various kinds.
In July, 1949 conferences were held with the County Commissioners of Nan-
tucket, who also constitute the Board of Selectmen and Board of Health. Matters
of sanitation, a proposed regulation for pasteurized milk, and the conduct of im-
munization clinics were discussed. Inspections were made of the privately owned
and municipally owned water supply systems and sewage disposal works. Five
years later, in September, 1954, the Council again met at Nantucket with the
Board, and discussed particularly the polio situation at Nantucket, programs for
vaccination and inoculation of school children, sanitation, and food handling. With
the Hospital Trustees and Superintendent the present buildings housing the Nan-
tucket Cottage Hospital were inspected, and the site of the proposed hospital was
viewed.
In Barnstable County in July, 1950 the County Health Officer met with the Public
Health Council to discuss his local problems, and with him the Council viewed
public health facilities, including sanitation and food handling at the National
P.D. 34 5
Guard Encampment at Wellfleet, and the water supply of Provincetown. A meet-
ing was held at the Cape Cod Hospital at Hyannis and on the following day at
Barnstable County Sanatorium at Pocasset.
In August, 1950, in cooperation with the Division of Marine Fisheries, an in-
spection was made of the sewer outlets and sources of pollution along the north
shore of Massachusetts. The Council met again in Gloucester in August, 1953 and
inspected the site of the new Putnamville Reservoir of the Salem-Beverly water
supply and the water filtration plant on Wenham Lake.
In Franklin, Berkshire, and northern Worcester Counties in June, 1951, inspec-
tions were made of the sanitary condition of the Westfield, Housatonic, and Millers
rivers, the Pittsfield water supply, and the Lee sewage treatment works. Con-
ferences were held with the Mayor of Pittsfield, the Commissioner of Public Works
of Pittsfield, and officials of the Athol Hospital. An inspection was made of the new
municipal incinerator at Pittsfield, one of the most effectively operated in this
section of the country. The source of water supply for the town of Bernardston, a
dug well, a most unusual source of town water supply, was visited.
In July, 1951 the Council met at the Woods Hole Oceanographic Institute, where
members of the scientific staff explained their studies on shellfish and other forms of
marine life; on Martha's Vineyard the Council inspected certain shores to observe
the effects of certain tidal conditions, and held conferences with representatives of
the Board of Selectmen.
At the invitation of Dr. Charles F. Wilinsky, a member of the Public Health
Council and Executive Director of Beth Israel Hospital, Boston, the Council held
its March, 1951 meeting at that hospital. Under Dr. Wilinsky's guidance the
Council visited various departments of the hospital, inspected the facilities for in-
patient and out-patient care, and viewed the work being done at the new Yamins
Research Memorial Laboratory for surgical research.
On September 28, 1955, at the invitation of Dr. Kenneth I. E. Macleod, Director,
Nashoba Associated Boards of Health, the Council met in the towns of Ayer and
Harvard in connection with the observance of the twenty-fifth anniversary of this
association. Representatives of several of the sixteen towns included in the district
attended the meetings. The general programs of the Associated Boards, special
programs of the individual communities, and a general outline of the history of the
Associated Boards of Health were discussed.
At the Lawrence Experiment Station in June, 1956 a meeting was held for a two-
fold purpose: to hold a hearing on the revocation of a hospital license, and to pro-
vide an opportunity for the Council to inspect various aspects of the work done by
the Department at the Lawrence Experiment Station on the chemical and bacterio-
logical analyses of water, tests on sewage and industrial wastes, air pollution, radio-
activity, etc.
Annually, in June, meetings of the Public Health Council were held at Amherst
coincidentally with the Amherst Health Conference.
The Committee on Environmental Sanitation, composed of Dr. Jakmauh, Chair-
man, Mr. Mutter, and the Commissioner, has met regularly prior to the regular
Council meetings to study matters of sanitary significance and to prepare recom-
mendations on them for presentation to the full meeting of the Council.
General Duties
The regular duties imposed upon the Council by General Laws, Chapter 111,
Section 3, and other statutes have been carried out. These include the following:
the approval and licensing of hospitals, hospital blood banks, convalescent and
nursing homes, boarding homes for the aged, public medical institutions, city and
town infirmaries, dispensaries, and dental clinics which comply with the Depart-
ment's minimum standards; the certification of laboratories which have taken part
in the annual evaluations carried on by the Department's Institute of Laboratories
and have demonstrated their ability to perform satisfactorily the tests listed; ap-
proval of changes in health district boundaries; approval of the creation of new
divisions or changes in title of existing divisions within the Department; approval of
6 P.D. 34
professional personnel in the Department and at State and county sanatoria; ap-
proval of contracts between medical milk commissions and dairies for the production
and sale of certified milk; approval of food regulations of local communities which
submit them for approval under General Laws, Chapter 94, Section 146; advice to
cities and towns and official agencies on sanitary problems of water supply, sewage
disposal, nuisances and offensive trades, and prevention of pollution of inland and
tidal waters; approval of out-of-state shellfish dealers who have been approved by
their respective state shellfish authorities and certified by the Public Health Service;
and contracts between the Commonwealth and municipalities and between two or
more counties or municipalities for the care of tuberculosis patients.
Heaeings
Public hearings required by statute were held by the Council on the following
matters : appeals from owners of hospitals or nursing homes from refusals of State or
local authorities to grant necessary approvals; appeals of owners of dairies from re-
fusals of local boards of health or inspectors to issue licenses or permits to sell milk;
and on regulations before approval.
In addition, under authority of Chapter 152 of the Acts of 1946, certain division
directors have been authorized by the Council to hold certain public hearings. The
Directors of Sanitary Engineering, of Food and Drugs, and of Hospital Facilities
have been so designated from time to time. The information presented at these
hearings was submitted to subsequent meetings of the Public Health Council for
action. This method has eliminated the necessity of holding a good many extra
Council meetings, with a consequent saving in time to the Council members and in
expense to the Commonwealth.
Hospital Survey and Construction
Applications from hospitals for financial assistance from Federal funds allotted
to the Commonwealth by the Surgeon General under the Federal Hospital and
Medical Facilities Survey and Construction Act, after approval by the State Ad-
visory Council, have been considered periodically. During this seven-year period
allocations of Federal funds have been granted to about 70 hospitals for new build-
ings, alterations, additions, or equipment.
Annually the revision of the Massachusetts State Plan for the administration of
this act has been studied and approved.
Regulations
Rules and regulations relative to the following matters have been approved and
adopted :
Bakeries and bakery products
Purity and quality of food
Pasteurized milk and establishments for the pasteurization of milk
Milk and egg products
Protection of dietetic foods
Licensing of hospitals and sanatoria
Use of blood or other tissue for purposes of transfusion
Distribution of biologic products
Sale of surplus biologic products
Isolation and quarantine requirements
Physical examination of school children
Issuance of premarital medical certificates
Cancer clinics
Minimum housing rules and regulations
Cross connections between public water supplies and fire or industrial water
supplies.
In accordance with Chapter 576 of the Acts of 1951, which requires that a public
hearing be held relative to rules and regulations which contain a penalty clause
or are made under a statute containing such a clause, wherever applicable such a
public hearing was held prior to the adoption of regulations.
A complete list of rules and regulations adopted by the Department since 1914
and still in effect is included under the report of the Commissioner of Public Health.
P.D. 34 7
REPORT OF THE COMMISSIONER OF PUBLIC HEALTH
Office of the Commissioner
After several years with the Department in various positions, the last ten as
Commissioner of Public Health, Dr. Vlado A. Getting left the Department in May,
1953 to accept a position as Professor of Public Health Practice at the University of
Michigan and as Consultant to the Detroit Health Department. The ten years of
his commissionership in Massachusetts covered a period of changing public health
practices. Dr. Getting not only made valuable contribution to progress in this field
within Massachusetts, but distinguished himself as one of the outstanding state
health officers of the country, and became a recognized leader in public health.
Dr. Samuel B. Kirkwood was appointed to the position of Commissioner of
Public Health and assumed the duties of this position on May 8, 1953.
Dr. Alton S. Pope retired from the Department on September 30, 1954, after
serving for more than twenty-five years as Director of Tuberculosis and Sanatoria.
During the last seventeen of these years he was also Deputy Commissioner. I
should like to record the sincere and deep thanks of the Department for Dr. Pope's
long and faithful service in the field of public health.
Reorganization of the Department
Early in 1949 the Department was reorganized by grouping all divisions and
sections into four bureaus, each bureau chief to assume responsibility for a specific
segment of the Department's functions, and to be directly responsible to the Com-
missioner. These bureaus were Environmental Sanitation, Preventive Medicine,
Tuberculosis and Sanatoria, and Administration.
After considerable study based on experience under the above organization it was
found advisable to enlarge the number of bureaus within the Department from four
to seven to permit a better grouping of functions and distribution of executive re-
sponsibility. This plan of reorganization was approved by the Public Health
Council on April 12, 1955 and was put into effect at the beginning of the 1956 fiscal
year, July 1, 1955. At the present time the Department is functioning through
these seven bureaus:
Bureau of Administration
Commissioner's Office
Division of Administration
Fiscal Section
Personnel Section
Legal Section
Division of Training and Research
Division of Health Information
Bureau of Environmental Sanitation
Division of Sanitary Engineering
Division of Food and Drugs
Bureau of Preventive Disease Control
Division of Cancer and Chronic Disease
Division of Communicable Diseases
Division of Dental Health
Division of Alcoholism
Bureau of Health Services
Division of Local Health Services
District Health Offices
Civil Defense
Nursing
Social Work
Nutrition
Division of Maternal and Child Health Services
Bureau of Hospital Facilities
Division of Hospital Facilities
8 P.D. 34
Bureau of Tuberculosis and Institutions
Division of Sanatoria and Tuberculosis
Bureau of Institute of Laboratories
Division of Biologic Laboratories
Division of Diagnostic Laboratories
The Division of Administration, the first division to be created within the De-
partment, on December 14, 1915, had been under the direct supervision of the
Commissioner until the creation of the position of Director of Administration,
which was filled by Leon A. Bradley, PhD. on February 8, 1955 to relieve the Com-
missioner of certain details and routine.
Staff Conferences
Regular conferences have been held by the Commissioner with his bureau chiefs
every Monday morning. On the first Monday of each month all division directors
participated in these conferences, and on the first Monday of each quarter the meet-
ings included also district health officers, institution superintendents, and section
heads.
Department staff meetings have been held either annually or semiannually and
have included as many members of the entire Department staff as possible.
Department Headquarters
The need for increased and unified headquarters for the Department has remained
a serious problem. During the past few years the Department has expanded greatly,
and the number and complexity of programs have increased, resulting in a demand
for more personnel and an increase in the duties of existing personnel. These added
responsibilities have intensified the already critical housing condition of the De-
partment. Additional quarters are urgently needed, either by renting or construct-
ing a suitable building. At present, Department offices, exclusive of the laboratories,
are scattered in six different buildings in Metropolitan Boston outside the State
House. Nowhere in the present quarters are there adequate and safe storage facil-
ities for the vital permanent records of the Department. The overcrowded and
scattered offices do not permit residents of the Commonwealth, physicians, members
of local boards of health, or members of the General Court to find personnel readily
for conference or advice on specific public health matters. Adequate space in a single
building would save money, utilize personnel more effectively, and permit more
efficient and adequate service.
In 1950 and 1951 partial consolidation of the Department's laboratories was ac-
complished by uniting the laboratories in Jamaica Plain into the Institute of Lab-
oratories. Efforts are being made to provide additional laboratory buildings at this
site. In 1954, the Water and Sewage Laboratories, which were located on the fifth
floor of the State House for many years, were transferred to the new building hous-
ing the Lawrence Experiment Station, so that the bacteriological and microscopical
analyses are now performed under the same roof as the chemical analyses.
Approving Authority for Medical Schools
The Approving Authority for Medical Schools, consisting of the Secretary of the
Board of Registration in Medicine, the Commissioner of Public Health, an osteo-
pathic member of the Board of Registration, and a layman, determines those medical
schools whose graduates may become candidates for registration in the practice of
medicine in Massachusetts. After hearings by the Approving Authority the follow-
ing schools were approved during the period of this report :
Southwestern Medical School
Chicago Medical School
University of Toronto
Stritch College of Medicine of Loyola University
University of Georgia Medical School
Dalhousie Medical School of Nova Scotia
Trinity College School of Physic, Dublin
P.D. 34 9
Bowman Gray School of Medicine, Lake Forest College,
Winston-Salem, North Carolina
University of Montreal
Kansas City College of Osteopathy and Surgery
University of London
University College, Dublin
University College, Galway
University College, Cork
University of Oxford, England
Cambridge University, England
University of Zurich, Switzerland
University of Basle, Switzerland
American University of Beirut
University of Copenhagen
Chicago College of Osteopathy
Chapter 759 of the Acts of 1955, entitled An Act Relative to Schools for the Train-
ing of Medical Laboratory Technologists, provided for three additional members of
the Approving Authority to act for the purposes of Chapter 759 only. These three
additional members include a hospital administrator or trustee and member of the
Massachusetts Hospital Association, an adequately trained and experienced lab-
oratory technologist, and a physician appointed from a list submitted by the
Section of Physiology and Pathology of the Massachusetts Medical Society.
Medical Panels
General Laws, Chapter 32, Section 6, as amended, directs the Commissioner of
Public Health to appoint chairmen of medical panels to review applications and
examine State and municipal employees applying for disability retirement. The
chairman, insofar as possible, must be a physician skilled in the particular branch
of medicine or surgery involved in the case; the other two members of the panel are
selected by the applicant and by the local retiring authority. By direction of
Chapter 181 of the Acts of 1952, all three members of the medical panel must con-
duct the examination in the presence of each other, but their findings are arrived at
independently of one another. Since 1951 the number of applications processed by
the Department each year has averaged 825.
In addition to medical panels for applicants for disability retirement, upon ap-
plication by the widow of a fireman or policeman for an annuity the Department
under General Laws, Chapter 32, Section 89 designates the third member of a board
to determine whether or not the death of said fireman or policeman was the result
of an injury received in the performance of his duty. Such requests average from
40 to 50 per year.
Rating Board
As Chairman of the Rating Board, created by General Laws, Chapter 32, Section
6, the Commissioner presided at hearings and interviewed applicants from the
uniformed branch of the State Police applying for retirement because of illness or
injury received in line of duty. After examination of the applicants and review of
their records, recommendations relative to retirement were made by the Board.
The annual average number of such applications was about seven.
Building and boiler inspectors of the Department of Public Safety and State
Police detective lieutenants upon reaching the age of 55 or completing 20 years of
service must have an annual physical examination to determine their fitness to
continue working to the compulsory retirement age of 65. In this group about nine
were annually examined by the Rating Board.
Milk Regulation Board
The Milk Regulation Board, consisting of the Chairman of the Milk Control
Board, the Commissioner of Agriculture, the Attorney General, and the Commis-
10 P.D. 34
sioner of Public Health, has held several meetings each year, attended by the Com-
missioner of Public Health or the Director of the Food and Drugs Division as his
representative.
Council for the Aging
The Council for the Aging was created by Chapter 591 of the Acts of 1955 and
consists of the Commissioners of Education, Mental Health, Public Health, Public
Welfare, and Labor and Industries, and four members appointed by the Governor.
This council acts in an advisory and consultative capacity, with the general objective
of coordinating the several State departments' programs designed to meet the prob-
lems of the aging and also to assist and coordinate such activities at community
levels.
State Planning Board
During the early part of the period covered by this report the Department was
represented at all regular meetings of the State Planning Board by the Commissioner
or by a member of the Division of Sanitary Engineering. The final meeting of this
board was held on April 30, 1953, when the State Planning Board was abolished and
its powers and duties were transferred to the Division of Planning of the newly
created Department of Commerce.
The activities of this board of greatest interest to the Department of Public
Health were:
(1) The study relating to development of improved recreational facilities at
ocean beaches.
(2) The work under Chapter 134 of the Acts of 1952, requiring that local boards
of health approve all real estate subdivisions before final approval by the
local planning board, aimed at eliminating the difficulties which have oc-
curred in real estate developments where no sewerage facilities exist and
where subsoil conditions are unsuitable for local sewage disposal.
(3) A complete aerial survey of the Commonwealth, including maps of critical
target areas for Civil Defense activities.
(4) Maps of primary and secondary roads, population densities, critical
target areas, and casualty centers, prepared for the State Civil Defense
Agency.
(5) A study by engineers of the Planning Board of all inland bathing beaches
in the Commonwealth.
Regulations
The following rules and regulations have been promulgated by the Department
and are still in effect :
Distribution of biologic products
Adopted 4/9/35; amended 5/14/40; 1/11/49; 12/15/53
Sale of surplus biologic products
Adopted 4/12/49; amended 12/15/53
Use of blood or other tissues for purposes of transfusion
Adopted 1/10/39; amended 4/10/39; 10/7/41; 11/4/41; 9/14/48; 3/11/52;
6/12/56
Cancer clinics and service unit values
Adopted 8/10/26; amended 6/14/27; 3/13/28; 1/5/35; 9/14/43; 10/5/43;
11/11/43; 12/14/43; 4/11/44; 1/14/47; 10/18/55
List of diseases dangerous to public health
Adopted 1907; amended 12/15/14; 12/14/15; 2/16/17; 4/3/17; 12/18/17;
10/29/18; 11/18/20; 12/8/21; 9/18/28; 6/11/35; 12/10/35; 11/10/36; 2/14/39;
5/1/41; 5/12/42; 4/14/43; 10/5/43; 12/14/43; 1/11/44; 11/3/48
P.D. 34 11
Diseases declared to be dangerous to the public health and reportable
Adopted 1907; amended 12/15/14; 12/14/15; 2/16/17; 4/3/17; 12/18/17;
10/29/18; 11/18/20; 12/8/21; 9/18/28; 6/11/35; 12/10/35; 11/10/36; 2/14/39;
5/1/41; 5/12/42; 4/14/43; 10/5/43; 12/14/43; 1/11/44; 11/3/48
Isolation and quarantine requirements of diseases declared to be dangerous to public
health
Adopted 8/9/38; amended 5/13/41; 1/11/44; 11/3/48; 8/12/52
Transportation of bodies dead of diseases dangerous to public health
Adopted 7/12/38; amended 8/9/38; 2/14/39
Funerals of persons dead of any disease dangerous to public health
Adopted 8/9/38; amended 5/13/41; 1/11/44
Cremation
Adopted 12/5/07; amended 10/29/18
Treatment of persons exposed to rabies
Adopted 8/10/37; amended 5/13/41
Approval of bacteriological and serological laboratories
Adopted 9/12/39
Use of a common drinking cup
Adopted 3/22/16
Use and concerning the providing of a common towel
Adopted 12/16/15; amended 3/22/16
Approval of lodging houses
Adopted 7/6/05
Barbering and barber shops
Approved 12/6/49
Cross connections between public water supplies and fire and industrial water
supplies
Adopted 2/9/37; amended 5/12/42; 10/9/51
To prevent pollution or contamination of any or all of the lakes, ponds, streams,
tidal waters, and flats within the Commonwealth or of the tributaries of such
tidal waters and flats
Adopted 8/14/45; amended 10/14/45
Supervision of plumbing
Adopted 6/11/35; amended 8/6/40; 1/10/50; 5/8/56
Minimum standards of fitness for dwellings
Adopted 12/6/49; 3/8/55
Operation of plants for the purification of shellfish
Adopted 6/5/28; amended 10/7/41
Enrichment of flour, white bread and rolls
Adopted 11/3/48
Establishing grades of milk
Adopted 5/8/35; amended 11/17/48; 6/12/56
Egg Nog
Adopted 6/12/56
Flavored milk
Adopted 6/12/56
Sale of rabbits intended for food purposes
Adopted 5/14/29
Governing the business of cold storage, made under the provisions of General Laws,
Chapter 94, Section 67
Adopted 10/10/33
12 P.D. 34
Sterilization of feathers, down, and second-hand material intended for use in the
manufacture of articles of bedding and upholstered furniture
Adopted 11/12/35
Making of each article of bedding and upholstered furniture
Adopted 12/10/30; amended 11/12/35
Manufacture and bottling of carbonated non-alcoholic beverages, soda water,
mineral, and spring water
Adopted 11/12/35; amended 4/7/36
Uncarbonated fruit beverages
Adopted 5/8/36
Business of slaughtering and meat inspection
Adopted 7/9/31; amended 12/10/35; 9/14/43
Poultry slaughterhouses
Adopted 9/14/43; amended 8/6/46
Approval of contracts for the production and distribution of certified milk
Adopted 10/14/36
Frozen desserts and ice cream mix
Adopted 9/11/34; amended 5/8/56
Bakeries and bakery products
Adopted 2/14/33; amended 1/10/50
Definition of pasteurized milk
Adopted 7/8/41; amended 11/4/41; 6/15/50
Establishments for pasteurization of milk
Adopted 2/12/35; amended 6/15/50; 10/20/53; 6/12/56
Standards and definitions of purity and quality of food
Adopted 2/9/37; amended 5/8/56
Pork products intended to be eaten without cooking
Approved 2/12/24
Dietetic foods
Adopted 5/12/53
Licensing of hospitals and sanatoria
Adopted 4/14/42; amended 2/9/43; 12/14/43; 3/14/50
Licensing of boarding homes for the aged
Adopted 11/3/48
Licensing of convalescent and boarding homes
Adopted 11/3/48
Dispensary license
Adopted 1/12/19; amended 5/13/19; 5/10/38
Dental clinic license
Adopted 8/10/43
General rules for police station houses, lock-ups, houses of detention, jails, houses of
correction, prisons, and reformatories
Adopted 1910; amended 4/8/30; 6/15/48
To establish standards for tuberculosis hospitals and sanatoria
Adopted 6/14/27; amended 6/5/28; 8/12/32; 1/17/39; 5/10/38; 10/21/48
Obtaining state subsidy
Adopted 5/11/20; amended 6/5/28; 2/14/33; 3/13/34
Minimum requirements for tuberculosis dispensaries as defined by the Department
of Public Health
Adopted 4/6/15; amended 7/11/16; 11/7/19; 7/14/25; 4/11/33
Minimum requirements for uniform dispensary record system
Adopted 7/14/25
P.D. 34 13
Governing the hospitalization of patients with chronic rheumatism
Adopted 5/8/45
Reporting and control of venereal diseases
Adopted 12/18/17; amended 5/12/18; 6/11/18; 3/11/19; 11/12/23; 10/1/25;
10/8/29; 1/14/30; 1/14/36; 8/9/38; 4/11/44; 11/3/48
Treatment of persons suffering from venereal diseases who are unable to pay for
private medical care
Adopted 2/14/33; amended 8/10/37; 8/9/38; 9/12/39; 11/6/40; 4/13/48;
11/3/48
Issuance of premarital medical certificates
Adopted 4/11/50
Approved prophylactic remedy for use in the eyes of infants at birth
Adopted 5/12/36
Physical examination of school children
Adopted 3/11/52; amended 8/25/53; 3/9/54; 2/14/56
Labeling of receptacles containing Benzol (Benzene), Carbon Tetrachloride and
other harmful substances [approved jointly with Department of Labor and In-
dustries)
Adopted 6/12/56
Regulations promulgated by Director of Marine Fisheries
Approved for sanitary requirements 4/13/42
Legislation
Annually laws are enacted by the General Court conferring additional responsi-
bilities on the Department. Summaries of the work entailed by these additional
duties are included in the reports of the individual divisions concerned. Similarly,
resolves have been passed providing for special investigations to be made by the
Department individually or jointly with other departments.
Following is the legislation submitted by the Department to the 1957 session of
the General Court:
1. An Act Authorizing the Department of Public Health to Establish a Sanitary
Code. This bill is recommended to fill the great need for integrated legislation in this
field. It will eliminate the massive confusion respecting statutory law, rules and
regulations and policy.
2. An Act Requiring Approval from the Department of Public Health Before
the Commissioner of Corporations and Taxation Issues a Charter of Incorporation
for any Corporate Purpose "Which Requires a License from the Department of
Public Health. This legislation is proposed to coordinate the actions of the Depart-
ment of Public Health and the Commissioner of Corporations in the specialized in-
stances where a corporation will require a license from the Department of Public
Health.
3. An Act Relative to the Keeping of Records by Hospitals, Dispensaries or
Clinics, Sanatoria, Convalescent or Nursing Homes, Infirmaries Maintained in
Towns, and Boarding Homes for the Aged. This legislation is needed to protect
the public who are treated or boarded at these licensed institutions. It corrects an
omission in section 70 of Chapter 111 of the General Laws which was noted by
the last legislature.
4. An Act Relative to Recording and Making a Report of Births. Under the
present law, a vital statistic is not required, namely the weight of the child at birth,
because of the invalid and statistically inaccurate notion that it would reveal con-
ception before marriage in some instances. Public health specialists consider weight
as an important factor in their compilations.
5. An Act Relative to the Facts to be Recorded by City and Town Clerks Rela-
tive to the Definition of a Live Birth. This legislation is proposed to define what a
"live birth" is. The present statute has no definition.
14 P.D. 34
6. An Act Relative to the Treatment of Chronic Diseases at Lakeville State
Sanatorium. This legislation is proposed to permit patients with chronic diseases to
be admitted to the Lakeville State Sanatorium.
7. An Act Relative to Admissions, and So Forth, at Lemuel Shattuck Hospital,
Pondville Hospital, and Westfield State Sanatorium. The Department of Public
Health offers this legislation so that its institutions will have conformity in the
policy of admissions.
8. An Act Providing for the Admission of Persons with a Chronic Disease to
County Tuberculosis Hospitals Under Certain Circumstances. This legislation is
needed because of the diminishing numbers of patients admitted into county tuber-
culosis hospitals and the increasing numbers of hospital beds needed for the treat-
ment of chronic diseases.
9. An Act Authorizing Admissions to County Tuberculosis Hospitals of Persons
Afflicted with Chronic Disease and Concerning Charges Thereof. This legislation is
needed because of the diminishing numbers of patients admitted into county tuber-
culosis hospitals and the increasing numbers of hospital beds needed for the treat-
ment of chronic diseases. This amendment would extend the statute respecting
charges for admissions of tubercular patients and make it applicable to the admis-
sion of chronic disease patients.
10. An Act Respecting Emergency Admissions to County Tuberculosis Hospitals
for Persons Afflicted with Pulmonary Tuberculosis or a Chronic Disease. This
legislation is needed because of the diminishing numbers of patients admitted into
county tuberculosis hospitals and the increasing numbers of hospital beds needed
for the treatment of chronic diseases. This amendment would extend the statute
respecting charges for admissions of tubercular patients and make it applicable to
the admissions of chronic disease patients. This covers emergency admissions.
11. An Act Relative to Admissions to Rutland State Sanatorium and Westfield
State Sanatorium. This legislation would eliminate the requirements of six months'
residence for admissions to these hospitals. The availability of beds and the vital
need for hospitalization far outweigh any requirement of residence which would be
advantageous to the Commonwealth.
12. An Act Relating to Charges for Support at State Sanatoria. This legislation is
proposed to eliminate the complex bookkeeping involved in the collection of unset-
tled cases, and particularly because the Department's experience has been that is
largely ineffectual in its efforts to get payments in these cases.
Future Possibilities in the Department
The seven years covered by this report have been interesting years. It has been
a confused period but a dynamic one through which many forces have surged,
deepening some old channels and obliterating others. No final pattern has ap-
peared; in no sense has 1956 seen the end of an era and the beginning of another.
At best, it can afford a brief pause to look about, and then push ahead.
As a result of many factors, some post-war, others of long standing, two significant
changes have appeared in the last decade.
The first is seen in the shift from simple and compartmented problems to those
much more complex, reaching at the same time into many phases of individual
and community life. Problems — and thereby their solutions — which formerly
fell into well defined pigeonholes now are seen as a fluid mixture of many elements
like the confluence of streams.
A second sign of the times is the appearance of a lay public much better informed
on health matters than ever before. Most significant of all, the public has wanted
to be better informed. It is taking keen interest individually and collectively in
problems of health, an interest that has never been equaled in previous times.
Specific problems are many and are indicators of these changes. Alcoholism is
now clearly recognized as a community question requiring many resources for
solution. Traffic and home accidents cannot be ignored as a major public health
issue, but at the same time this problem cannot be solved by health workers alone.
P.D. 34 15
If the aging population and chronic disease call for new therapy, it cannot be
confined to the hospital, for rehabilitation extends into every corner of community
life. Not all the long-known communicable diseases have been controlled, and the
large group of virus diseases continues to plague us. In our new means of control
of all these diseases, we have a public informed through many sources, which is
no longer satisfied by treatment but wants preventive action.
These changes represent the challenge of the future to the Health Department.
In the first place, they demand a degree of reorganization within the Department
itself. With a tradition of years, a department at any one time finds itself organ-
ized in somewhat static divisions which have grown up largely in relation to the
leading problems of the past. New, more complex, broad problems require a much
more fluid organization. Mechanisms must be found for increasing the flexibility
of the Department's structure. An answer lies partly in a regrouping of divisions
into larger units on a functional basis. The new organization, for instance, should
be sufficiently flexible to permit establishing a Division of Rehabilitation which
would include elements of many other divisions. Coordination of this type will
be a vital necessity. An increase in the number of coordinating departmental
committees or a heavier responsibility laid upon a single executive committee is
to be expected.
Just as within the Health Department such a reorganization lies ahead, so the
relation of the Department to other departments of the State Government will
change. The Health Department will be represented, and should be, on many
more ad hoc commissions, which are in themselves a response to the broader
problems of total community life.
A careful revaluation of the responsibilities and duties of the State Health
Department in relation to those of local health agencies must come. Here a some-
what paradoxical situation will rule. Although the increasing complexities of
community living call for mutual acceptance of some degree of centralized control,
the sense of home rule and local responsibility will and should continue to be
strong. In general the central authority should develop along the lines of a co-
ordinating body, establishing certain policies applying to all communities. A
central office, further, should strengthen its function as a resource agency, providing
experts for consultation with local health bodies and for study of specific situations
and problems. One of its most valuable contributions will be a continuing evalu-
ation of health services throughout the State. Out of all this will come its final
role of acting as a stimulant in the development of health programs.
Operation of most of these programs, however, would seem to be a local health
responsibility. So the problems of implementation will come to rest on the local
level, where the community situation is best known and best understood. How
much territory the local area should include will vary. This question must be
carefully scrutinized. There is a minimum size, a minimum population, which
can provide, from its own resources, satisfactory local health services. Each
community will be called upon by its own people to evaluate its own health services
objectively. If these are found wanting, the community must provide additional
means through cooperative action with neighboring cities and towns.
Against this background, certain health problems stand out clearly. Specialized
care must be provided for the aging and for sufferers from chronic disease. The
continuing needless deaths of mothers in childbirth and of infants prematurely
born and dying in the first weeks of life must be prevented. Disaster and accident
control must be developed. The newer aspects of tuberculosis control through
home treatment require evaluation. Facilities for sewage treatment and disposal
must be extended to meet the needs of industrial expansion and housing develop-
ments. Water resources must be increased to satisfy rapidly increasing demand.
Developments in the production and use of atomic energy present new health
hazards that must be controlled.
None of these problems can be met by a single simple solution.
One of the most immediate needs for the Health Department is the recruiting
and training of professional personnel at every level. Public health is a specialized
profession with many facets, calling for expertly trained individuals. It is an
16 P.D. 34
area in which competence can be attained only through hard work and continual
study. The Training Division of the Health Department will become one of its
most active and important sections.
Another duty of the Health Department in the coming years is to develop closer
association between the health officer, the local physician, and the layman in
coordinating efforts toward better individual and community health. All three
of them must aid in creating and maintaining a well informed public opinion on
health matters.
With this cooperation, public opinion on health subjects will rest, as it should,
on competent professional advice, with respect for the decisions of experts. The
community must then be willing to get out and work for the health services it
desires.
Respectfully submitted
Samuel B. Kihkwood, M.D.
Commissioner of Public Health
Gordon M. Fair Raymond L. Mutter
William H. Griffin Conrad Wesselhoeft
Paul J. Jakmauh Charles P. Wilinskt
Public Health Council
P.D. 34 17
BUREAU OF ADMINISTRATION
DIVISION OF ADMINISTRATION
Upon the reorganization of the Department of Public Health in 1914, a Division
of Records and Accounts was established. This division was renamed Division of
Administration on December 14, 1915, and there has been a Division of Administra-
tion under the direct supervision of the Commissioner of Public Health continuously
since that date. It was not until February 8, 1955 that Leon A. Bradley, Ph D.
was appointed to be the first Director of the Division of Administration. Dr.
Bradley was formerly the Head of the Department of Bacteriology and Public
Health at the University of Massachusetts. He came to the Department in 1950
to supervise its Field Training Program, and it was from the directorship of that
program that he was transferred to the Division of Administration.
There are three major activities of the Division; fiscal, personnel, and legal
affairs. The fiscal office formerly consisted of a business office and a fiscal office;
the former under the supervision of Mr. Louis A. Phaneuf and the latter under the
supervision of Mr. Thomas Mackey. Upon their retirement, Mr. Harry W. Attwood
became the first Assistant Director, Business Agent, a title and responsibility he has
maintained ever since. The fiscal office prepares the budgets, both State and Fed-
eral, under the direction of the Commissioner; is responsible for the execution of the
budgets in all details ; pre-audits and post-audits expenditures made by the Depart-
ment; prepares monthly reports for both Federal and State accounts; processes all
travel vouchers and State automobile accounts; and prepares payrolls for employees
of the Department.
The personnel section processes all requisitions for permanent, temporary, and
emergency employment ; cooperates with the Division of Civil Service in the prepar-
ation of posters for Civil Service examinations ; and maintains the personnel records
for the Department and its institutions.
The legal section follows all legislation pertaining to public health ; assists in the
preparation of bills to be introduced by the Department ; and generally advises on
all legal matters before the Department.
The funds of the Department come primarily from State appropriations and
Federal grants and to a lesser extent from private sources. The expenditures for
the year ending June 30, 1956 amounted to $7,955,727.33 ($1.64 per capita) for
institutional care and $5,469,922.93 ($1.13 per capita) for other public health
activities. All funds for institutional care are received from State appropriations.
Funds from Federal and private funds, amounting to $2,133,036.93, were expended
in the general program. This amount includes $930,468.80 expended for polio
vaccine purchased directly by the government for use in the Massachusetts program.
The Federal Government contributed 39 per cent of funds expended by the Com-
monwealth for health services, exclusive of institutional care.
It is interesting to note the increase in the number of employees in the Depart-
ment from the period of January, 1950 through June, 1956. On January 18, 1950
there were employed in our institutions 1246 persons. Since that time the Lemuel
Shattuck Hospital has been constructed and placed in operation, and the Depart-
ment has been charged with the operation of the Massachusetts Hospital School.
As of July 1, 1956 there were employed 2098 persons in our institutions. However,
849 were employed at the Lemuel Shattuck Hospital and the Massachusetts
Hospital School. The number of employees in other institutions as of July 1, 1956
was 1249, indicating that there has been very little change in employees at our
other institutions. The number of employees in the Department other than in
institutions has remained relatively constant in the figure just below 600. In
December, 1952 there were 591 employees, whereas in January, 1956 there were 588.
18 RD. 34
DIVISION OF TRAINING AND RESEARCH
The guided missile of public health is the trained worker. Direction must be
built in with power. This is not a new concept, and for many years the Division of
Training has been actively engaged in the training of local and Department per-
sonnel. It was not until 1950, however, that steps were taken to coordinate the
training activities of the various divisions and sections of the Department and to
expand the program to include supervised field experience for health officers,
nurses, medical social workers, health educators, and sanitation personnel.
The objectives of the Division of Training since 1950 have been:
(1) To provide pre-service and in-service training courses for all types of
public health workers associated with or employed by health agencies.
(2) To serve as an accredited field training unit for approved schools of public
health, medical social work, and public health nursing.
(3) To provide supervised field experience recommended as a component of,
or as a supplement to, academic instruction for other professional and sub-
professional groups.
(4) To be a research center for the development of administrative and organi-
zational patterns for training, special curricula, instruction techniques,
and evaluation practices.
The Division of Training is now prepared to serve not only as a coordinating
agency but to participate in the planning, preparation, and presentation of com-
prehensive training programs for employees of State and local health departments
and for students from colleges, schools, and universities who are preparing for
professional careers in the various public health specialties.
In 1950 a five-year grant from the W. K. Kellogg Foundation made it possible to
establish the New England Field Training Center at the University of Massachu-
setts, with assistance from the Communicable Disease Center of the Public Health
Service. The scope of field training was expanded to include not only sanitation
personnel but also public health physicians, nurses, and health educators. Field
training for medical social workers was also made possible through funds provided
by the Children's Bureau.
Perhaps the most significant trend responsible for the enlarged scope of the
training program has been the increasing demand for more highly specialized and
better trained workers in State and local health agencies. This meant that orienta-
tion and apprenticeship training must be extended beyond the Department to the
personnel of health agencies serving the public directly. Short courses, institutes,
seminars, clinics, and workshops have been established. In fiscal 1954-1955 a total
of 165 courses were given to 14 groups comprising 5279 persons. Visitors from
health departments and agencies throughout the country and abroad, new em-
ployees, and students of public health and preventive medicine received the benefits
of the expanded program.
In the field training area, students received supervised experience in local agencies,
and field teachers in these agencies attended refresher courses. Not only did the
trainees themselves benefit, but the agencies enjoyed a better trained and more
extensive instructional staff; both local health units and the Department were
aided in the recruitment of professional personnel. The intimate contact between
students, agency employees, and administrators helped in the subsequent place-
ment of trainees, especially in the field of environmental sanitation.
Other important developments in this period were the residency program for
career physicians in public health, which was approved by the American Medical
Association in 1951, and stipend assistance for full-time or part-time study in
various institutions by members of the Department and local health units. In
1952-1953, for instance, full-time study was carried on by two physicians, four
public health nurses, four medical social workers, two health educators, a sanitary
chemist, and a sanitarian; 15 other persons did part-time post-graduate study.
The orientation of foreign visitors served to extend the Department's influence
to the far corners of the world. Because of its importance as a world medical center,
P.D. 34 19
Boston attracts a large number of these visitors. They are sponsored and assigned
to the Department by the Division of International Health of the Public Health
Service, the World Health Organization, and other agencies participating in global
health programs. Itineraries are scheduled within the Department and with other
public health and medical facilities of the area. During the past year 48 of these
trainees have been channeled through this Department for less than two weeks
observation periods, and 22 for longer periods. Their varied interests required the
preparation and supervising of 38 different schedules in 14 fields of interest.
The Medical Social Training Project
One of the significant events of our time has been the recognition of social work
as a vital part of the public health effort. Massachusetts was the first state to add
this activity to its public health department. Special interest therefore attaches to
the Medical Social Training Project, which was established in 1949 through a grant
from the Children's Bureau, in cooperation with the three schools of social work in
Boston and the Harvard School of Public Health. The stated objective was to
increase interest in and knowledge of public health among social workers, and thus
to help in meeting the shortage of personnel for social work positions in public
health agencies.
Through this project academic training has been combined with supervised field
work. Its purposes include provision of accredited field experience and classroom
instruction for medical social work students, and of non-accredited field experience
and orientation for workers in service ; collaboration with the schools of social work,
participation in staff development, and cooperation with the Department's Section
of Social Work and Division of Training on special training projects. An important
feature of the Project's program has been provision of both district health offices
and institutions as areas for field experience.
From 1950 to 1955, accredited field work training was provided for 18 second-year
graduate students in medical social work (11 women and seven men), for one first-
year student, and for one student taking an advanced program. The students spent
three days a week in the field for nine months and attended classes the remaining
two days. Seven of these 20 students came from six different states outside of
Massachusetts and from Hawaii.
Field observation visits to districts and hospitals, varying from one day to a
month, were made by 164 students from the three schools of social work and the
Harvard School of Public Health, and by 25 social workers, an educator, and two
lay leaders in social work programs from five states and 14 countries. Three of
these visitors were medical social work faculty representatives from schools of
social work or public health.
20 P.D. 34
DIVISION OF HEALTH INFORMATION
Information and education in public health can be distinguished but not separ-
ated — they interfuse. In the early part of this period health education was
emphasized by the Division of Health Information. Health educators were assigned
to district offices and worked in local communities to stimulate formation of re-
gional health units; close relations were established with health educators in outside
official and voluntary organizations.
As time went on, however, the stress was thrown more and more on the collection
and distribution of information. Health education as such received less attention,
partly because of cuts in appropriations, but chiefly because of a lack of properly
trained and qualified personnel. It is true that in 1955 a health educator from the
central office was working in the Northeastern District, and another was helping to
promote the important Children's Accident Prevention Program of Greater New
Bedford. But the rest of the staff, although formally classed as health educators,
were actually specialists in communication of one kind or another. What the
Department needed — and was getting — was the assistance of a service division
which could aid in formulating, processing, and disseminating the information and
educational material emanating from the various bureaus and divisions.
Another vital function of the Division was that of effecting closer working rela-
tionships with the public health forces beyond the walls of the Department. This
might take the form of helping an executive secretary to develop a promotional
program, preparing a manuscript for a division head and getting it published in a
medical magazine, or putting together an exhibit for a convention.
History is more than the recording of events, and it is more important to five
history than to write it. Nevertheless, the events must be recorded. The outstand-
ing developments and achievements in our division were the following.
Personnel
Until 1950, health information was carried on by a section in the Division of
Administration, with a part-time head. In that year, a full-time chief was appointed
and a production expert was added to the staff. In 1952 the section became a
division, with a physician as its director. In succeeding years the staff was strength-
ened by acquiring a seasoned newspaperman, a skilled photographer, and an equally
skilled artist. In the spring of 1954 an editor with long experience was appointed to
take charge of manuscript preparation, write and edit reports, and assist with
publicity.
Services
Photography and Art Work
An outstanding joint accomplishment of the artist and photographer was a
television program on tuberculosis, prepared in collaboration with the Massachu-
setts Tuberculosis and Health League. The project involved over two months'
work and effected a large saving for the Department. This film was later used for
health education purposes throughout the State.
Art work included the development of exhibits, the originating of covers and
posters, the preparation of charts, graphs, and so forth, and the designing and
execution of brochures, flyers, and other audiovisual aids. The artist also acted as
technical consultant for the Department and allied agencies.
The photographer's primary function was to supply pictures for the Department's
publications. This involved documenting activities in private hospitals or State
institutions and field work by Department personnel. Photographs were prepared
for exhibits, television programs, news stories, Sunday rotogravure sections, and
syndicated magazines. Slides were produced for in-service training programs, for
general audiovisual purposes, and as part of the school health education program.
Library and Film Service
The library underwent improvements and received numerous additions. Its
services were extended to public health workers and physicians both within the
Department and from this country or abroad. Approximately 2000 requests for
P.D. 34 21
literature and information were received each year. Also, the librarian handled
hundreds of telephone calls from agencies and individuals needing information
or assistance.
The film service circulated about 1500 films yearly.
Publicity
Besides routine news releases to daily and weekly newspapers through the State,
radio and television contacts were made in special situations such as the polio
vaccine field trials of 1954 and the hurricane emergencies of 1954 and 1955. Closer
ties were established with the New England Journal of Medicine, the Harvard
School of Public Health, and the news services in the State House. A mailing list
of medical and public health organizations and periodicals was compiled for releases
of special significance.
Publications
In 1953 the weekly Public Health Bulletin Board made its appearance, incor-
porating the news formerly circulated in the Communicable Disease Bulletin, and
announcements and news items previously published in the Newsletter. In this same
year Newsletter was renamed Commonhealth and received a new format. The
editorial style of both these publications was improved and their mailing lists were
steadily enlarged. By 1955 the circulation of Commonhealth was about 4000,
including state health departments throughout the nation, and the weekly bulletin,
rechristened This Week in Public Health, was going to approximately 1400 individ-
uals and organizations in the State.
Distribution and Printing
Along with the usual mailing services, the Division assumed responsibility for the
annual State-wide distribution of school health record forms — a burden previously
borne by the Division of Maternal and Child Health. Routine requests for public
health literature increased in number. The printing and binding of pamphlets,
leaflets, and other literature advanced both in quality and in quantity.
22 P.D. 34
BUREAU OF HEALTH SERVICES
In the period up to 1954, Dr. Robert E. Archibald was in charge of the Bureau of
Preventive Medicine, which included the Divisions of Local Health Administration,
Maternal and Child Health, Communicable Disease Control, Venereal Disease
Control, and Dental Health. In 1954, the Divisions of Communicable Disease
Control, Venereal Disease Control, and Dental Health were continued in the Bureau
of Preventive Medicine with Dr. Herbert L. Lombard as Bureau Chief; and Dr.
Archibald was put in charge of the Bureau of Health Services, comprising the Divi-
sion of Maternal and Child Health Services and the Division of Local Health
Services, which includes the Sections of Public Health Nursing, Medical Social
Work, Nutrition, and Civil Defense, and the district health offices. The Bureau
chief, although acting as a deputy commissioner earlier, replaced Dr. Alton S. Pope
officially as Deputy Commissioner in 1954.
DIVISION OF LOCAL HEALTH SERVICES
In July, 1950 the position of Field Program Supervisor was established in the
Division of Local Health Services with Mr. Rudolph K. Holly appointed to the
position.
In 1949, as a direct result of the findings and recommendations of the special com-
mission to study and investigate certain public health matters, appointed by Gov-
ernor Bradford in 1947, the Union Health Department Act was passed and went into
effect on November 3, 1949. The following year a State-wide citizens' committee
with one representative from each community was appointed by the Governor for
the purpose of informing the people of the Commonwealth regarding the intent of
this legislation. A health educator was assigned full-time to work with this com-
mittee. At the request of interested local groups, 86 towns in the State had official
committees appointed by their town moderators to study and investigate the plan
and make recommendations to their respective towns as to what action should be
taken by the town. Many of these committees reported favorably, and several
communities actually voted at town meeting to have their town join with neighbor-
ing communities to form a union health department. However, the Union Health
Act was amended on July 1, 1953 to become an Act Relative to the Organization of
Regional Health Districts. The compulsory feature of the law was removed and as
a substitute, a small subsidy of 50 cents per capita could be provided for initial
capital outlay by a regional health district. To date, no communities have taken
advantage of this permissive legislation to set up a regional health department.
However, during the years covered by this report, many improvements have been
made in local health services and facilities; for example, since 1950 new health
centers have been established in the following five communities : Brookline, Quincy,
Salem, Way land, and Springfield. A building has been promised to the Randolph
Board of Health to be utilized as a health center, but will not be made available
until 1957. Many communities for the first time have employed either a medical
health officer or a full-time non-medical administrator, with the result that at the
present time there is a total of 20 full-time local health units administered by a
physician and 33 under the supervision of a non-medical administrator. Eighty-six
per cent of the population of the State reside in these communities. The Nashoba
Health Unit added three towns to its membership and strengthened its entire
health program. At the present time it is functioning very satisfactorily.
Another interesting development was the setting up of associations of boards of
health. The Metropolitan Health Officers Association enlarged its membership by
including cities and towns outside of the Metropolitan Boston area. An association
of boards of health was established in Plymouth County and another in Berkshire
County. In addition, a Southeastern Association of Boards of Health was developed.
The officers of these associations were requested to serve as an advisory committee
to the Department, and semiannual meetings have been held. This advisory com-
mittee has been extremely helpful in advising the Department regarding many of
its problems. Likewise the Commissioner has an opportunity to assist in solving
major problems of our local health departments.
P.D. 34 23
In 1955 the Division prepared a manual of information for local boards of health
which was distributed throughout the State.
The home accident prevention study begun in 1948 was continued by the Division
of Local Health Administration up to the time that a grant was received from the
Kellogg Foundation, when the program was taken over by the Division of Environ-
mental Sanitation. In 1950 the Nursing Section prepared an excellent manual
entitled Home Accident Prevention for Public Health Nurses. This was given wide
distribution throughout Massachusetts, and on request, many copies were for-
warded to other States. The Division made a study during 1951 of environmental
factors involved in all deaths from accidents in the home. In 1949-1950 and 1951-
1952 the Department received certificates of commendation from the National
Safety Council for its efforts in home accident prevention.
Northeastern District
In 1949 the Northeastern District consisted of 45 communities served by a staff
of nine professional workers. By 1956 its boundaries had been extended south and
west to include 68 communities with a total population of 1,516,102 and served by a
district staff of 16 trained public health workers. In September, 1955 the district
office was transferred from the town of Wakefield to the North Reading State
Sanatorium.
During the six-year period of this report, there has been more emphasis placed on
training opportunities. School physicians, obstetricians, physicians attending well-
child conferences, local nurses, and sanitarians have been stimulated to participate
in planned courses. Graduate social service students continue to be assigned to the
district health office for field training. Employees of local boards of health, partic-
ularly sanitarians, have been encouraged to take part in university refresher
courses. Three seminars for teachers of health education have been held. Con-
comitant with on-the-job training programs the district staff has assisted local
communities in securing services of new trained personnel.
Better acceptance of training opportunities and almost complete cooperation in
the single-session specialized educational meetings have been noted. This became
evident at the time of the establishment of the new School Health Regulations,
when attendance at orientation meetings for superintendents reached almost 100
per cent. Similar meetings were held for individuals concerned when the "Pre-
mature Infant Law" became effective and the "Preferred and Minimum Standards
for Day Care Centers" were established.
In the area of promotional effort to raise the quality of local health services, all
members of the district team participated in the educational activities for the inter-
pretation of the Union Health Law. In 13 communities local study committees
were formed. A complete statistical analysis of local expenditures for health services
in each community of the district was completed. Some of the interest and better
understanding of public health generated by this extensive promotional program
continues today. Local boards of health have been stimulated to revise obsolete
regulations. Certain communities have taken the necessary steps to establish in-
dependent boards of health. Increasingly, employing agencies have sought trained
personnel, especially in nursing and sanitation. As of the date of this report, 49
communities have adopted milk pasteurization regulations and 52 communities
have initiated approved tuberculosis case registers.
The Northeastern Health Officers and Agents Association has been absorbed by
the Metropolitan Health Officers Association.
Programs for the demonstration of topical application of sodium fluoride to the
teeth of children were conducted. An increase in the number of communities adding
fluorides to the local water supply has been observed. Fourteen communities have
voted action on fluoridation ; nine of these are actually adding fluorides.
In 1952 the City of Salem undertook a self -survey of health facilities and services.
The Salem Health Center materialized largely as a result of this study. Other ex-
perimental programs include the Gloucester diabetes survey in 1950 and the con-
tribution to home accident information provided by the Lynn study of 1949.
24 P.D. 34
Six communities participated in the original Salk polio vaccine trials of 1954 with
about 75 per cent participation by the eligible children. By 1955 and 1956 mass
inoculation programs were undertaken by every community. As an aftermath of
the widespread polio epidemic of 1955, all staff members participated in a coordin-
ated plan to assist local communities in setting up plans and facilities for adequate
follow-up of cases.
In 1956, all staff members were given specific Civil Defense assignments and
oriented to their responsibilities and functions in serving as the nucleus of the
medical and health services section of Civil Defense Area I.
The changing emphases and needs of public health generally have been reflected
in the demands on specific staff programs. The trend to suburbia has increased
local sanitation problems and necessitated more assistance from sanitation staff in
the areas of sewage disposal, water supply, and problems of pollution.
The needs of our growing aged population increasingly are the educational con-
cern of the staff.
With a booming population of youngsters there is generally greater interest in
assurance of an adequate medical examination of children at the time of preschool
registration. The indices of immunization continue to go upward, with almost
universal use of the triple antigen.
Mental health is another area of citizen interest with public health implications.
Of the seven active local community councils, five have been concerned with mental
health projects as their field of "health" activity.
Southeastern District
Change has been the dominant note in the health districts south of Boston. The
suburban towns near Boston saw marked increases in population in the late 1940's,
and by 1949 most of the communities within 15 miles of the city were beginning to
experience serious growth problems. As these small towns commenced to expand,
lacks became obvious — zoning laws seldom had been adopted, housing develop-
ments were not controlled, sewage disposal regulations were inadequate, public
water systems needed extension, trained personnel including sanitarians and public
health nurses were not available. Following these lacks very closely were the in-
adequate school facilities that confronted the towns and the high tax rates following
construction of new schools. Reluctance of towns to spend funds for health pro-
grams in view of their heavy school costs slowed health department progress until
problems such as private sewage disposal became acute, and it became apparent
that the population growth of the southeastern towns was not merely a temporary
increase.
In order to meet the problems of the towns as they changed, changes in the
district health program were necessary. Specific consultation service regarding
housing developments was offered, and there were concentrated efforts to encourage
the adoption of suitable health regulations to protect both the towns and the per-
sons moving into the communities. Where local personnel were lacking the local
boards of health were encouraged to obtain trained personnel or to provide training
for local personnel interested in a future in public health. The district staff, rather
than providing direct service to local boards of health, has provided consultation
and instruction to local personnel, a time-consuming process but in line with the
general policy of turning the health programs back to the local boards of health.
Some specific instances where progress in health departments can be noted are
the establishment of health centers and the employment of full-time personnel.
Three health centers — Quincy, Wayland, and Brookline — have been built and
opened. A number of towns have appointed agents — Hull, Marshfield, Norwood,
Milton, Natick, Randolph, Abington, East Bridgewater, Avon, and Somerset —
and there have been additional school nurses employed in many towns. Services of
existing voluntary nursing agencies have been purchased in still other communities
to meet their public health nursing needs. Several communities have adopted
fluoridation of their water supplies, including Hingham, Hull, Sharon, Seekonk,
Medway, and Cohasset.
P.D. 34 25
Progress in intercommunity interest and understanding is seen in the formation
of a number of groups of local and area personnel. The Quincy Inter- Agency Group,
composed of health, education, welfare, youth, and related personnel in Quincy and
the nearby area, has been an organization that has stimulated much cooperative
functioning of the agencies concerned. Similar organizations in southern Norfolk
County and in part of Plymouth County made up of local personnel from a number
of towns also have been active. The Southeastern Association of Boards of Health
and the Plymouth County Association of Boards of Health have proved an excellent
means of education and communication among the members of boards of health.
Local solution of local health problems is the ultimate goal for these organizations,
and they present an encouraging picture for future improvements in the health
program.
Major changes in the district lines and consolidation of personnel have occurred
during the period between 1954 and 1956. Eight of the cities and towns of the North
Metropolitan District were assigned in 1954 to the South Metropolitan District
Office, located in Quincy, raising the number of towns in that district from 49 to 57.
In July, 1954 the Southeastern District Office in New Bedford moved to a building
on the grounds of the Lakeville State Sanatorium in Middleboro. In September,
1955 the South Metropolitan District Office in Quincy moved from the Quincy
Health Center into this same building and the new district was consolidated as the
Southeastern Health District. In May, 1956 six towns along the western border
were transferred to the Central District to conform to Civil Defense area lines. The
present district now includes 103 cities and towns served by a field staff of 16 plus a
clerical staff of five.
Civil Defense assignments were made in the spring of 1956, incorporating all
members of the staff into the medical and health services section of Civil Defense
Area II.
Central District
On July 1, 1949 most of the area now considered as the Central District was
served by two district health officers and their staffs. One, the North Central Dis-
trict, had its headquarters in the building in Ayer now used by the Nashoba Health
Association. The other, the South Central District, had its headquarters at 476
Main Street in Worcester.
During 1949, the main effort and objective, aside from routine functions, was the
promotion of local health units, in connection with the Union Health Law. The
work of the district staff along this line assisted in bringing about the following:
(1) The reactivation of the Nashoba Association with an increased membership
of towns.
(2) The formation of the Norwoco (Northern Worcester County) Health
Association, including the towns of Hubbardston, Phillipston, Royalston,
and Templeton.
The Nashoba Association has gone on to increased membership and scale of
functioning. The Norwoco Association has remained in its original state as an asso-
ciation for public health and bedside nursing, in spite of the efforts made at its in-
ception to develop it into a local health unit, with some of the more essential local
functions of such a unit.
In 1949, as the result of the expansion of the Nashoba Unit, the district office was
moved from the Nashoba building to Fitchburg, where it remained until the move
to Rutland State Sanatorium in 1955.
The years following 1949 saw the fading out of some of the district activities, to-
gether with the taking on of new activities in other fields. For example, with the
diminishing of financial resources, the district lost the services of the sanitation
officer, and this important field of activity in relationship with local health depart-
ments was necessarily neglected, except in the instances of emergencies and special
problems.
The inspection and licensing of nursing and boarding homes and town infirmaries
became an important activity of both district staffs in cooperation with the two
nursing home inspectors. The inspection program was developed to a high degree
26 P.D. 34
and included formal invitations for instruction of the proprietors of such places,
together with informal conferences as the occasion required.
There was considerable activity in the field of dental health, through the efforts
of the dental hygienists in the district offices and other members of the staff.
Fluoridation of the public water supply has become an accomplished fact in
Athol, Templeton, and Shrewsbury. Fluoridation was well on its way to accomplish-
ment in Ayer and in Gardner, but was indefinitely shelved as the result of the efforts
of certain groups. A great deal of study work laying the foundation for confirma-
tion of favorable results from fluoridation in Athol has been done.
The chief problem in the field of communicable diseases resulted from the large
number of cases of poliomyelitis which occurred in the late summer and fall of 1955.
Members of both district staffs were actively engaged in the follow-up and case
recording resulting from this outbreak. Some of the nurses were engaged in the care
of polio patients.
The tornado in June, 1953 and the floods in 1954 engaged the district staff mem-
bers, particularly those in the South Central District, in disaster work, in coordina-
tion with the Civil Defense Agency.
In September, 1955 the office of the North Central Health District was moved to
the Rutland State Sanatorium and its title was changed to Central District (North).
In March, 1956 the office of the South Central District was moved to the Rutland
State Sanatorium also. The combined offices at Rutland are now designated as the
Central District and render services hi an area corresponding to that formerly
covered by the North and South Central Districts.
Western District
Since August, 1951 the district health officer in the Amherst office has had the
responsibility of supervising the Connecticut Valley and Berkshire districts. In
1955 this entire area was designated as the Western District with the Amherst office
as headquarters. The Pittsfield office continued in operation. In this same year
the Western District was made to correspond with Civil Defense Area IV, and the
district health officer serves as Civil Defense Area Medical Officer.
Considerable progress has been made in improving local health services. As the
result of a survey made in Agawam by Professor Ira Hiscock of Yale, a full-time
trained agent-sanitarian was employed in 1953. Other towns appointing a full-time
trained agent-sanitarian were South Hadley and Amherst. The city of Holyoke for
the first time appointed a full-time physician as director of public health. In 1955
the Berkshire District Association of Boards of Health was organized. At the re-
quest of this association, a detailed study of the cost of local health services in each
community in the county was undertaken and accomplished. This study stimulated
considerable interest in the need for improvement of local health services.
Floods in August 1956 caused great damage in Holyoke, Russell, Westfield, and
Easthampton.
During the period covered by this report, seven communities in the Western
District adopted pasteurization regulations.
A State-aided cancer clinic was established in the Pittsfield General Hospital in
February of 1956.
The public health nurses arranged for a series of weekly meetings each spring and
fall for local public health nurses. The topics discussed were based on the needs
expressed by nurses in local communities.
Through the efforts of the nutritionist, several new school lunch programs were
established and were used for the purpose of teaching better nutrition to school
personnel and the children.
The social workers and physiotherapists were required to carry a heavy case load
in connection with the Greenfield, Pittsfield, and Springfield crippled children's
clinics.
It is of interest to note that during this seven-year period, not a single community
in the Western District implemented fluoridation of the public water supply
although a great deal of discussion and education was carried on throughout the area.
P.D. 34 27
Nubsing Section
This period has seen some changes and progress in the activities of the Nursing
Section. The two three-year demonstration programs of public health nursing in
local communities (Princeton and Sterling; and Templeton, Royalston, Phillipston,
and Hubbardston) were completed and accepted by these local communities as
their responsibility.
During the reorganization of the Department of Public Health, Public Health
Nursing became a section instead of a bureau, and was transferred from the Division
of Administration to the Division of Local Health Services.
Educational activities have increased, and now a pattern for in-service education
for local public health nurses has been established. The public health nursing super-
visor in each district office is responsible for planning a series of weekly meetings
each spring and fall, based on the needs expressed by nurses in local communities.
A Maternity Nursing Institute, sponsored by the Department of Public Health
and the Massachusetts Chapter of the American Academy of Pediatrics, and of
three days' duration, has been held annually for the past three years at the Boston
Lying-in Hospital for local hospital and public health nurses.
Other workshops have been held on the Infant and Preschool Child, the Nurse in
the School Health Program, Cancer Nursing, and Field Teachers Instruction in
Public Health Nursing Agencies.
Members of the Public Health Nursing Section participated in developing a
Home Accident Prevention Manual for Public Health Nurses, a Survey of Matern-
ity Nursing Services, a Salary Study of Public Health Nurses throughout the State,
and a Study of Nursing Resources for public health nursing students in universities.
Members of the Section have also participated in and conducted studies of public
health nursing services as requested in local communities throughout the State.
Members of the Section continue to serve on many professional committees,
representing the Department of Public Health.
Personnel Changes — At the close of World War II, all positions for staff nurses
in the district health offices were discontinued. The pediatric nursing consultant
was assigned to State Civil Defense headquarters. Our consultant nurse in tuber-
culosis resigned. The activities of the Nursing Section are handicapped by the loss
of these two nurses. Nurses working in local communities constantly indicate a
need for assistance in both of these areas. With the increasing numbers of tuber-
culosis patients requiring nursing care in the home and the problems of mothers
with young children, it is important that consideration be given to providing these
services.
Social Work Section
By the year 1950, one or more medical social workers had been assigned to each
of the eight district health offices, responsible for all of the social services which
might be offered or requested of the Department. Direct case work service to
patients was increasingly supplemented by consultation service on the health and
social problems of individuals, many of whom were not under any program of public
medical care. Physicians asked for help in making plans for terminal care of private
cancer patients; hospitals sent parents of children requiring institutional care. In
addition, in the districts, social workers were increasingly identified with community
activities in stimulating and expanding health and welfare resources, and with ed-
ucational projects both inside and otuside the Department. This expansion con-
tinued until 1955, when district offices were transferred to isolated locations and
increased expense for personal or telephone contacts necessitated a different ap-
proach to the social and health problems of the areas.
The educational project of the Section has shown steady progress. In 1950, three
students from the Boston schools of social work were accepted for eight months'
field work training in public health. Each year since then, three or four students
have received field training in public health social work. In 1952, through a further
grant from the Children's Bureau, it became possible to offer four fellowships in
public health social work to qualified students who had completed one year of post'
28 P.D. 34
graduate study in a school of social work. In addition to students under this plan,
the Medical Social Work Training Project has been responsible for observation or
field experience of varying lengths for some 150 other persons. Also, there has been
close collaboration with the schools of social work in developing public health con-
tent in the curriculum.
With the opening of the Lemuel Shattuck Hospital, the Section offered consulta-
tion service in the selection of a head social worker, and social service became an
integral part of the program in this as in other Department institutions. The trans-
fer of the Massachusetts Hospital School from the Department of Public Welfare
in 1954 was a further step in the integration of services for the orthopedicaliy handi-
capped, beginning with social services in the clinics for crippled children and con-
tinuing in the social service departments of the institutions. Even when children
were referred for surgery to non-governmental hospitals, this integration continued
to function through careful policy planning with the hospital social service depart-
ments.
During this period, there has been increased participation in program making
and policy planning in connection with a wide range of projects and organizations.
Among those for which section help in planning or section consultative or super-
visory service has been requested are the following: projects for research in heart
disease and abnormal pregnancy; services for children with hearing loss; a study of
the problems faced by the parents of handicapped children; a study of social service
needs in a county tuberculosis sanatorium.
Service on the School Health Council, on the State Planning Committee for
Polio, and on the Tufts College Committee on Cleft Palate Problems, advice and
assistance to the National Foundation for Infantile Paralysis, to Group Approach
in Rehabilitation, to the Massachusetts Cerebral Palsy Association, and many
similar agencies are other indications of the broadening influence of the Social Work
Section.
The major area of social work activity remains in relation to services to mothers
and children in well-child programs, in school health, and in providing social services
to children and their families where there are psychosocial problems related to illness
and handicap. Increasingly during the past decade, the social workers in the De-
partment have become active in the problems of the aged and chronically ill, both
in individual services and in community planning.
Nutrition Section
Direct service has given way to consultation service in the years since 1949. The
change of emphasis made possible the extension of nutrition education throughout
the health services. Direct service was continued chiefly to patients in Crippled
Children's Services, a few local well-child conferences, and to individuals on request.
Nutrition education for more people resulted when consultation and instaff
training were begun. A nutritionist was in each district office to give training not
only to district staff members but to the staff of local public and private agencies,
particularly those which reached families. By keeping members informed of nutri-
tion developments, by interpreting nutrition research, and by supplying nutrition
education materials, they in turn were able to recognize the nutrition implications
in their particular disciplines and could motivate those within their sphere of in-
fluence to practice better food habits.
Nutrition workshops, institutes, conferences, and in-service education programs
for nurses, teachers, dietitians, community nutritionists, home economists, and
school lunch personnel were a part of each year's program. Meetings and demon-
strations were arranged for those having adults or children in group care in boarding
and nursing homes, day care centers, and children's homes.
The school lunch program in all its phases was a major interest. Working with
the Office of School Lunch Programs local participation was stimulated, help given
in maintaining standards and increasing pupil acceptance, and nutrition education
promoted with the school lunchroom serving as a laboratory where nutrition knowl-
edge could be put into practice.
P.D. 34
29
Food habit surveys proved valuable in arousing local interest in better nutrition.
These surveys were joint projects of parents, school administrators, teachers, and
school lunch personnel. Another type of survey was made during this interval as a
part of the hypertension study.
Increased interest in problems of the aging involved their better nutrition and
work with weight control, chronic disease, heart, and cancer programs.
Curriculum planning and revision of courses of study was done with those teach-
ing nutrition in schools for nurses and licensed attendants.
Civil defense and disaster planning were a part of the nutrition program. Ma-
terials for use in training local groups in mass feeding were prepared as a joint effort
of the Department of Public Welfare, the Red Cross, and the Massachusetts
Dietetic Association.
Students and public health workers from 24 different countries and all sections
of the United States visited the Nutrition Section for orientation. Graduate stu-
dents from the Universities of Tennessee, Western Reserve, Harvard, Cornell,
Columbia, and North Carolina, and Simmons College came for field work to com-
plete the requirement toward an advanced degree in nutrition. Dietary interns
from the Boston Dispensary and from Peter Bent Brigham, Mount Auburn, Beth
Israel, and Massachusetts General hospitals came for a day's field experience in
public health nutrition.
Leaflets, pamphlets, and slides were developed to meet particular needs, and com-
mercial films, filmstrips, and posters were evaluated for use in teaching nutrition.
The accompanying chart shows the role of the nutritionist in public health.
COOPERATIVE ACTIVITIES WITH DEPARTMENT STAFF
30
P.D.34
PUBLIC HEALTH NUTRITIONISTS
work with
PUBLIC AGENCIES
HEALTH DEPT.
Health Officers
Hirni
Sanitarium
Haalth Educator s
Hospital Inspectors
Other specialists
WELFARE DEPT.
Horn* Economist*
Social Worker*
SCHOOL DEPT.
School CommlftotS
Super. r.t*ndenr»
Principals
Toachors
Hoolth Staff
Lunch manager & cooks
AGRICULTURE DEPT.
Extension workers
Marketing Specialists
MENTAL HEALTH DEPT.
Schools (or Practical Nurses
Dietitians
PRIVATE AGENCIES
Health and Nursing.
Associations
Hospitals
ORGANIZED GROUPS
Community Councils
Parent An'n
Women's Clubs
Service Clubs
Youth Groups
Industrial groups
IstrJlvidualt:
Bsrfclind tor follow-up
personal inquiries
Social Welfare and
Family Societies
PROFESSIONAL
ASSOCIATIONS
Public Health Ass'.
Home Economics Ass'i
Dietetics Asa's)
School Food Service
League lor Horsing
Health Education
Universities
Private Schools
Libraries
ELEMENTARY AND
SECONDARY SCHOOLS
"NUTRITION HANDBOOK FOR
TEACHERS"
CURRICULUM PLANNING
NUTRITION SERVICES
in cooperation with
Mossechesetts Deportment of Educatie
STATE TEACHERS COLLEGES
CONSULTATION ON NUTRITION
TEACHING & MATERIALS
LECTURES
SCHOOL LUNCH OFFICE
PROMOTE NUTRITION
ASPECTS OF PROGRAM
MEETINGS FOR LUNCH WORKERS
FOOD SERVICE CONSULTATION
FOR INSTITUTIONS
VOCATIONAL EDUCATION
COURSES FOR HOME ECONOMICS
TEACHERS
CURRICULUM PLANNING
UNIVERSITY OF MASSACHUSETTS
CONFERENCES • SCHOOL OF
HOME ECONOMICS
CURRICULUM PLANNING •
SCHOOL OF NURSING
LIBRARY EXTENSION
NUTRITION BIBLIOGRAPHY
COOPERATION WITH THE
BOOKMOBILE SERVICE
P.D. 34 31
Civil Defense Section
The Massachusetts Civil Defense Agency was established in 1950 as a staff
agency for the Governor to enable him to carry out his responsibilities under the
Massachusetts Civil Defense Act.
The Commonwealth of Massachusetts Executive Order No. 25, dated January 3,
1955, delegated to the Department of Public Health the responsibility for providing
the Director, Massachusetts Civil Defense Agency, with a full-time staff with which
to operate the Medical Services. This staff is responsible to the Director of Civil
Defense and to the Commissioner of Public Health.
All bureaus of the Department of Public Health have an integral part in the Civil
Defense structure, and all members of the Department are assigned secondary and
highly important functions in Civil Defense, which whenever possible parallel their
regular assigned duties with the view of utilizing their skilled and highly specialized
knowledge.
In addition to the personnel problem the Medical Services of the Massachusetts
Civil Defense Agency is concerned with the over-all picture of public health prob-
lems that would be likely to arise out of natural or enemy-caused disasters. The
Service is responsible for casualty care and all the auxiliary services that such care
implies; for example, establishment of casualty stations, transportation of casual-
ties, complementing available hospital facilities, and substituting for those de-
stroyed.
The Service comprises many divisions such as Disease Control, Environmental
Sanitation, Mortuary, and Blood sections, and is intimately concerned with the
personnel problem on a State-wide basis, maintaining a constant recruiting service
for personnel allied to the medical profession. Close liaison is maintained with
other services such as Rescue, Radiac, Water, and Engineering. The relation with
the Welfare Service is particularly close, as the problems arising out of the care of
evacuees and casualties of disaster are immediately obvious and of such magnitude
as to stagger the imagination.
The maintenance of supplies is extremely important, and they are strategically
placed throughout the Commonwealth so as to be available upon request of com-
munities when needed and within the shortest possible time. Nearly 300 first-aid
stations are scattered throughout the Commonwealth. Several 200-bed emergency
hospitals are in storage, and the program of procurement of additional hospitals
continues. These hospitals are for emergency use only and are to be operated
where required, as they are mobile. It is planned to conduct them in existing hos-
pitals or in new schools which seem to be peculiarly adapted to their operation. Two
hundred and thirty-one of these hospitals are slated for storage.
The Medical Services has secured and stored $1,500,000 worth of emergency
medical supplies, including emergency equipment for procuring blood. Equipment
for testing radioactivity of air, food, and water has been purchased, but the Radiac
Service is no longer a part of the Medical Services. An extensive training program
is in progress for personnel to be attached to Civil Defense hospitals, first-aid
stations, and in other categories required in fulfilling the responsibilities of the
Medical Services. Over 500,000 persons in Massachusetts have had their blood
typed under the Massachusetts Civil Defense Agency Blood Typing Program,
which has been carried out under the auspices of the Institute of Laboratories.
Numerous committees of outstanding men and women in the medical, nursing,
and other professions are in existence, their function being to advise on problems
peculiar to civil defense.
The activities of the service are numerous and complex and require a continuity
in planning and training to meet the problems that would arise out of an enemy
attack or in the case of natural disaster of a magnitude sufficient to require the
resources of the Massachusetts Civil Defense Agency and the Medical Services.
32 P.D. 34
DIVISION OF MATERNAL AND CHILD HEALTH SERVICES
Maternity Care
The maternal mortality rate in Massachusetts varied between 3.3 and 5.5 per
10,000 live births during 1950 to 1954. However, the maternal mortality study
carried on jointly by the Department and the Massachusetts Medical Society since
1937 still shows a significant number of maternal deaths to have been preventable.
Hemorrhage, toxemia, and anesthesia continue to be the leading causes of prevent-
able deaths of Massachusetts mothers.
Efforts to reduce maternal mobidity and mortality in Massachusetts were di-
rected primarily toward improvement of all aspects of prenatal care through
assistance given to practicing physicians, nurses, nutritionists, and social workers.
This assistance was offered in the following ways : through providing discussions by
visiting consultants with practicing physicians at their regular hospital staff meet-
ings, through seminars and institutes on maternity care for each of the above-
mentioned professional groups, and through conferences on total maternity care
for groups of supervisory personnel representing all these disciplines.
Seminars, institutes, and conferences were organized and sponsored in coopera-
tion with the Massachusetts Medical Society, schools of nursing and of social work,
the Harvard School of Public Health, hospitals, and the Children's Bureau. Courses
in maternal care were given for physicians at the Boston Lying-in Hospital over a
five-year period and were attended by some 650 doctors. Similar courses at Simmons
College were attended by 102 registered nurses. Those given at the Boston Lying-in
Hospital were attended by 154 nurses representing 65 hospitals, 20 visiting nurse
associations, and two boards of health. Scholarships at the Harvard School of
Public Health were given to three physicians for a course in maternal and child
health. Scholarships in maternity nursing were provided to 14 nurses at Boston
University. Through this Division, by means of special appropriation from the
Children's Bureau, the Department continued to assist in the support of teaching
programs in maternity and infant care at Boston University and in maternal and
child health at the Harvard School of Public Health. Consultation was provided
to several prenatal clinics by the Assistant Director and Maternity Nursing Con-
sultant, and they assisted in the organization and conduct of a demonstration
parents' class in Northampton in cooperation with that community's physicians,
Visiting Nurse Association, and hospital.
Among the publications prepared during these years in which the Division was
directly or indirectly concerned was a guide for Organization and Conduct of Prenatal
Clinics, revised in 1950 and distributed through the district health offices. In 1955,
the Committee on Maternal Welfare of the Massachusetts Medical Society prepared
Minimum Standards for Prenatal Care. In addition, a useful Bibliography on Ma-
ternity and Infant Care was revised, and prenatal and postnatal letters were dis-
tributed on request to approximately 64,000 Massachusetts mothers.
Legislation of concern to the Division which was sponsored by the Department
included an Act to Further Regulate the Filing of Notice of Intention of Marriage
and the Issuance of Certificates of Such Filing, an Act to Require Reports of Births
Occurring in Airplanes, passed in 1950, and an Act to Require Hospitals to Deter-
mine Blood Type of Patients, passed in 1955.
Infant Care
Since 1950 the birth rate has continued to rise. In 1954, when 107,086 live in-
fants were born to Massachusetts residents, the rate was 22.1 per 1000 population.
More than 99 per cent of these babies were born in hospitals. About 7 per cent of
infants born in Massachusetts are pre-mature, and one of every five dies during the
first week of life.
The infant mortality rate has not decreased appreciably in recent years. The
rate per 1000 live births in 1949 was 24.4, and in 1954, the last year for which rates
are available at present, it was 23.3. Because the principal cause of infant deaths
is prematurity, the Division stressed services aimed at reducing the incidence of
prematurity and improving the survival rate of these infants. Its program included
P.D. 34 33
the support and administration of postgraduate training and the provision of con-
sultation service.
Twelve teams of pediatricians and nurses, supervisors of premature units, at-
tended institutes on the care of premature infants sponsored by the New York State
Department of Health and the Children's Bureau. Hospitals which sent teams
were St. Luke's Hospital of New Bedford; St. Vincent's, Hahnemann, and Wor-
cester City hospitals of Worcester; the Mercy and Wesson hospitals of Springfield;
St. Luke's Hospital of Pittsfield; the Boston City, St. Margaret's, and New England
Center hospitals of Boston, and the Cambridge City Hospital. In addition, a team
from the Department attended such an institute.
Seminars on prematurity were conducted in a number of hospitals throughout the
Commonwealth upon request of their respective medical staffs. About 400 physi-
cians, 100 nurses, and 20 hospital administrators attended these seminars. Two
nurses were sent to Los Angeles for a refresher course in care of the premature infant.
The Maternity Nurse Consultant continued to organize and supervise conferences
on this subject for groups of nurses throughout Massachusetts.
The Assistant Director and Maternity Nurse Consultant served as consultants
to hospitals having a maternity service in relation to techniques of care of the
maternity patient and newborn infant, especially the infant prematurely born.
Also, consultation was given in cooperation with the Division of Hospital Licensing
in respect to new maternity units under construction and old units being remodeled.
Other activities in this area included preparation of a pamphlet, C/O Your Baby,
which was distributed in addition to pamphlets available from the Children's
Bureau. In keeping with previous activities, financial support was provided 21
well baby clinics throughout the Commonwealth.
The "Premature Law" was revised in 1949 and further amended in 1955. The
change in 1955 raised the weight criterion for financial assistance from 4J^ to 5
pounds. Reporting of births of premature infants to boards of health is still in-
complete. It is more complete from larger hospitals. Also, their reporting of in-
fants of 4 }4 pounds or less at birth is more complete than that of heavier premature
babies. For example, in 1955, when 87 per cent of prematures were so reported,
94 per cent of infants weighing 4K pounds or less were reported, in contrast to 76
per cent of those weighing over 5 pounds. That the financial assistance provided
for the hospital care of these infants has been considerable may be seen in Table I.
Table I
Payments for Hospital Care of Premature Infants by
Community Boards and Departments of Health and the
Massachusetts Department of Public Health
Year
No. of Cases
Total Cost
1950 .
608
$165,998
1951 .
593
155,557
1952 .
607
180,734
1953 .
680
180,129
1954 .
646
176,695
1955 .
698
190,103
Preschool Care
Well-Child Conferences — Following demonstration of the value of well-child
conferences, 161 communities have organized such clinics. We have assisted many
of these conferences to establish and maintain standards, and in 40 communities
have also provided financial assistance. In seven of these conferences, held in Han-
son, Mattapoisett, Norton, Mansfield, West Bridgewater, Westport, and Attleboro,
vision and hearing tests were given to a total of 547 children. As a result of com-
munity participation, these conferences now request only occasional consultation
support from the Department. In addition to these services, the Department has
cooperated with the Harvard School of Public Health in promoting courses given
each year for physicians who wish to learn more about health supervision of well
children.
34 P.D. 34
Day Care — In 1950, legislation was revised concerning board of health licensing
of non-public agencies giving day care to young children. Boards of health were
circularized to determine the number and location of these agencies in 1951 and
again in 1952. In 1951, 429 centers were reported by 128 communities. In 1952,
869 such agencies were reported by 185 towns. At that time, 307 agencies were
reported by Massachusetts' 17 largest communities. However, it is not to be sup-
posed that such agencies occur only in the larger centers of population, for they
appear as regularly in our smallest communities. Effort has been made to encourage
and assist communities in establishing rules and regulations and standards for their
licensure.
Through the Committee on Day Care Standards and Licensing Procedures of
the United Community Services of Metropolitan Boston, and in cooperation with
the Associated Day Care Services of Metropolitan Boston, the Massachusetts De-
partments of Education, Mental Health, and Public Welfare, and the United Com-
munity Services of Metropolitan Boston, two pamphlets, Recommended Minimum
and Preferred Standards for Agencies Giving Day Care to Children Under Seven Years
of Age and Your Child Deserves the Best in Day Care, a Pamphlet for Parents, were
prepared and widely distributed to public and private agencies within the spheres
of influence of all the organizations sponsoring these pamphlets. The first pamphlet
was intended to assist boards of health which license private day care agencies for
preschool age children. The second was developed to assist parents in choosing an
appropriate private nursery school, kindergarten, or day-care center. These
pamphlets have been well received elsewhere in the country and widely distributed
on request of other state and private organizations concerned with the field. This
committee has continued to work to the end of good standards for the daytime care
of the preschool child apart from his home.
In 1955, the Metropolitan Boston Health Officers Association and the Boston
Association for Nursery Education formed a Joint Committee on Day Care for the
purpose of assisting communities with problems in respect to these agencies. This
committee has set up a consultation service of experts in the field of early childhood
education whose services have been made available to boards of health, and has
been instrumental in effecting a course to be offered for licensing personnel.
Conservation of Hearing and Vision
Until 1950, very little assistance and very few services were available for handi-
capped children of preschool age. The immediate result was that many preschool
children with severe hearing losses did not have the opportunity to learn speech
during the preschool period, which is, from a developmental standpoint, the most
favorable time for this type of learning. Another result of this deficiency was that
preschool children with impaired hearing were in no position to become habilitated
at the public school level when they became of school age.
In 1951 a preschool hearing center for hard of hearing and deaf children was
established in Pittsfield. This nursery school was set up in cooperation with local
agencies, professional personnel, and the parents of hard-of-hearing children. Since
the establishment of this center, eight others have been organized: Taunton,
Waltham, and Watertown in 1952; Quincy in 1953; Lowell in 1954; Boston and
Salem in 1955; and Fitchburg in 1956. These nursery schools were equipped with
the finest auditory training equipment, toys, medical consultation, and teaching
staff. The teachers worked with both children and parents on a program of auditory
training, lip-reading, rhythm exercises, and speech training. Parents played a key
role in the therapy and were encouraged to undertake a definite educational role in
the day-to-day strengthening of the children's impairments. One of the key ob-
jectives of the training was to prepare children for entrance into public schools
whenever possible rather than institutionalizing them in schools for the deaf.
The nurseries for impaired children have proved quite successful, and it is be-
lieved that many children have had their lives materially altered for the better as a
result of the training which they have received at these installations.
Another important addition to the services given by the Child Growth and De-
velopment Section is the auditory training program. Under this program, complex
P.D. 34 35
electronic auditory trainers are installed in the homes of hard-of-hearing and deaf
children. In many cases this amplifying equipment enables the child to hear the
voices of his parents and brothers and sisters for the very first time. The auditory
trainers are sometimes connected to the family television set so that the impaired
child may. improve in his lip-reading abilities and at the same time derive recreation
and enjoyment from appropriate programs. The extensive use of auditory training
procedures in the home and in our nursery schools points the way, in many instances,
to the early acceptance of a hearing aid and ultimate habilitation at the public
school level. Through these methods the child with a hearing handicap is literally
bathed in sound from his very earliest years and thus makes the best possible use of
his residual hearing.
Field reports from parents and educators on the value of our nursery schools and
auditory training program have thus far been uniformly favorable. Both the speech
and the speech reception of hard-of-hearing and deaf children enrolled in these
programs have improved markedly during the course of training.
For many years preschool children and school children who had hearing losses
sufficient to warrant the use of a hearing aid were not able to obtain one. However,
in 1954 the Legislature appropriated a small sum of money which was designated
for use in purchasing hearing aids for hard-of-hearing and deaf children. This
section was thereupon required to establish procedures to insure adequate case
finding, the economical purchase of hearing aids, and the fair and adequate geo-
graphical coverage among recipients. The Section also was required to provide for
efficient methods for instructing the recipients of hearing aids in the proper use of
the equipment and to provide for the proper maintenance of equipment. The initial
program met only a small part of the acute needs of hard-of-hearing and deaf
children throughout the Commonwealth. So great was the need that by October of
1954 the complete appropriation for hearing aids had been exhausted. Fortunately,
the Legislature has seen fit to increase subsequent appropriations for hearing aids,
but available funds are still lacking to meet the needs of all our children.
Experience gained in the first years of the hearing aid distribution program has
proved invaluable. In the second year of operation, the purchase price of each aid
was limited to a maximum of $120, since in the great majority of cases a satisfactory
hearing aid can be purchased for this price. All recipients of hearing aids must be
evaluated at the Winthrop Foundation at the Massachusetts Eye and Ear Infirm-
ary, the Hearing Clinic at the Children's Medical Center, or the Clarke School for
the Deaf at Northampton.
The State-wide hearing conservation program has continued its steady growth.
With the exception of relatively few towns, all the cities and towns in the Common-
wealth have received assistance in developing and expanding their school hearing
conservation programs. In most instances these programs meet the requirements of
State health regulations which govern such activities. In the matter of equipment,
there are now almost 300 modern electronic audiometers owned and used by the
schools throughout the Commonwealth. Local testing personnel are now being
trained at the rate of about 200 testers per year.
The work which this section is doing has been recognized throughout the country.
For example, supervisors of the hearing conservation programs from Georgia, Cali-
fornia, Rhode Island, and Texas have visited this Division to learn more about our
program.
The Massachusetts school vision conservation program has also expanded greatly
in this seven-year period. At the present time practically all cities and towns are
using the Massachusetts Vision Test for screening school children. Over 400 ap-
proved Massachusetts Vision Test units are owned by cities and towns throughout
the Commonwealth. Every community in the State has one or more local persons
who have been given training in test procedures by personnel from the Child Growth
and Development Section. The annual rate of training school personnel in these
techniques is also currently running at the rate of 200 testers per year. A large
number of visitors from other states come to Massachusetts annually to see our
school screening system in operation and to investigate various other phases of our
vision and hearing conservation programs.
36 P.D. 34
School Health
The school health work of this Division has not been adequate so far as consulta-
tion is concerned, as we have had a physician in charge of this program for less than
four years; that is, from September 1950 through April 1954.
In 1952, legislation was passed requiring every child in the public schools to be
"separately and carefully examined in such manner and at such intervals ... as may
be determined by the Department of Public Health after consultation with the De-
partment of Education and the medical profession."
In-service training courses in school health education have been given at the fol-
lowing State teachers colleges: Worcester (two courses), Framingham (two courses),
Fitchburg, Lowell, Bridgewater (three courses), North Adams, and Salem. Teacher
training courses were also given in cooperation with Springfield College (two
courses) and Boston University (four courses). Also, in cooperation with Harvard-
Boston University Extension Division, courses were given in Worcester, Lowell,
and Dan vers. Summer school health workshops were conducted at Boston Uni-
versity and the University of Massachusetts.
Two Teacher School Health Institutes have been held for the Archdiocese of
Boston, in Cambridge and in Quincy. In addition, throughout the State, local in-
service training of teachers and evaluation studies of school health programs were
given to local schools. The Department also cooperated in a pioneer demonstration
for the in-service training of teachers in Mental Health.
In 1951 the Department was authorized by the Legislature to draw up new regula-
tions for the physical examination of school children. A new health record card was
devised, and regional conferences were held for school superintendents, physicians,
and nurses at which the current regulations were described.
Beginning in 1955, a new series of regional workshops in the administrative
aspects of school health services was instituted in cooperation with the School
Health Council. This Council, formed in 1940, coordinates the activities of the De-
partments of Public Health, Mental Health, and Education in the area of school
health and advises the respective commissioners on matters of policy in this field.
As another project of the School Health Council, the former School Health Man-
ual has been rewritten under the title An Administrator's Guide to the School Health
Program. In connection with this new publication, the Coordinator of School
Health has been the coordinator and editor.
Services for Crippled Children
Analysis of the statistics for the seven-year period covered by this report shows a
steadily increasing service to crippled children in Massachusetts. During this
period a total of 30,059 clinic visits were made in the twelve orthopedic and two
plastic clinics, in contrast to 16,923 clinic visits during the previous seven years.
The number of new cases admitted to Services for Crippled Children increased
from 906 in 1949 to 1,120 in 1955. The number of active cases increased from 1988
as of January 1, 1949 to 3447 as of December 31, 1955.
During the past seven years the clinic load has increased to such an extent that
it has become necessary to have more than the allotted eleven monthly orthopedic
clinic sessions per year. Two orthopedic consultants were assigned to the Haverhill
and Fall River clinics. Other clinics scheduled extra sessions as needed to accom-
modate the increased case load.
In 1952, a State-wide children's cardiac program was started. Under this pro-
gram, children with congenital malformations of the heart or other cardiac condi-
tions which might be benefited by surgery may receive diagnostic services and /or
cardiac surgery if recommended.
The cost of hospital care for crippled children hospitalized has increased from a
maximum all-inclusive per diem of $14 paid up to January 1, 1954, at which time a
per diem rate based on hospital costs became effective. The total hospital days of
patients hospitalized by Services for Crippled Children was 12,928 in 1949 and 17,-
928 in 1955.
P.D. 34
37
Treatments given by physical therapists increased from 4,090 for the year 1949
to 6,807 for 1955. This increase was made possible by the establishment of treat-
ment centers where more children could be treated than by making home visits on
each child.
Yearly statistics for the period covered by this report are shown in Table II.
Table II
Services for Crippled Children, 1950-1955
Orthopedic
Year
Clinic Visits
Case Load
New Cases
Old Cases
1950
3567
2096
685
1411
1951
3576
2190
653
1537
1952
3984
2354
646
1708
1953
4028
2530
702
1828
1954
4498
2647
677
1970
1955
4660
2796
693
2103
Rheumatic Fever
Year
Clinic Visits
Case Load
New Cases
Old Cases
1950
933
352
193
159
1951
937
403
172
231
1952
827
404
125
279
1953
790
430
146
284
1954
713
429
125
304
1955
739
481
162
319
Plastic
Year
Clinic Visits
Case Load
New Cases
Old Cases
1950
271
192
55
137
1951
297
205
41
164
1952
402
242
58
184
1953
425
280
55
225
1954
476
302
68
234
1955
509
325
64
261
Congenital Heart
Year
Case Load
Days Hospital Care
1952
23
265
1953
40
535
1954
54
377
1955
67
682
The responsibility of the Department of Public Health in relation to the Annual
Census of Physically Handicapped Children and the Home Teaching Program con-
tinues to be carried in the Division of Maternal and Child Health Services under the
direction of the Supervisor of Clinics, Services for Crippled Children. Activities in
the discharge of this responsibility include :
(1) Consultation to the Department of Education and local school personnel on
the health, medical and social needs of handicapped children; evaluation of
the need for certain children to receive education through home instruction
rather than in regular public school classes, or in special schools or classes;
and the determination that all handicapped children are having needed
medical care. The consultation services to local school personnel and other
agencies are given under the direction of the district health officers by the
Public Health Nursing and Social Work Supervisors in the health districts.
In the seven-year period covered in this report, an average of 1807 children
a year received instruction at home, in hospitals or convalescent homes.
(2) The maintenance of a register of physically handicapped children, under 21
years of age, known to the Department. Sources of information for the
register, in addition to the Annual Census of Physically Handicapped
Children, include reports of infants with congenital deformities, children
served by the State Crippled Children's Clinics, and those reported by other
state and private agencies serving handicapped children.
38
P.D. 34
Number on Register, December 31, 1949 . . . . . 29,347
Number of orthopedically handicapped . . . 17,165
Number of non-orthopedically handicapped . . 12,182
Number on Register, December 31, 1955 . . . . . 36,157
Number of orthopedically handicapped . . . 21,762
Number of non-orthopedically handicapped . . 14,395
In December, 1954 the Director of the Division of Maternal and Child Health
Services, with the approval of the Commissioner, appointed a committee to study
the needs of crippled children in the State. The report of the committee, submitted
on May 12, 1956, contained general information and tables showing the work and
growth of the Crippled Children's Program during 1949 through 1954, a statement
of diagnostic categories not served by Services for Crippled Children, and a sum-
mary of those additional categories which the districts reported should be covered.
The report showed the very considerable volume of work being done by district
personnel as part of these services. The report included recommendations for im-
mediate improvement of the program and for long-range planning for improved
services.
Statistical Services
The statistical section of the Division collected and analyzed statistics on the
various aspects of the maternal and child health and crippled children's programs.
These statistics have been of value not only to the staff of the Division but also to
other members of the Department and to research workers studying the problems
of the mother and the child.
Legislation
During this seven-year period, laws were passed covering the following phases of
maternal and child health and crippled children's services.
Maternity
Chapter 113 (1950)
Chapter 232 (1954)
Chapter 449 (1955)
Chapter 72 (1952)
Chapter 753 (1955)
Chapter 205 (1950)
Chapter 673 (1951)
Chapter 492 (1952)
Chapter 89 (1951)
Chapter 342 (1952)
Chapter 304 (1953)
Chapter 352 (1953)
Chapter 383 (1953)
Chapter 508 (1954)
Chapter 514 (1954)
Chapter 113 (1955)
Premarital Blood Test
Paternity via Blood-Grouping Tests
Hospitals to Determine Blood Type of Certain Patients
Infant
Recording of Birth Certificate in Town of Residence if Infant is
Born out of State or out of U. S.
Prematurely-born Infants (Amendment to Chapter 601 (1949).)
Preschool
Child Care Centers and Day Care Centers
Assistance for Blind Children
Care at Lakeville State Sanatorium for Children with Arthritis
School Age Child
Infectious Diseases in Children
Expenses of T & A Operations Paid by Local Welfare Depart-
ments to Be Reimbursed by State Department of Public Wel-
fare
Use of School Buses for Transportation to Certain Educational
or Recreational Projects
Transportation of School Children with Cerebral Palsy
Care of Children with Muscular Dystrophy at Lakeville State
Sanatorium
Transferring the Massachusetts Hospital School and Hospital
for State Minor Wards to the Department of Public Health
Instruction for Mentally Retarded
Employment under 16 Years of Age
Special Projects
Several new projects were introduced during this period. They included the
Greater New Bedford Children's Accident Prevention Program, Poison Informa-
tion Center, Special Project for Providing Intensive Medical Care to Women with
Abnormal Carbohydrate Metabolism in Pregnancy, and Epilepsy Training Program.
Support was afforded all of them save the first-mentioned by means of funds from
the Children's Bureau for special projects.
Greater New Bedford Children's Accident Prevention Program — This program in-
volved not only provision of service but also study of methods of community co-
operation between public and private agencies in establishing a program to prevent
childhood accidents at home, at school, and elsewhere in the child's environment.
P.D. 34 39
Its objective was to demonstrate the value of such a specific program for prevention
of accidents to children. It was carried on for four years, and supported in part by
the Charles H. Hood Dairy Foundation.
Poison Information Center — In cooperation with the Children's Medical Center,
the Boston Floating Hospital, the Boston City Hospital, the New England Chapter
of the American Academy of Pediatrics, the Massachusetts College of Pharmacy,
and the Department of Legal Medicine of Harvard Medical School, a program was
established to assist physicians in the care of their child patients who have been
poisoned. Material concerning the incidence of poisoning among children, the types
of poisons involved, and the most effective treatment for each type of poisoning
has been made available to physicians throughout the Commonwealth. A Poison
Information Center was established in the Children's Medical Center, from which
physicians receive information concerning the ingredients of potentially poisonous
compounds commonly ingested by children and the current method of treating
these patients if the compound contains a poisonous substance.
Medical Care for Pregnant Women — This project was established to provide in-
tensive and comprehensive medical care, including dietary therapy and insulin
where necessary, for pregnant women having abnormal carbohydrate metabolism.
It was carried out at the Boston City Hospital and the Boston Lying-in Hospital.
The principal objectives were to prevent fetal wastage, certain complications of
pregnancy, and maternal deaths; to decrease the chance of diabetes occurring in in-
fants born to mothers with abnormal carbohydrate metabolism during pregnancy,
and hopefully to delay the onset of diabetes in later life in women who demonstrated
abnormal carbohydrate metabolism during pregnancy.
Epilepsy Program — An epilepsy training program was established through the
Seizure Unit, Children's Medical Center, for physicians and technicians. It has
been estimated that at least one of every 200 persons suffers from epilepsy. The
number of physicians especially qualified to treat epilepsy is relatively small. Also,
there is a dearth of technicians qualified to make electroencephalogram tracings.
Dr. William G. Lennox is in charge of this program. The training course for physi-
cians and technicians is for a period of one to three months and includes both
didactic and clinical training. In 1952, 10 physicians and 1 1 technicians were trained ;
in 1954, the number was seven physicians and 13 technicians.
Training in Maternal and Child Health — Financial support was continued for
courses in maternal and child health services and in administration of maternal and
child health programs at the Harvard School of Public Health. During the year
1955-1956, 18 students in the basic course in maternal and child health came under
this program and there were an additional eight students in the course on adminis-
tration. During these years, modifications and adaptations of this program have
been made as experience has shown them to be necessary. There has been an ex-
pansion of the staff, a broadening of facilities available for field observation and
studies, and an intensification of teaching of students who are majoring in maternal
and child health services. There has been increasing use of case material from clin-
ical and public health resources, for example the family clinic. In addition, one
fellowship in maternal and child health services was given annually to a qualified
physician at the Harvard School of Public Health.
Other Training Programs — The maternity and pediatric nursing courses were
continued at Boston University, and scholarships in pediatric nursing were given
through the Boston University School of Nursing in cooperation with the Chil-
dren's Medical Center. In 1948, the Medical Social Work Training Project was
established in cooperation with the three schools of social work in Boston : Simmons
College, Boston University, and Boston College. The Medical Social Work Faculty
at the Harvard School of Public Health has also cooperated in this project. Through
this course, 20 students have received this special training. During these years, fel-
lowships in rheumatic fever and in pediatric cardiology were provided in coopera-
tion with the Children's Medical Center, the House of the Good Samaritan, and the
Harvard Medical School.
Publications
During this period, ten publications were made by this Division.
40 P.D. 34
BUREAU OF PREVENTIVE DISEASE CONTROL
DIVISION OF CANCER AND CHRONIC DISEASE
The activities that constitute public health programs vary according to time and
place. In some parts of the world sanitation of the environment must still have the
most important role, while in many health departments a major part of the time is
even now devoted to the control of communicable disease. In areas such as Massa-
chusetts, emphasis is being placed more and mere on the control of chronic disease.
The reasons for this change are obvious. The population is growing older. In 1850,
6.2 per cent of the Massachusetts population was 60 years of age or over. Half a
century later the percentage was 8.0; in 1930 it had reached 14.6, and an estimate of
the present percentage is 16.0 per cent. The causes of death have changed markedly.
At the turn of the century, diabetes, apoplexy, heart disease, cancer, and nephritis
accounted for slightly less than 20 per cent of all deaths, while at the present time
these conditions account for about 70 per cent of all deaths.
A complete chronic disease control program is a blending of administration,
service, and epidemiology. The weight given to the component parts may vary
from state to state, but these parts are still present to some degree in all programs.
Massachusetts allots great weight to epidemiology. Here, the possible relationship
of the various sites of cancer to such factors as heredity, habits of living, occupation,
and other environmental hazards are studied with the objective of adding to the
sum total of knowledge regarding these diseases.
The epidemiological work done by the Division has been recognized by the
Rockefeller Foundation, the Commonwealth Fund, the American Cancer Society,
and the Public Health Service, all of which have given special grants over the years
for this type of work.
The work of the Division of Cancer and Chronic Disease is divided into four
component parts: cancer control, heart disease control, control of other chronic
diseases, and an incipient geriatric program.
Thirtieth Anniversary
In the spring of 1956, the Division celebrated the 30th anniversary of the Massa-
chusetts Cancer Program. Thirteen clinics prepared special programs for this
occasion, either in the form of a teaching clinic or a cured cancer clinic. The Division
published a booklet highlighting important events over the period :
1926 — An Act to Promote the Prevention and Cure of Cancer and the Ex-
tension of Resources for Its Cure and Treatment — approved May
29, 1926.
The first cancer clinic opened in Newton, December 17, 1926.
Tumor Diagnosis Service integrated into the Massachusetts Cancer
Program.
1927 — The following cancer clinics opened during the year:
Lowell Pondville
Lynn Springfield
Worcester
Pondville Hospital opened — capacity 90 beds.
1928 — The following cancer clinics opened during the year:
Berkshire County Franklin County
Boston Dispensary Lawrence
Fitchburg New Bedford
First annual meeting of the cancer clinic chiefs and the social workers.
1929 — Three-day graduate course in cancer for physicians. Division of Adult
Hygiene established. (Changed to Division of Cancer and Other
Chronic Diseases in 1945, and to Division of Cancer and Chronic
Disease in 1955.)
1930 — Brockton Cancer Clinic opened.
P.D. 34 41
1932 — First Cured Cancer Clinic.
Achievement Week.
1933 — The book Cancer and Other Chronic Diseases was published. This was
the culmination of a four-year study of the chronic disease problem in
Massachusetts.
1935 — Cooperative Cancer Control Committees were first organized. (This
activity continued until 1948.)
1935 — Pondville Hospital enlarged — capacity 147 beds.
The following cancer clinics opened during the year :
Beth Israel Greenfield
Gardner Newbury port (discon. in
1942)
Gloucester North Adams
Northampton (discontinued in 1939)
1936 — Cape Cod Cancer Clinic opened (discontinued in 1947).
1937 — Monsignor Roche House for cancer opened at the Westfield State
Sanatorium.
Fall River Cancer Clinic opened.
Westfield Cancer Clinic opened.
1938 — Salem Cancer Clinic opened.
1939 — Beverly Cancer Clinic opened.
Quincy Cancer Clinic opened.
1940 — Cancer, A Manual for Practitioners, first edition, was distributed to
every practicing physician in Massachusetts. (A second edition was
distributed in 1950, and a third in 1956.)
1944 — Cancer education was introduced into the Massachusetts schools.
1948 — The American Cancer Society, Massachusetts Division, Incorporated,
assumed the major part of the responsibility for cancer education of
the laity.
1954 — The George H. Bigelow Building opened at Pondville Hospital.
The Mount Auburn Hospital Cancer Clinic opened.
1955 — The following cancer clinics opened during the year:
Cambridge City Hospital
Free Hospital for Women
Massachusetts Memorial Hospitals
1956 — Boston City Hospital Cancer Clinic opened.
Epidemiology and Biometrics
Cancer of the Lung
The major epidemiological activity of the Division of Cancer and Chronic Disease
dealt with cancer of the lung. The Division, in conjunction with Dr. Leonid S.
Snegireff of the Cancer Control Unit, Harvard School of Public Health, has been
studying this problem since 1950.
A first report on this study was published in Cancer, July-August, 1956. The
final report will be published as a Harvard Monograph.
The major findings are as follows:
1. The disease is increasing at a far greater rate than any other form of cancer.
2. The total adjusted rate for males is increasing faster than that for the fe-
males, but in the older age groups the difference is not significant.
3. An excessive amount of lung cancer has been observed in some occupational
groups, and it is probable that a certain percentage of the cases are related
42 P.D. 34
to occupation. However, our lung cancer data, which included all occupa-
tions throughout the lifetime of the individual, did not furnish proof that
occupation was of major importance.
4. Individuals with chronic and/or frequent respiratory conditions appeared to
have more lung cancer than the remainder of the population.
5. Individuals whose work was wholly outdoors had a higher rate than those
whose work was partially outdoors. This latter group, in turn, had a higher
rate than those individuals who worked wholly indoors.
6. Individuals using an excessive amount of alcohol had higher rates than those
who did not.
7. There appeared to be slightly more lung cancer among city dwellers than
among those living in the country, but the data did not show consistency.
The combined counties of Barnstable, Dukes, and Nantucket had a higher
adjusted rate than the cities of Springfield and Worcester, but the combined
counties were slightly lower than Boston.
8. Cigarette smoking was found to be the most outstanding variable in the
study. The lifetime cigarette smoking habits of individuals with lung cancer
and of the controls were estimated and computations made on the basis of
the number of years the individual smoked 1 package of cigarettes per day
(for example, the individual smoking 3 packages of cigarettes per day for
one year would be considered equivalent to an individual smoking 1 package
of cigarettes per day for three years). It was found that there was very little
lung cancer among individuals smoking the equivalent of 1 package of cig-
arettes per day up to 20 years. However, the increase became rapid after 25
years and the individual who had smoked the equivalent of 1 package of
cigarettes per day for 55 years or more had 10 times as much lung cancer as
those individuals smoking 1 package of cigarettes per day for less than 25
years and about 30 times more than those who never smoked. Very few
women were found who had smoked the equivalent of 1 package of cig-
arettes per day for as long as 25 years.
Health Protection Clinic Demonstration
The health protection clinics demonstration was one effort to evaluate more
screening to detect chronic disease. Between December 1, 1949 and June 30, 1952,
over 9000 people were screened. An extensive history was taken; hemoglobin,
blood sugar analysis, visual test, hearing test, x-ray of the chest, height and weight,
blood pressure, and physical examination were offered throughout the demonstra-
tion. In the latter part of the demonstration, electrocardiograms and vaginal
smears were done routinely. Since a screening cannot be expected to detect every
diagnosable condition, the findings in the study were satisfactory. The demonstra-
tion revealed that such a screening program was too costly and indicated that some
of the tests should be omitted in a service program.
Three papers were published regarding this project: "The Evaluation of a Pilot
Clinic," New England Journal of Medicine, September 25, 1952; "The Cost and
Evaluation of Multiple Screening," New York State Journal of Medicine, November
1, 1952; "Multiphasic Screening; What is It? What are the Advantages?" Trans-
actions of the 58th Annual Meeting of the National Tuberculosis Association, May,
1952.
Cancer Detection Center
An evaluation of a cancer detection center was made, supported in part by a
grant from the Public Health Service. Among the conclusions drawn were the
following:
The small number of cancers found among asymptomatic subjects would have
been greatly increased if applicants with symptoms had been accepted by the
Center.
The place for examination of persons with symptoms is the private physician's
office or a cancer diagnostic clinic, rather than a detection center.
P.D. 34 43
The few cancers found among asymptomatic persons, as well as the high cost of
each examination, precludes large-scale financing of cancer detection centers by
either governmental or voluntary agencies.
Many of the procedures carried out at the detection center probably could be
done by the general practitioner if proper instruments were available to him at a
reasonable cost and if he were willing to spend sufficient time in taking a history
and making an examination.
A report of this demonstration was published in the New England Journal of
Medicine, November 2, 1951.
Cancer of the Buccal Cavity
A study of the etiology of cancer of the mouth is being conducted by the Division
and by Dr. Harry Harding, consultant dentist at the Pondville Hospital. A thor-
ough oral examination is made on all patients and a careful epidemiological history
is taken to uncover possible causative factors.
Diabetes Self -Testing Study
A study was carried out in Gloucester to determine the extent to which a com-
munity would participate in self-testing of urine as a diabetic control measure. The
study was under the joint sponsorship of the Medical Staff of the Addison Gilbert
Hospital, the Massachusetts Department of Public Health, and the Public Health
Service. The study showed that a community will participate in a self-testing pro-
gram where there is concerted action on the part of local groups. However, 41 per
cent of those who obtained the kit free of charge failed to use it, and many others
whose tests had been positive failed to consult a physician regarding their condition.
This study was reported in Diabetes, the Journal of the American Diabetes Asso-
ciation, May, 1952.
Cancer of the Uterus
In 1950, the result of the study of cervical cancer was published in Cancer, No-
vember, 1950. This showed that early marriage, early termination of pregnancies,
and divorce or separation remained significantly associated with cancer of the
cervix. When cancer of the cervix cases were studied in relation to histological
classification, the important variables were found to be related to the epidermoid
type, and not to the adenocarcinoma group. Cancer in situ, however, showed re-
lationship with early marriage and divorce. These findings were published in book-
let form, The Laboratory Diagnosis of Cancer of the Cervix, edited by Homburger and
Fishman.
Cytology Study
The findings in the cytology study were published in 1950. The incidence of
cancer among individuals with no gynecological symptoms was less than 1 per cent.
Cancer of the uterus was found in about 30 per cent of individuals with bleeding as
a symptom, in about 5 per cent among those with vaginal discharge, and in about 3
per cent of those with other gynecological symptoms.
This study was reported in the New England Journal of Medicine, April 3, 1952.
The Chronic Disease Survey in the Brookfields
The chronic disease survey, conducted in the four Brookfields, included questions
regarding heredity, occupation, living conditions, habits, and chronic diseases.
The personnel were furnished by the Division, while the traveling expenses were
supplied by Harvard University, utilizing a special grant for this purpose from the
American Cancer Society. That part of the data pertinent to the incidence of
chronic disease was reported by Lombard and Quinn in Commonhealth; that part re-
garding heredity, occupations, living conditions, and habits is to be utilized in the
rural control phase of the lung cancer study.
Evaluation of Cancer Education
The results of two evaluation studies on cancer education were reported during
this period, one in the Massachusetts Health Journal, May, 1950 and the other in
the Bulletin of Cancer Control, July, 1954. These studies furnished an estimate of
44 P.D. 34
the public's knowledge of the public health aspects of cancer, and the later one gave
some indication of improvement that had taken place in the city of Waltham.
Cancer of the Prostate
An article on "Epidemiology of Cancer of the Prostate" was prepared and pub-
lished in a monograph, The Laboratory Diagnosis of Cancer of the Prostate, Horn-
burger and Fishman. This included a review of the literature on the subject and
end results from the Massachusetts Cancer Clinics, which showed a great improve-
ment in five-year survivals during recent years.
Epidemiological Consultation
All research papers prepared by Pondville and Westfield physicians which con-
tain statistics are reviewed by this Division to determine the statistical soundness
of the conclusions. In addition, many physicians throughout the State are request-
ing that papers prepared by them be verified statistically.
Statistical Articles
Inasmuch as from statistical studies the Massachusetts Cancer Program received
its inspiration, determined its scope, evaluated its activities, changed its policies,
and obtained new ideas for cancer control, the Director of this program has been
asked on many occasions to discuss this subject.
In 1953, the book Physiopathology of Cancer by Homburger and Fishman, was
published. One chapter in this book, "Statistical Studies in Cancer," was written
by the Director. A paper on statistics in the cancer program was published in 1952
in the Harvard Public Health Alumni Bulletin. Two articles appeared in the pro-
ceedings of the Second National Cancer Conference, 1952, published by the Ameri-
can Cancer Society, and a review of the statistical work of the Division appeared
in Public Health Reports, published by the United States Department of Health,
Education, and Welfare ("Twenty-six Years of Cancer Control," July, 1953).
Services
Cancer Clinics
The cancer clinics have had phenomenal growth within the past six years. Due
to the efforts of Representative Rico Matera, additional funds were obtained which
enabled the Division to open new clinics and reactivate others. As of July, 1956
there were 25 State-aided cancer clinics and two State cancer clinics. In 1955, the
unit payment values were changed in order that services offered in State-aided
cancer clinics might be extended and improved. During the six years represented
by this report 27,756 new patients attended the cancer clinics. An average of over
24,000 patients made return visits to the clinic each year.
Traditionally, the clinics furnish group diagnosis for any individual in Massa-
chusetts who is suspected of having a cancerous or precancerous condition. Ap-
proximately 85 per cent of patients attending the clinics are referred by practicing
physicians who utilize the diagnostic facilities of the clinics to confirm their own
diagnoses.
Tumor Diagnosis Service
A tumor diagnosis service is maintained by the Department of Public Health in
conjunction with the Cancer Commission of Harvard University. Any physician
or hospital may have suspicious tissue examined pathologically to determine the
presence or absence of cancer. This service is used by physicians, many of whom
have no other pathological service available, and by pathologists who confirm
diagnoses in borderline cases.
In 1945, approximately 4000 specimens were examined, and from that time to the
present there has been a phenomenal increase in the use of this service until at the
present time, over 13,000 specimens are being examined annually.
Education
Professional
Physicians — Cancer education of physicians is accomplished largely through
teaching clinics. Physicians who would find it difficult to travel to Boston can easily
arrange to spend a few hours attending a local clinic. In practice, the doctor might
P.D. 34 45
see one or two cases in the course of a year, whereas the clinic provides an additional
opportunity to see a wide variety of cases and to follow the newer trends in diagnosis
and treatment.
In the six-year period, 143 teaching clinics were held, with an average physician
attendance of 35.
The second edition of Cancer, A Manual for Practitioners was distributed to all
practicing physicians in the Commonwealth in 1950, and the third edition in 1956.
The following are quotations from the preface of the second and third editions :
"This second edition has been prepared in answer to the continuing demand. The
advance in the knowledge of cancer and its treatment has made many sections of
the first edition incomplete."
"Cancer detection and therapy have changed significantly in the six years. In
this third edition all of the chapters have been revised and several new chapters
have been added. This manual has been designed primarily to aid practitioners in
the early diagnosis of cancer. It is anticipated that students will find the third
edition as useful an educational tool as others have found the previous editions.
The accepted methods of treatment have been described, but no attempt has been
made to go into details."
A chapter on "The Epidemiological Aspects of Cancer" and a second chapter on
"The Cancer Control Program of the Massachusetts Department of Public Health"
were included in this volume.
Nurses — Several nurses' institutes have been held. These institutes consist of a
concentrated two-week period of instruction and observation at Ponclville Hospital,
the State-aided cancer clinics, and various institutions. The course includes dis-
cussion of the various sites of cancer from the surgical, pathological, radiological,
and nursing points of view, and seminars on the public health aspects of cancer
control. The number of nurses who may attend the institute is limited in order that
each nurse may be given individual attention.
Workers in Biometrics — Due to the scarcity of women trained in biometric pro-
cedures, it has been necessary to furnish in-service training. Several courses in
bicmetrics have been given during the six-year period. In two of the courses person-
nel from the Massachusetts General and the Massachusetts Memorial Hospitals
requested permission to attend.
Lay Education
Since 1948, lay education in cancer control has been largely the responsibility of
the Massachusetts Division of the American Cancer Society. During the past six
years, the Division furnished some pamphlets and provided speakers; in addition,
a considerable amount of time was devoted to the evaluation of lay education.
Visitors
During recent years representatives from 26 foreign countries and from 41 states
and territories requested information regarding the cancer program. Many visited
the Division, others wrote for information.
Registration
At the inception of the Massachusetts Cancer Program the policy was adopted
that all cancer cases should be followed until death. For 30 years the follow-up of
patients has been continuing, and at the present time some of the first-year patients
are still living. The percentage of lost cases is extremely low, being in the neighbor-
hood of 2 per cent. This system forms the basis for many of the Division's studies.
Certain sites of cancer have far more cases of cancer than do other sites. It has
been possible, therefore, to study extensively the end results of treatment for certain
sites, but it has been impossible to study some sites due to the sparsity of cases.
On the national level, the difficulties of determining satisfactory end results are
great. Variations in geographical location, classification, selection of cases, and
methods of therapy have made it impossible to obtain uniform and comparable end
results. The Public Health Service has requested those registries in the United
46
P.D. 34
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P.D. 34 47
States which are reasonably satisfactory to pool their data so that studies can be
made that have a national significance, and enough cases to study the rare tumors.
The Massachusetts Registry was invited to participate in this endeavor.
Heart Program
The cardiac program as it functions in Massachusetts has stressed services to
prevent progression of disease processes and cardiac invalidism, education of pro-
fessional personnel to stimulate early case finding and improved patient care, re-
habilitation services for cardiacs, and epidemiological research.
During the period, vital statistics data were studied to determine the magnitude
of the cardiovascular disease problem in Massachusetts. Approximately 58 per cent
of all deaths in Massachusetts were attributed to the cardiovascular diseases.
Funds are supplied for six medical social workers who assist patients in carrying
out physicians' advice. For the individual with a chronic illness, social and economic
problems are greatly magnified, and their solution may often constitute an essential
part of the prescribed treatment plan.
Cardiac Work Classification Unit
A pilot Cardiac Work Classification Unit functions under the combined auspices
of the Bay State Medical Rehabilitation Clinic, the Massachusetts Department of
Public Health, and the Massachusetts Heart Association. The clinic has functioned
for four years at the Boston Bay State Rehabilitation Center. The cardiac unit
provides a consultation service in cardiac diagnosis and in classification of individ-
uals relative to their capacities for employment, for private physicians, hospitals,
clinics, industries, and other social agencies.
Research
Boston Dispensary — Records have been collected for a study of rehabilitation of
individuals with heart disease. This important research project demonstrates
utilization of maximum rehabilitation services for cardiac patients.
Boston Lying-in Project — A combined service and research program is being
given to the Boston Lying-in Hospital to study the effects of heart disease in preg-
nancy. The provision of supportive services and greater utilization of community
resources augment the armamentarium of the cardiologist in preventing cardiac
disability associated with the stresses of pregnancy.
Instruction in adapting work-simplification methods to household tasks enables
the pregnant cardiac to save 75 per cent of the energy expended, and further aids in
the maintenance of cardiac reserve.
Psychological and Social Consequences of Heart Disease — A preliminary study
dealing with the social and psychological consequences of heart disease is being con-
ducted in cooperation with the Public Health Service. This is an attempt to de-
termine the effect of social situations, of family, of finances, and of employment on
the cardiac.
Lawrence General Hospital Cardiac Clinic — At the Lawrence General Hospital
Cardiac Clinic a study is being conducted to demonstrate the value of a cardiac
team which is composed of a cardiologist, social worker, public health nurse, and
nutritionist. The members of this team are present at each clinic session and
each case is reviewed and evaluated by group discussion and participation. In
addition to working with the patient in the clinic, care will be extended into the
home by each of the team members.
Professional Education
Physicians — Information is furnished to physicians on new discoveries in heart
disease, through a bulletin sent to all physicians requesting it. The Department
cooperates with the Massachusetts Medical Society in furnishing postgraduate
education.
Nurses — Recognizing the need for professional education for nurses in all fields
relating to the newer concepts of patient care in cardiovascular disease, the Cancer
and Chronic Disease Division undertook to develop such a program. Participants
48 P.D. 34
in the program included physicians, social workers, nutritionists, and nurses.
Courses have been completed in the following locations in the state: Andover,
Cambridge, Fitchburg, Lakeville, Lawrence, Lowell, Northampton, Pittsfield,
Quincy, Salem, Waltham, and Worcester. These courses were from six to eight
weeks in duration and the average attendance at a given session was 46. The total
number who registered was 892 and there were several who attended who failed to
register.
Geriatric Program
Tentative plans for the geriatric program are as follows :
Establishing of a Teaching Clinic for Prospective Workers in Geriatrics — The care
of the geriatric patient differs markedly from that of the ordinary patient. Most
physicians and nurses are unfamiliar with the best methods for handling this type of
patient. The present-day physician is geared to combat the individual disease, and
it is necessary for him to learn new techniques in order to give the best care to the
geriatric patient. Here, emphasis is placed on the over-all welfare of the patient
rather than any one disease entity. Recreation, work, and nutrition may be as
important as medication. The geriatric clinic must conduct research into the best
way of caring for the aging sick, utilizing mental hygiene, physiotherapy, rehabilita-
tion, and some medicine. The teaching geriatric clinic will train physicians, nurses,
and ancillary personnel in the best methods of conducting such clinics.
Service Geriatric Clinics — Several geriatric clinics will be organized as soon as
the necessary arrangements can be made and staffs trained to conduct them. It is
expected that these clinics will, in turn, use their faculties to demonstrate to the
profession the best method of handling the problems of this old-age group.
Research — The aged person is the sum total of all his previous experiences. For
example, it is believed that some of the chronic diseases have their origin in occur-
rences years before the disease manifests itself ; heart disease may follow rheumatic
fever or syphilis; hypertension appears to be inherited; certain forms of cancer ap-
pear to be associated with poverty; lung cancer may follow prolonged years of
cigarette smoking, and heart disease may also be related to smoking. Not only do
the chronic diseases have their origin in earlier life, but the other facets which com-
prise the geriatric problem also begin before senescence.
The accompanying diagram shows the likely time of origin. However, the exact
time of onset of many of the contributing factors is, of course, unknown and it will
require extensive research to complete such a diagram accurately. A long-term
study of geriatric patients in the clinics, perhaps supplemented by studies made in
nursing homes as well as homes for the aged, is anticipated. The non-directive
technique of interviewing should be employed and calls should be frequent so that
the patient would talk freely. It is believed that sufficient information will be ob-
tained regarding the time of onset of some of the factors inherent in many of the
aged to enable the establishment of prevention programs for at least some of the
problems of old age.
P.D. 34 49
In Memoriam
CHANNING C. SIMMONS, M.D.
Died August 15, 1953
Dr. Simmons had been an active supporter of the cancer program since its in-,
ception in 1926. During the war years, he served as Assistant Director. He edited
the two editions of the book Cancer, A Manual for Practitioners, and made a survey
of the State-aided cancer clinics. For many years he served on the Cancer Ad-
visory Committee, at first as a member and later as Chairman. After he terminated
his official connection with the Department, he frequently visited at the Division
office since his advice was sought on many occasions.
BRA T. NATHANSON, M.D.
Died May 3, 1954
Cancer lost one of its foremost workers and the Division of Cancer and Chronic
Disease lost a good friend when Dr. Ira T. Nathanson passed away. From his early
days at Pondville Hospital to the time of his death, he kept in close contact with the
Division.
50
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62 P.D. 34
DIVISION OF ALCOHOLISM
The Division of Alcoholism was established by an act of the General Court
signed by the Governor on August 17, 1950. Under this act the Department of
Public Health was authorized to develop a program for alcoholism. The objectives
assigned to the Department were threefold: (1) the establishment of such clinic
and hospital facilities as are necessary for the proper diagnosis, treatment, and
rehabilitation of persons addicted to the excessive use of alcoholic beverages;
(2) the study of problems related to alcoholism ; (3) the promotion of a preventive
and educational program concerned with the problems of alcoholism.
In order to carry out the provisions of this law the Department established the
Division of Alcoholism as of November 17, 1950. The alcoholism program is
organized on the basic principle that the alcoholic is a sick person who can be
helped to recovery and is worthy of such assistance; furthermore, "that when an
illness becomes so widespread in the population, so serious in its effects, so costly
in its treatment that the individual cannot cope with it himself, it then becomes
a public health responsibility." This quotation is from Dr. Thomas Parran,
former Surgeon General of the United States Public Health Service.
Alcoholism is now considered to be the fourth most important public health
problem in the United States, being exceeded in importance only by heart disease,
tuberculosis, and cancer. The distinguishing characteristic of the modern approach
to this age-old problem is the understanding that alcoholism is a progressive disease
or illness which may be arrested at any stage in development, but once established
can only be successfully controlled by total abstinence. While we do not as yet
have a complete understanding of the exact pathologic changes that go on in the
body during the progress of this disease, we do know that it is an irreversible
reaction and that it seems to be in the nature of a sensitized phenomenon similar
to, but not identical with, anaphylaxis. It has been believed for ages that once
an alcoholic always an alcoholic. This belief has been confirmed by recent scientific
study and is the basis for the saying that for the alcoholic "one drink is too many
and a thousand not enough."
Administration
The Division of Alcoholism occupies a suite of offices on the fifth floor of No. 8
Beacon Street, Boston. It has an authorized staff of a Director, Assistant to the
Director, Supervisor of Social Services, and Senior Clerk and Stenographer. The
first director of the Division was Dr. John C. Ayres, who resigned his position
with the Department to become Commissioner of Health in Springfield. On
August 1, 1953 Dr. James B. Moloney was appointed Director and remains to the
present time.
The State cooperating alcoholism clinics are 10 in number; they are used for
the diagnosis, treatment, and rehabilitation of persons addicted to the excessive
use of alcoholic beverages.
These clinics are located in the out-patient departments of general hospitals.
The Department reimburses these hospitals for the operation of these alcoholism
clinics in accordance with the standards set by the Division of Alcoholism. Each
of these clinics has a physician-in-charge who is particularly trained in the clinical
aspects of the treatment of alcoholism. The physician-in-charge assumes the
responsibility for the clinical management of all patients in that clinic. He is
assisted by one or more physicians in accordance with the size and case load of
the clinic. In addition to the physicians, the clinics have full-time social workers,
and in some the services of a psychologist are used on a part-time basis. Clerical
assistants are employed on a full-time basis in all the clinics.
One of the key individuals in the cooperating clinic team is the social worker,
who interviews all patients. Therefore, the social worker must be an individual
endowed with tact and understanding and one who wins the confidence of the
patient.
Essential to an alcoholism control program is the adequate reporting of patients
with alcoholism. Table I depicts the number of patients admitted to the co-
RD. 34
63
operating clinics from 1951 to 1955, inclusive. Table II shows the referral source
of patients admitted to the clinics. Table III gives the occupation status of
patients admitted, and Table IV depicts the age and status of patients discharged
from the cooperating clinics.
Table I — Age and Sex of Patients Admitted to Clinics for Alcoholism
1951-1955
19.1
1952
1953
1954
1955
Total
Age
M
F.
M.
F.
M.
F.
M.
F.
M. F.
M. F.
10-14 ....
1
_
3
2
_
_
_
_
_ _
4 2
15-19 .
2
—
7
5
1
—
—
—
1 1
11 6
20-24 .
5
3
37
12
6
1
14
6
13 3
75 25
25-29 .
30
6
70
18
48
9
39
8
45 10
232 51
30-34 .
73
16
87
21
81
14
61
21
90 19
392 91
35-39 .
79
19
82
29
73
14
69
31
132 30
435 123
40-44 .
86
27
79
11
88
31
90
26
138 30
481 125
45-49 .
63
17
55
9
90
18
90
16
128 25
426 85
50-54 .
39
9
33
10
45
14
55
10
103 19
275 62
55-59 .
19
6
10
—
20
5
37
5
42 7
128 23
60-64 .
8
5
5
—
14
2
14
4
19 10
60 21
65-69 .
—
—
1
—
4
—
7
1
8 2
20 3
70-74 .
3
—
—
—
2
—
2
—
6
13
75-79 .
1
—
—
—
_
—
1
—
1 1
3 1
80-84 .
—
-
—
—
—
—
—
—
1
1
Not Stated
-
2
4
1
4
-
2
2
5 1
15 6
Total
409
110
473
118
476
108
481
130
732 158
2571 624
Table II — Referral Source of Patients Admitted to Clinics for Alcoholism
1951-1955
Source
1951
1952
1953
1954
1955
Total
Self
Relative
Friend .
Court .
Social Agency
Physician
Spouse .
Clergy .
A. A. .
Other .
154
54
52
83
38
60
24
6
11
37
152
56
55
84
60
96
15
13
12
48
96
46
37
84
54
120
19
6
16
106
111
39
30
78
98
132
20
26
35
42
83
136
77
52
101
220
16
40
57
108
596
331
251
381
351
628
94
91
131
341
Total
519
591
584
611
890
3195
Table III — Occupational Status of Patients Admitted to Clinics for Alcoholism
1951-1955
Occupation
1951
1952
1953
1954
1955
Total
Professional workers . . . . .
8
20
39
18
32
117
Semiprofessional workers . . . .
16
8
6
15
25
70
Proprietors, managers and officials
25
22
22
36
44
149
Clerical and Sales .....
98
93
86
77
128
482
Craftsmen, foremen . . . . .
87
90
99
108
217
601
Operatives .......
21
27
49
31
48
176
Service workers, domestic .
5
37
9
—
13
64
Not domestic ......
62
41
61
113
119
396
Laborers .......
110
156
100
97
144
607
Housewives ......
56
40
32
43
69
240
Students .......
3
2
—
1
3
9
Military .......
3
2
2
-
3
10
Not stated .......
25
53
79
72
45
274
Total
519
591
584
611
890
3195
64
Table IV
P.D. 34
Age and Status of Patients Discharged from Clinics for Alcoholism
1951-1955
Self-Terminated
Unresponsive or
Age
Recovered
or Lost
Uncooperative
Total
15-19
1
1
1
3
20-24
12
14
8
34
25-29
32
57
35
124
30-34
87
107
86
280
35-39
86
114
91
291
40-44
129
107
83
319
45-49
119
107
63
289
50-54
67
77
46
190
55-59
49
37
17
103
60-64
26
10
10
46
65-69
6
4
3
13
70-74
5
—
—
5
75-79
1
-
-
1
80-84
1
—
—
1
Not stated
8
15
6
29
Total
629
650
449
1728
Treatment
There are three prime requisites for the successful treatment of alcoholism.
The first is that the person suffering from this illness admit that he is in need of
help; second, he must request help; and third, he must agree to cooperate in treat-
ment. Given these three essentials, a person suffering from this illness has a good
chance of recovery and rehabilitation. The road back to sobriety is difficult and
is beset with many obstacles, and the goal of complete rehabilitation means
readjustment to complete social living, but it can be accomplished, as has been
demonstrated so admirably by the thousands of persons who have recovered from
alcoholism through Alcoholics Anonymous.
Popular belief to the contrary notwithstanding, the typical alcoholic is not
invariably a "Skid Row" character. Representatives from all levels of society
succumb to alcoholism, from the humblest unskilled manual laborer to the most
highly trained mechanical and professional worker. Alcohol is no respecter of
persons. Anyone can be caught in the mire of addictive drinking if he drinks
steadily enough and for a sufficiently long period of time. This does not mean
that abnormal persons, or those suffering from personality defects or aberrations,
may not become alcoholics, because they frequently do. But the alcoholism is
probably separate and distinct from the underlying personality defect.
The out-patient clinic is the basic unit of service to the alcoholic. In each case
the different problems involved are studied and plans are formulated for treatment.
The individual must be helped to adjust his life, without alcohol, to the community
and environment wherein he lives or expects to live. Merely to keep the alcoholic
sober in the artificial environment of an institution or in complete dependence on
a therapist is expensive, ineffective, and bound to lead to failure.
Establishment of such cooperating clinics in out-patient departments of general
hospitals offers many advantages. To the alcoholic, it means the acceptance of
his affliction as a disease to be cared for in a facility where other ailments are
similarly treated. This tends to remove the stigma so frequently attached to
alcoholism, and it renders the alcoholic more ready and willing to recognize, admit,
and accept his inability to handle alcohol and to seek help. To the physician, it
means the ready availability of a specialized diagnostic and therapeutic service
necessary for treating patients as a whole. To the hospital staff, it offers first-
hand knowledge as to the nature of alcoholism and its treatment. Furthermore,
it makes available a facility where patients primarily admitted or hospitalized for
an organic illness may be referred for study and treatment of a secondary alcoholic
problem. To the hospital, it also means the offering of additional beneficial services
to the community, thereby increasing its value to the community at large.
Drugs used in the treatment of alcoholism are of two main categories: (1)
prophylactic and (2) symptomatic.
P.D. 34 65
The drug disulfiram, more popularly known as antabuse, originated in Denmark,
and at first was hailed as the long-sought for "cure" for alcoholism. But the initial
enthusiasm has waned, and now it is considered to be a potentially dangerous drug
which may have some value when skillfully used. In effect this drug puts a psycho-
logical barb- wire fence around the alcoholic, or in fact any person so far as taking
the first glass of an alcoholic beverage is concerned. But the effect lasts only a
few days after cessation of taking the pills. The drug has many contraindications
and can only be given with the knowledge, consent, and cooperation of the patient.
The symptomatic drugs, as the name implies, are tranquillizers, and in skillful hands
probably have some value. But drug therapy is only an adjunct, and not neces-
sarily a requisite adjunct, to treatment. Psychiatric and supportive social therapy
are used as indicated. Each case is individualized and treatment is offered on this
basis. This, however, does not preclude the use of group therapy in suitable cases.
In the final analysis, alcoholism is a biosocial problem of the first magnitude,
which requires the combined efforts and resources of several disciplines for its solu-
tion. Medicine, psychiatry, and social service are involved in the remedial or
therapeutic phase, but the only way that alcoholism can be prevented — and after
all, prevention is the prime objective of all public health work — is through edu-
cation.
Education
The third objective assigned the Department by the original legislation was the
"promotion of a preventive and educational program concerned with the problems
of alcoholism." This is a particularly difficult assignment, as there has been no
concise and authoritative declaration of principles by the leaders in the field of
alcoholism. The restrictions imposed by the protagonists of both the "Wets"
and the "Drys" and the diverse cultural and religious backgrounds of pupils make
the path of the alcoholism educator narrow indeed.
The plan of operation, therefore, in dealing with this problem of education for
prevention has been to adhere strictly to an objective presentation of scientifically
demonstrable facts, so that each individual may preserve his inalienable right to
his own decision as to drink or not to drink alcoholic beverages.
66 P.D. 34
DIVISION OF COMMUNICABLE DISEASES
Roy F. Feemsteb, M.D., Dr. P.H., Director
General Statement
The period 1950-1955 was ushered in by a general low prevalence of communicable
diseases, 1950 showing the lowest total since 1916. The next two years showed an
increase, reaching 119,000 cases in 1952. This was followed in 1953 with a drop to
about the same level of 1950, and a gradual rise again to 112,000 in 1955. These
fluctuations are due largely to variations in the acute communicable diseases of
childhood.
Prevalence of Communicable Diseases
Brucellosis — This disease, which was formerly tabulated under undulant fever,
has been at a consistently low level during the six-year period. Only once were
more than 20 cases reported in a single year. In 1955 only nine cases were reported.
Since the disease in the past has been largely due to the bovine organism and has
been transmitted by milk, this is a good measure of the widespread acceptance
and efficient application of pasteurization.
Chicken Pox — This disease did not fall below 12,000 cases per year during the
period, and in 1953 it exceeded 23,000 cases, the highest number ever recorded.
It is interesting to compare this incidence of a disease for which we have no immuni-
zation with that of smallpox, which has completely disappeared from the State.
Diphtheria — After 25 years of increasing acceptance of diphtheria immuniza-
tion and a continual increase in the effectiveness of the agents, diphtheria is finally
declining to almost the vanishing point. The incidence dropped below 100 for the
first time in the history of the State in 1951, and during the last four years has
only once exceeded 30 cases per year. In 1955 only 19 cases were reported.
Dysentery, Bacillary — For some undetermined reason this disease showed a
sudden increase in 1953, confined largely to some of the larger municipal areas in
the State, and occurring especially among families in low-income groups. Without
any increased measures of control the disease has gradually declined since that date.
Encephalitis, Infectious — This disease has been at the highest level during the
period since the occurrence of Von Economo's disease in the '20s and '30s. The
disease may have resulted from the increased interest in virus diseases and greater
use of virus laboratories in making diagnoses. Some of the cases are no doubt due
to Coxsackie viruses and ECHO viruses.
In 1955 there was a mild recurrence of eastern equine encephalomyelitis, resulting
in four human cases and illness in more than 40 horses.
Gastroenteritis — This disease, as such, is not reportable except that the Depart-
ment must be informed when outbreaks occur. Many of the cases, of course, are
eventually reported as Salmonella infections or bacillary dysentery. The bulk of
the outbreaks, however, are usually due to staphylococcus food poisoning. A list
of the outbreaks which have been brought to the attention of the Department
will be found in the tabulation of outbreaks later in this report.
German Measles — Except for 1952, when 15,000 cases were reported, this disease
has been at a low level throughout the period.
Hepatitis, Infectious — This disease showed a rapid increase, beginning in 1952
and reaching nearly 1300 cases in 1954. In 1955 it dropped to under 900 cases.
This rise in incidence is a part of a national wave of the disease. Until we have
further experience it is difficult to determine whether the rise was due to increased
reporting by physicians who were just discovering that the disease should be
reported or whether the increase was real. If it eventually turns out that we have
nearly 1000 cases per year, an increase to 1300 would mean very little.
Malaria — Reported cases of this disease have very little significance since they
are all acquired outside of the State.
Measles — The period was characterized by two record outbreaks of this disease
— the highest in 1952 — but more than 50,000 cases were reported in 1955. In
P.D. 34 67
spite of this high prevalence the number of deaths remained below any other period
in the past.
Meningitis, Meningococcal — This disease fluctuated between 60 and 85 cases
during the period. In spite of the fact that the sulfonamides and other specific
treatments are quite effective, the deaths fluctuated between 13 and 27 per year.
Meningitis, Other Forms — The influenza bacillus is responsible for one-half to
two-thirds as many cases as the meningococcus, but almost equals the number of
deaths. Because of the frequent reporting of aseptic meningitis, which was formerly
confused with nonparalytic poliomyelitis, meningitis undetermined has been on
the increase.
Mumps — Mumps rose to the highest level in the history of the State in 1954,
with over 18,000 cases recorded. On the other hand, three years during the period
have shown only about half that number of cases.
Poliomyelitis — Interest in this disease has continued to mount. In 1953 the
Division participated in a nation-wide evaluation of the usefulness of gamma
globulin in the prevention of the paralysis of poliomyelitis. These studies were
disappointing because it was not possible to show that there was any great value
in its use in household contacts after a case had occurred.
In 1954 the Department participated in the nation-wide poliomyelitis vaccine
field trials, during the course of which more than 14,000 children in the first, second,
and third grades of 25 communities received polio vaccine and an equal number an
inert material. Massachusetts' contribution to this study was minimal because
poliomyelitis was at a low level during this study, and because many of the cases
which were reported as poliomyelitis were really minor illnesses due to confused
viruses.
Two events characterized the year 1955: first, the giving of one dose of polio
vaccine to first and second grade children throughout the Commonwealth, and
then the long pause in the program due to the fact that some lots of vaccine proved
unsafe. The second event was the largest outbreak of poliomyelitis that ever
occurred in this state, 3950 cases having been recorded. With funds made available
by the National Foundation for Infantile Paralysis, a special study of the value of
one dose of polio vaccine was carried out during the progress of this epidemic.
This study demonstrated the usefulness of even one dose in an epidemic situation.
Rabies — Not only were there no human cases of rabies during the period, but
there were no rabid animals discovered in the State. Under such circumstances
it becomes increasingly difficult to maintain inoculation of dogs with rabies vaccine.
If the disease should be reintroduced by a dog coming in during the incubation
period, the low immunity of the dog population might furnish an opportunity for
an epidemic among animals.
Salmonellosis — There was a continual rise in the incidence of this disease during
the period, going from about 70 cases in 1950 to nearly 350 in 1955. This disease
is difficult to control because the reservoir of infection lies among animals and is
introduced into the human population by animal foods which we consume. The
bulk of the cases occur as single cases or small family outbreaks, but occasionally
there is a small epidemic when a kitchen becomes infected with the organism. A
table giving the varieties of Salmonella organisms most frequently encountered
appears in Volume II of this report.
Scarlet Fever — This disease has been at a low level during the whole period,
due partly, no doubt, to the mildness of the disease in recent years, but also due
to the widespread use of sulpha drugs and antibiotics which keep down the numbers
of streptococci harbored in the population.
Smallpox — The continued absence of this disease from the State is heartening
but is partly explained by the fact that 300,000 doses of smallpox vaccine are dis-
tributed annually for immunization purposes. It is now almost 25 years since a
case of the disease occurred in Massachusetts.
Typhoid Fever — Only once during the period were there more than 25 cases
reported in a single year. The period ended with the lowest prevalence of tbe
disease ever recorded.
68 P.D. 34
The number of typhoid carriers on our list is gradually declining, due to the
advanced age of most of the carriers and to the fact that there is little replacement
following active cases of the disease.
Whooping Cough — Since the first year in this period whooping cough has been
making new low records of prevalence. The period ended with the lowest incidence
of the disease that has ever been recorded in the State. Much of this is, of course,
due to the widespread use of pertussis vaccine now included in our triple antigen
for the immunization of preschool children.
Other Diseases — Occasional cases of anthrax, psittacosis, Rocky Mountain
spotted fever, trichinosis, and tularemia continue to occur, but the incidence of
these diseases was not remarkable during the period.
Reorganization
In 1950 the Diagnostic Laboratory, consisting of the two divisions, the Bacterio-
logical Laboratory and the Wassermann Laboratory, was transferred to the Institute
of Laboratories. No further mention of the activities of the Laboratories will
be made in the report of this Division.
Epidemiology
Due to the inadequate salary for the Assistant Director, this position has not
been kept filled, so that during a good portion of the period only one physician,
in addition to the Director, has been available for carrying on the work of the Divi-
sion. In addition, the number of district health officers has been reduced to five,
and since they usually make the primary investigations, each has more work to do.
Consequently, the records of the Division have been falling behind. This situation
would have been acute, indeed, if the number of epidemics had not been on the
decrease. Those which have occurred have been mainly staphylococcus food
poisoning and Salmonella infections.
Special Projects and Studies
Diphtheria Study — The study on the practicability of immunizing high school
students against diphtheria without preliminary Schick tests was concluded early
in the period, and the program for giving diphtheria toxoid to high school students
was incorporated in our recommendations regarding immunizations.
Boston Exanthem — Early in the period, a study was carried out with the assist-
ance of Dr. Neva of the Children's Medical Center on an illness characterized by
a skin rash which differed from measles, German measles, scarlet fever, roseola
infantum, and other childhood diseases. Eventually Dr. Neva was able to isolate
a virus from specimens from these children and the new disease was named the
Boston exanthem.
Equine Encephalitis — In 1953, meteorological conditions in the spring made it
appear that a bad mosquito year was in prospect, and it was feared that encephalitis
due to the eastern equine virus might reappear. A study was undertaken to deter-
mine if the virus was present in the State, with the assistance of the Virus and
Rickettsia Laboratory of the Public Health Service. About 150 specimens of blood
from birds were sent to the laboratory for examination. Nearly one-fourth of
them showed evidence that the birds had been infected with either the eastern or
western virus. In addition, the eastern virus was isolated from one bird. The
eastern virus was also isolated from a horse which had been diagnosed as having
horse sleeping sickness. This was good evidence that the virus was present in the
State in 1953.
Poliomyelitis — In the midst of the 1955 outbreak of poliomyelitis, the Depart-
ment was asked by the National Foundation for Infantile Paralysis to undertake
a study of the usefulness of one dose of polio vaccine in preventing the paralysis
of poliomyelitis. Since the staff of the Division was too heavily loaded with work
connected with the outbreak, it was necessary to organize a team of temporary
workers to carry out the project. This study revealed that one dose of vaccine was
quite effective in preventing paralysis.
P.D. 34 69
Milk Regulations — This Division continued its interest in passing the regulations
requiring the pasteurization of milk. During the period, the number of communi-
ties which had such regulations increased from 111 to 146. Pamphlets are regularly
supplied by the Division on various aspects of milk and its value as a food and
danger as a carrier of disease, to assist in obtaining the passing of such regulations.
Intekstate Problems
During the period, the Director has participated in making several studies
regarding problems which involve numerous states.
Rabies — Two conferences in New York City were attended by representatives
of the states of New England as well as New York, Pennsylvania, and New Jersey.
Early in the period invasion in Massachusetts from eastern New York was feared
and special vigilance was being observed to discover if any rabid animals were
entering the State from the west. New York and Pennsylvania were both having
acute problems with rabies in wildlife, with accompanying loss of domestic animals
bitten by foxes. Control measures have reduced the disease in these two states,
and the threatened invasion in Massachusetts has not taken place.
Gamma Globulin — In 1953, the National Foundation for Infantile Paralysis
released gamma globulin for the prevention of poliomyelitis, and since there was
great question in regard to its possible usefulness, a national study was undertaken.
The Director was a member of the national committee and attended several meet-
ings outside the State in regard to the problem. The study failed to reveal any
practical usefulness of gamma globulin.
Polio Vaccine Field Trials — When the National Foundation for Infantile
Paralysis undertook a national study of the usefulness of Salk's polio vaccine, the
Director was a member of a national committee which guided the direction of the
study. Several meetings were held in New York City, Atlanta, and Columbus,
Ohio. The studies were evaluated by a group at the University of Michigan headed
by Dr. Thomas Francis and proved conclusively that polio vaccine gave protection
against paralysis.
Mass Use of Polio Vaccine — The same committee which had guided the studies
of the field trials of polio vaccine was called upon to guide the use of the vaccine
furnished by the National Foundation for Infantile Paralysis in 1955, and to make
recommendations in regard to the distribution of polio vaccine in 1956. The Di-
rector attended several out-of-state meetings in connection with this committee
and also meetings called by the Public Health Service.
Pakistan Program
In 1952, when the Department undertook to staff the health team being sent
to Pakistan by the Department of State of the United States Government, the
Director was sent to Pakistan on a three-months trip to make preliminary plans
for the work of the team. Thereafter, he continued for a time as a member of the
Advisory Committee of the Department on the Pakistan Program.
Residency Training
When the Department undertook to provide residency training for physicians
in preventive medicine, the Director was asked to assume responsibility as Edu-
cational Director for this program. He attended a national meeting on the program
at the University of North Carolina and worked with the Department's Director
of Training in setting up the program for this group.
Revision of Regulations
A number of changes were made in the isolation and quarantine requirements
for communicable diseases in 1952. Proposed changes were submitted to an
Advisory Committee for revisions before adoption.
70 P.D. 34
Communicable Disease Information
Early in the period, the Division was publishing information in regard to com-
municable diseases in its weekly publication called Communicable Disease Informa-
tion. In 1952, this publication became a departmental outlet for news and the
name was changed to This Week in Public Health. The information which had been
going out previously in the publication of the Division has continued to be included
in the departmental organ. Those articles on communicable diseases of wider
interest are reprinted in pamphlet form for distribution. The Director also acted
as editor of the Department's column in the New England Journal of Medicine.
Publications
During this period the Division was responsible for the publication of the following
articles :
Clinical and Epidemiological Features of an Unusual Epidemic Exanthem, by
Franklin A. Neva, M.D., Roy F. Feemster, M.D., and Ilse J. Gorbach, M.D.,
Journal of the American Medical Association, 155: 544-548 (June 5, 1954).
An Outbreak of Salmonellosis Traced to Watermelon, by Gilbert E. Gayler, M.D.,
Robert A. MacCready, M.D., Joseph P. Reardon, M.D., and Bernard F. McKernan,
M.D., Public Health Reports, 70: No. 3 (March, 1955).
Evaluation of Poliomyelitis Vaccination in Massachusetts, Alton S. Pope, M.D.,
Roy F. Feemster, M.D., David E. Rosengard, M.D., Florence R. B. Hopkins,
M.D., Boris Vanadzin, M.D., and Edgar W. Pattison, M.S., New England Journal
of Medicine, 254: 110-117 (January 19, 1956).
Note: Statistical tables showing the incidence of diseases are shown in Volume
II of this report.
P.D. 34 71
DIVISION OF DENTAL HEALTH
This report covers the second half of the first decade of this Division's activities.
During this period the staff of nine professional dental personnel and three clerical
personnel have directed their energies to the control of dental diseases by con-
tributing to the development of specific preventive procedures, control methods,
and dental health educational procedures at the community level.
The practical application of the first major technical breakthrough in the pre-
vention of dental caries by the fluoridation of water supplies has not only produced
encouraging trends in the suppression of tooth decay, but has stimulated more
public and professional discussion on the public health significance of dental dis-
abilities than in any other period in the Department's history.
Fluoridation
Twenty Massachusetts communities began the fluoridation of their water sup-
plies on a continuing basis during this period — the first beginning in May, 1951.
In most of these communities the Division has taken baseline dental caries preva-
lence measurements for future evaluation purposes. In those communities of
oldest fluoridation history interim measurements have indicated the beginning of
dental caries suppression. An example of the order of these findings is included in
Table I.
The subject of fluoridation has usually been attended by considerable public
debate in those communities where it has come up for official consideration. The
Division has served as a resource of information for local officials looking into the
question. During this period the probability of a community adopting this pro-
cedure once it has opened the subject to popular debate has been about fifty per cent.
Other Preventive Measures
During these years the topical application of fluoride salts to children's teeth
has been attempted by some communities as a public health approach to the pre-
vention of dental caries. In general, the method has been found cumbersome in
operation and remains unevaluated in the few locations where it still is practiced.
Educational attempts at reducing excessive carbohydrate consumption as a
threat to dental health have been one of the chief foundations of public health
efforts in this field.
Professional Resources
The numbers of dentists and dental hygienists available during this period have
grown with the same speed as that of the general population, leaving the dentist-
population and dental hygienist-population ratios in a favorable position relative
to those of the nation and the other states. The Division has been able to assist
the development of these trained personnel by directing material resources to the
professional schools in the State through the medium of educational project grants.
For the public health aspects of professional dental training, the Division has
designed and conducted in-service training courses for those in public employment.
During this time about one-half of the dental hygienists in public health work
have received this type of training, but only 5 per cent of the dentists have had
this opportunity, as these resources have been available to them only during the
last several months of this period.
Disease Prevalence and Treatment Effectiveness
Requests by communities for evaluation of their dental health programs have
provided opportunities for measurement of certain oral diseases. Of chief signifi-
cance have been the observations on dental caries history of school age children.
Tables II and III illustrate this particular diseasa prevalence and the relative
treatment effectiveness for it in a group of communities observed in 1953. These
observations were performed under the conditions prescribed by the Council on
Dental Health of the American Dental Association for Type III examinations.
Repeated observations of this type have left us with the impression that oral disease
prevalence has remained unchanged during this period in all areas except those
which have undertaken the fluoridation of water supplies. Toward the end of
72
P.D. 34
this period there has been some evidence that a significant improvement has been
made in the timely treatment of dental defects by conventional dental operative
procedures.
Projections of our observations have led us to the belief that at the close of this
period in the school-age population of this State, three teeth were decaying every
minute and that one-half of them were receiving timely reparative dental treatment
for the control of the disease.
Table I — Fluoridation Data, Athol, Massachusetts, 1951 and 1954
Age (in Years)
6
7
8
9
1951
1954
1951
1954
1951
1954
1951
1954
Number of Cases
123
164
175
169
178
157
199
119
Percent with one or
more DMF
70
33
87
65
99
92
97
94
DMF
2.07
0.79
2.81
1.75
3.93
2.81
4.75
3.70
D/DMF
.98
.89
.92
.85
.88
.73
.82
.61
M/DMF
.00
.01
.00
.01
.01
.02
.02
.05
F/DMF
.02
.11
.08
.14
.11
.25
.16
.34
Table II ■ — Average Number of Decayed, Missing, and Filled Permanent Teeth
Per Child by Age in Sixteen Massachusetts Communities, 1953
Age
Number
of
Cases
Percent -with
One or More
DMF Teeth
Decayed
Teeth
Per Child
Missing
Teeth
Per Child
Filled
Teeth
Per Child
DMF
Teeth
Per Child
a
obs
5
220
17%
0.30
0.00
0.02
0.32
0.87
6
1354
42%
0.96
0.00
0.05
1.01
1.42
7
845
75%
1.85
0.02
0.33
2.20
1.63
8
687
88%
2.42
0.06
0.56
3.04
1.73
9
490
94%
2.87
0.16
0.90
3.93
2.15
10
345
96%
3.53
0.28
1.11
4.92
2.88
11
308
99%
4.97
0.49
1.49
6.95
4.11
12
534
99%
5.61
0.55
2.30
8.46
4.53
13
600
99%
6.20
0.72
3.01
9.93
4.89
14
552
100%
6.20
0.83
4.20
11.23
5.19
15
110
100%
7.20
1.17
4.18
12.55
6.21
16
92
100%
5.43
1.49
6.75
13.67
5.15
17
167
100%
4.97
1.47
7.78
14.22
5.84
Table III — Average Number of Decayed, Extracted, and Filled Deciduous Teeth
Per Child by Age in Sixteeen Massachusetts Communities, 1953
Age
Number Percent with
of One or More
Cases def Teeth
Number of Number of
Decayed Extracted
Teeth Teeth
Per Child Per Child
Number of Number of
Filled Teeth def Teeth
Per Child Per Child
obs
4
5
6
7
8
347 68%
427 83%
1427 88%
845 91%
570 92%
2.00 0.04
3.70 0.30
4.71 0.51
4.48 0.73
4.18 0.69
0.86 2.90
0.89 4.89
0.86 6.08
0.97 6.18
0.88 5.75
3.05
3.86
4.05
3.60
3.05
Community Dental Health Programs
Assistant communities in the development of their own dental programs has
been a major effort of this Division. With the chief efforts directed at the health
of the school-age child, these local programs in 1955 screened about one-half the
school-age population for the early detection and correction of dental defects by
the use of 250 dentists and 79 dental hygienists. By the use of board of health
dental clinics they provided dental services to 86,000 children, or approximately
10 per cent of the total population of the age levels they were designed to serve.
It is estimated that these local programs reached 25 per cent of the total school
population through their health education efforts by use of media prepared by this
Division.
P.D. 34 73
DIVISION OF VENEREAL DISEASES
The Division of Venereal Diseases occupies a suite of offices located on the second
floor of the Ford Building, 15 Ashburton Place, Boston. It has an authorized
complement of a Director, Assistant Director, two public health nursing super-
visors, and a stenographic and clerical staff of 11. The clerical staff consists of one
principal clerk, one senior statistical clerk, two senior clerk-stenographers, one
junior key punch operator, three junior clerk-stenographers, and three junior
clerk-typists.
The Division of Venereal Diseases is one of five divisions in the Bureau of Pre-
ventive Medicine. This regrouping of the division into the Bureau of Preventive
Medicine took place in fiscal 1955.
Budget
The appropriation for the fiscal years 1949-1956 follows:
Personal
Laboratory, Medical
Miscellaneous
Services
Travel
and General Care
Expenses
1950 $53,360
00
$1,432
04
$314,037
78
$7,652
00
1951
56,665
00
1,250
00
313,210
00
6,890
00
1952
60,925
00
940
00
300,120
00
8,151
00
1953
61,150
00
1,000
00
303,980
00
6,473.00
1954
54,855
00
1,050
00
293,400
00
4,789
00
1955
63,005
00
950
00
292,400
00
8,5541
00
1956
61,590
00
950
00
292,500
00
8,616
00
Modus Operandi
According to Chapter 111, Section 117, of the General Laws, the Division of
Venereal Diseases is required to plan, promote, and carry out a sound venereal
disease control program. This constitutes prevention of venereal disease as well
as finding and treating these diseases when they occur. Thus, the Division must
promote good social hygiene measures, initiate case-finding procedures, and provide
for diagnostic, treatment, and case-holding facilities.
The Division is not alone in carrying out a preventive program for disease
control. It is a well known fact that sexual promiscuity is the underlying factor
in the spread of venereal disease ; that if sexual promiscuity is reduced or controlled
there will be a corresponding decrease in venereal disease. One of the methods
used to discourage promiscuity is to make such illicit relationships illegal and punish-
able under the law. Thus, the fear of legal sanction decreases the extent of promis-
cuity. More important than the fear of legal sanction is the education of the indi-
vidual in the principles of sound social hygiene. This is a continuing process begin-
ning in infancy and carried out into adulthood. The education begins in the home
and is supplemented by the teachings of the church, schools, physicians, communi-
ties, youth agencies, law enforcement groups, welfare, social agencies, etc. All of
these groups of people by their concerted action can influence the incidence of
sexual promiscuity and venereal disease.
There are 23 state cooperating venereal disease clinics located strategically
throughout the State. With the exception of four, they are set up in the out-
patient departments of general hospitals. Here the medically indigent are examined
and treated if infected. Here too the work of contact investigation begins with the
all-important interview, which is conducted by specially trained public health
nurses and in a few clinics by trained medical social workers. On these interviews
depends the outcome of the contact investigation.
The Department reimburses these hospitals and clinics for the maintenance and
operation of the venereal disease clinics in accordance with the high standards set
by the Division of Venereal Diseases. Each of the clinics has a chief in charge who
is a physician particularly trained in the clinical aspects of venereal disease. There-
fore, he assumes the responsibility for the clinical management of all patients in
74 P.D. 34
that clinic. He is assisted by one or more physicians in accordance with the size
and case load of the clinic. In addition to the physicians, the clinic has a number
of clinic nurses. Social workers are available either on a full-time or part-time
basis, in accordance with the clinic's case load. There are three clinics in which
no social worker is employed. These clinics use the social worker in the District
Health Office to perform the social service work requested by the clinic chief.
One of the key individuals in the cooperating clinic team is the epidemiologist,
who interviews all patients for pertinent contacts and brings these latter individuals
to the clinic for diagnostic work-up and treatment if infected. However, if the
contact prefers to go to a private physician, arrangements are made to furnish
this physician with all pertinent data so that he may be on a particular watch for
that disease to which the contact was exposed. Our epidemiologists, for the most
part, are graduate registered nurses who have had considerable training in general-
ized public health nursing and specialized training in venereal disease control.
Interviewing and contact tracing require specific talents, such as tact and under-
standing, being able to win the confidence of patients, yet being sufficiently forceful
to impress patients to develop good social attitudes, particularly towards sex.
These nurses must also possess perseverance, ingenuity, and initiative in order to
carry out the primary functions of interviewing and investigation.
The epidemiologist working from a cooperating clinic covers a specific area, and
all patients and contacts residing within her area are her responsibility. Thus,
the epidemiologist is not only responsible for the follow-up of patients and contacts
living in her district and originating from her clinic, but she also does the follow-up
of any contact or person living in her district but originating from any other clinic
within the state or from out of state.
In Metropolitan Boston, the organization of epidemiological services has been
modified because of the larger case load and the fact that clinic sessions are held
more frequently, and in some hospitals morning as well as evening clinics are in
session. Thus, each of the venereal disease clinics in Boston is headed by a special-
ized public health nurse who is called the Clinic Executive. She directs all aspects
of the clinic, including contact interviewing. The investigations are carried out
by five nurse epidemiologists. Each epidemiologist has an office in one of the
Boston clinics and has an assigned district. Like her co-worker outside of the
metropolitan area, she visits patients, contacts, and suspects located in her district
regardless of the hospital to which the patient has reported or irrespective of the
origin of the contact or suspect report. In addition to contact investigation, the
epidemiologist in the Metropolitan Boston area also interviews military patients
for contacts.
Resume of Activities
The past seven years were marked by many changes in the administrative,
clinical, and public health practices of the Division in keeping with modern venereal
disease control activities. One year prior to this report, the Division staff prepared
a new epidemiological and lapsed case report. Hand in hand with these new forms
and a prerequisite to their proper completion was the development of standards
for interviewing and describing contacts of patients with venereal diseases. Fol-
lowing this, changes had to be made in the morbidity reporting system. Beginning
with the state cooperating venereal disease clinics, where the bulk of reported cases
came, dual-purpose I.B.M. cards were designed to serve as registration cards for
the clinics as well as disposition or morbidity report forms. At the same time, a
central registry file was developed for the Division of Venereal Diseases and one
similar, but on a lesser scale, for the State cooperating clinics.
From fiscal 1951 to 1953, experience was gained with the new morbidity forms
for the clinics, and on the basis of this experience a new morbidity report form for
private physicians and institutions was put into effect in February, 1953.
P.D. 34
□ □
DDDD
□ □□□□
75
I | CONTACT
| | SUSPECT
□ R0UTIN
□ „*us„
□ p„E„„
□ispre
REGISTRATION CARD
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH
DIVISION OF VENEREAL DISEASES
ROOM 546 STATE HOUSE
BOSTON 33. MASS.
/
/—
OR DISPOSITION
RESULT OF DIAGNOSTIC
OBSERVATIONS
OISEASE AMD STAGE
H THIS
INFECTION
R
REMARKS
I NOT INFECTED
□ primary
□ secondary
|-|E«RLY LATENT
1 1
1 \"'rtC €D
1 1 TRANSFERRED TO
DDDD
HS7H
j 1 LOST TO FOLLOW UP
| | GONORRHEA
{ j % ON SUSPICION
| ' ICHANCROIO
□ SKSSffl*
[""I OTHER 'SSSJIs™
1 1 lymphogranul
1 — |5enereuu
SICNlo
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH
DIVISION OF VENEREAL DISEASES
ROOM 546 STATE HOUSE
JW 84T2C2
BOSTON 33. MASS.
CONFIDENTIAL. G. I_. CHAPTER 111. SECTION 119
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH
REPORT OF A CASE OF VENEREAL DISEASE
NAMt OF PATIENT-
.AGE ion DATE OF BIRTH)
STREET (IF NAME GIVEN ABOVE)
.DATE OF DIAGNOSIS.
SEX. Q MALE
CITY OH TOWN.
OCCUPATION _
□ FEMALE
MARITAL STATUS. □ SINGLE □ MARRIED
□ WIDOWED Q DIVORCED Q SEPARATED
DACE: □ WHITE □ COLORED □ OTHER
□ PRIMARY
□ SECONDARY
□ LATENT
□ EARLY
□ LATE
SYPHILIS
□ NEURO
_ □ CARDIOVASCULAR
D LATE Jr
Q MUCOCUTANEOUS
□ OTHER
□ CONGENITAL
POSITIVE TESTS
□ DARKFIELD
□ BLOOD
□ SPINAL FLUID
QOTHER "SPECIFY)
GONORRHEA
POSITIVE TESTS
□ GENITOURINARY Q SMEAR
Q EVE □ CULTURE
Q OTHER □ OTHER
OTHER VENEREAL DISEASES
POSITIVE TESTS
□ CHANCROID □ DUCREY SKIN TEST
□ GRANULOMA INGUINALE □ SMEAR OR BIOPSY
□ LYMPHOGRANULOMA VENEREUM □ FREI SKIN TEST
MAS PATIENT HAD PREVIOUS TREATMENT FOR THIS INFECTION? □ Y« □ No IP Yes. □ adequate □ Ik
ORDER SUPPLIES HERE NUI
REPORT BLANKS
LITERATURE FOR PATIENTS
LITERATURE FOR PHYSICIANS
ALL VENEREAL DISEASE PATIENTS HAVE CONTACTS. HAVE TOU INTERVIEWED FOR CONTACTS?
SIGNED
STREET
CITY OR TOWN.
76 P.D. 34
CONFIDENTIAL, G. L.. CHAPTER 111, SECTION 119
USE THIS SIDE OF FORM TO REPORT THE FOLLOWING
CHECK ONE
□ CONTACT
□ PATIENT HAD POSITIVE TEST FOR SYPHILIS ANO DID NOT RETURN
□ PATJENT PREMATURELY DISCONTINUED TREATMENT FOR DATE OF LAST VISIT.
NAME OF CONTACT OR PATIENT.
STREET AGE
CITY OR TOWN SEX
OCCUPATION PLACE OF EMPLOYMENT MARITAL STATUS-
FOLLOWING INFORMATION FOR CONTACTS ONLY:
CONTACT OF
□ SYPHILIS RELATIONSHIP TO PATIENT
□ PRIMARY □ MARITAL □ FRIEND □ PICKUP □ PROSTITUTE Q OTHER
Q SECONDARY
□ EARLY LATENT WILL YOU LOCATE AND EXAMINE THIS CONTACT? □ YES □ NO
□ OTHER (SPECIFY!
□ GONORRHEA IF NOT. THE DIVISION STAFF WILL ASSIST IN LOCATING AND
□ CHANCROID REFERRING CONTACT FOR MEDICAL EXAMINATION
[] GRANULOMA INGUINALE
□ LYMPHOGRANULOMA VENEREUM
OTHER INFORMATION HELPFUL IN LOCATING CONTACT:.
PATIENTS USUALLY HAVE SEVERAL CONTACTS.
PLEASE USE SEPARATE FORM FOR EACH CONTACT.
PH-VP-IS. BOM O-BS-COBeOO
State Coopekating Venekeal Disease Clinics
There were twenty-four state cooperating venereal disease clinics, but on July 1,
1953 one was eliminated, leaving a balance of twenty-three clinics, which are operat-
ing up to the present time. Standards for the diagnosis and treatment of the
venereal diseases were developed with the help of the advisory committee composed
of the clinic chiefs. The first of the standards were published on June 9, 1949 and
were amended over the years as newer and more effective methods of treatment
were announced. The latest standard for the diagnosis of syphilis was published
in June, 1956.
Early in this period the Division prepared frozen malarial blood for the treatment
of parenchymatous neurosyphilis, but as time went on and when penicillin was
demonstrated to be equally as effective as combined penicillin and malaria, the
frozen malarial blood treatment was discontinued.
In the meantime, the Division published quarterly the Bulletin of Venereal
Diseases, which dealt with some phases of the clinical problem of these diseases.
About 20 per cent of the venereal disease control problem in Massachusetts
represents military cases, and in 1951 our military control program was intensified.
Through the Armed Forces Disciplinary Control Board, the Director, as their
civilian advisor, recommended and received their approval for more effective inter-
viewing procedures. Beginning with Camp Devens, the nurse epidemiologists
were assigned to all military installations in Massachusetts to interview military
patients with venereal diseases. This cooperative venture resulted in benefits both
to the military and civilian communities. In June, 1951 the Director was awarded
a citation for his work Math the Armed Forces Disciplinary Control Board.
The Division of Venereal Diseases was responsible also for the investigation of
draftees as well as separatees discovered to have a positive blood test for syphilis
or other signs of venereal diseases.
P.D. 34 77
Premarital Examination Law
For the past seven years the Division has been tremendously interested in the
development of a medical reciprocity between the states insofar as the premarital
medical examination is concerned. Thus, if a resident of Massachusetts wishes
to be married in another state, he or she may visit his or her private physician for
a blood test, which is performed at the State Laboratory. Then the doctor com-
pletes the Massachusetts medical certificate, which will be honored by the other
State. Similarly, the certificates of other states will be honored by Massachusetts
under similar conditions. At the present time, there are 40 states and three terri-
tories which have premarital examination laws. Massachusetts will accept the
certificates of 36 of these states, and two of the three territories. There are four
Canadian provinces which also have premarital examination laws. Massachusetts
will accept the certificate of one of them. In return, there are 19 states and two
territories which have agreed to accept the Massachusetts premarital certificate
when properly completed. It is our plan to establish mutual reciprocity arrange-
ments with all states having such laws.
In conjunction with our program for a better understanding of the Massachusetts
Premarital Examination Law by our State residents and doctors, two pamphlets
were prepared. The first one was published in the American Journal of Social
Hygiene, January, 1953, entitled "Marriage and the Law — Medico-legal Require-
ments in Massachusetts," and it was specifically designed to assist doctors, marriage
registrars, and clergymen to answer questions which are frequently asked of them.
The second pamphlet is entitled "Planning Your Marriage" and was designed for
lay consumption. Supplies are kept by marriage registrars and are given to those
who ask questions about the marriage law.
Prenatal Syphilis Study
In June, 1951 the Division of Venereal Diseases undertook a prenatal syphilis
study. The purpose of this program, which continues to the present day, is to
answer five major questions:
(1) What is the incidence and prevalence of prenatal syphilis at the hospitals
under study?
(2) How many women develop syphilis during pregnancy subsequent to the
initial negative prenatal blood test?
(3) At what month during pregnancy is the prenatal blood test taken for
patients delivering at a large hospital?
(4) How many women delivering at a large hospital have no prenatal blood
test taken at all?
(5) To what degree will anesthesia influence the blood test?
Up to the present time 27,580 pregnancies have been tabulated on I.B.M. cards
for analysis. It is expected that this study will continue for another five years.
Education
A well-informed staff is essential to any program. In the field of venereal diseases r
it is of paramount importance because of the intimate and delicate nature of the
work. Therefore, the staff education program is planned in August of each year;
it consists of monthly meetings of two hours each from October to June, inclusive.
The first hour is taken up with a discussion of some phase of venereal disease control
from either a clinical or public health aspect, and a guest speaker is invited for this
part of the meeting. The second hour is spent in a discussion of the problems arising
during the previous month. The staff education program was initiated in 1949
and has not only been effective in improving the caliber of the work, but has also
brought about the closer integration of the field staff.
In 1949 the Division launched an educational program among schools of nursing
after a preliminary survey indicated that this subject was neglected in the nursing
curriculum. A six-hour course on the Clinical and Public Health Aspects of the
Venereal Diseases was prepared and offered to them (Graph 1).
78
P.D. 34
Graph I
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH, DIVISION OF VENEREAL DISEASES
LECTURE HOURS GIVEN IN SEX EDUCATION AND VENEREAL DISEASES
1948 . 1956
JL
i
H Venereal Di.eases
1 1 1 1 1 1 1
^jfrftrsfnTTil:
si :::::: :::::::::;::
^iHiiiiii::: iiHflH
'*'"■ '''■'''''' '■$&&. ^B
^-f: :::::: ;;: j^MBJ
.-*? '■'■:'■"; ;; jidfl
„* :::::: :: UmB
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/"Sfflr! ,':",'
HHHI
Field training courses in venereal disease control were offered at a graduate
nurse level, and each year about 12 nurses take our eight-week field training course.
A film library was created, and in fiscal 1955 there were 452 showings, primarily
in schools of nursing. Complementing the film library, literature on the venereal
diseases was compiled.* During the last fiscal year 24,580 pieces of literature were
distributed.
During the past seven years the lowest reported number of patients with syphilis
occurred in 1950, and an increase took place every year thereafter. In May, 1955
cases of primary and secondary syphilis increased in steplike fashion, continuing
through the entire year. These seven years have seen the decline in syphilis, and
beginning with 1951 its resurgence. Present-day control methods will not eradicate
the venereal diseases, since they are designed only to reduce them. Our methods
of control are not geared and by their very nature will not eradicate these diseases.
Therefore, the objective of the Venereal Disease Control Program is to reduce them
to their irreducible minimum. The venereal diseases are spread essentially through
sexual promiscuity, but the problem of sexual promiscuity has as yet to be solved.
There will always be an infectious reservoir of venereal disease in the community.
The sexual mores of our people will determine whether this reservoir is to increase
or decrease. If control efforts are relaxed, and the present level of sexual promiscuity
persists, one can easily predict epidemics of these diseases in the future.
♦This literature can be obtained from the Division of Venereal Diseases.
P.D. 34 79
Publications
Fiumara, N. J. — Describing a Contact of Venereal Disease. American Journal
of Syphilis, Gonorrhea, and Venereal Diseases, July, 1949.
Fiumara, N. J. — Ten Principles of VD Contact Interviewing. Journal of Social
Hygiene, October, 1949.
Fiumara, N. J. — Premarital Examination Law. New England Journal of
Medicine, August 10, 1950.
Fiumara, N. J. — A Plan to Simplify Premarital Laws. American Journal of
Public Health, Vol. 40, No. 10, October, 1950.
Fiumara, N. J. — Massachusetts Premarital Examination Law and Interstate
Marriages. New England Journal of Medicine, February 1, 1951.
Fiumara, N. J. — Interstate Marriages and the Massachusetts Premarital Law
Journal of Social Hygiene, February, 1951.
Fiumara, N. J. — The Role of Police in Contact Investigation. American
Journal of Social Hygiene, June, 1951.
Fiumara, N. J. — Congenital Syphilis in Massachusetts. New England Journal
of Medicine, October 25, 1951.
Fiumara, N. J., Fleming, W. L., Downing, J. G., and Good, F. L. — The Incidence
of Prenatal Syphilis at the Boston City Hospital. New England Journal of Medi-
cine, July 10, 1952.
Fiumara, N. J., and Hassett, A. J. — Planning Your Marriage. Journal of Social
Hygiene, January, 1953.
Fiumara, N. J. — Results of Investigation of Contacts Reported by Military
Services — 1951. American Journal of Syphilis, Gonorrhea, and Venereal Diseases,
November, 1952.
Fiumara, N. J., and Hassett, A. J. — Marriage and the Law — Medico-legal
Requirements in Massachusetts. American Journal of Social Hygiene, January,
1953.
Fiumara, N. J., Segal, J., and Jolly, J. — Venereal Disease Contact Investiga-
tion — A Combined Military-Civilian Program. Public Health Reports, March,
1953.
Fiumara, N. J. — Results of Investigation of Contacts Reported by Military
Services — Massachusetts, 1952. American Journal of Syphilis, Gonorrhea, and
Venereal Diseases, 38, 48-53, January, 1954.
Fiumara, N. J. — The Venereal Diseases — Present and Future. American
Journal of Public Health, Vol. 43, No. 11, November, 1953.
Fiumara, N. J. — Where Military and Civilian Meet — With a Focus on Boston.
Journal of Social Hygiene, December, 1954.
Fiumara, N. J. — Results of Investigation of Contacts Reported by Military
Services — Massachusetts, 1954. United States Armed Forces Medical Journal,
March, 1955.
Fiumara, N. J., Appel, B., Hill, W., and Mescon, H. — Syphilis and Its Manage-
ment — A Present-Day Problem. New England Journal of Medicine, June, 1956.
Fiumara, N. J., and Hill, William — Congenital Syphilis in the Absence of a
Positive Serology in the Mother : A Third Indication for the Treponema Pallidum
Immobilization Test. In press.
Fiumara, N. J. — Investigation of Military Contacts — Massachusetts, 1949-
1955. In press.
Easter, Etbel M., and Fiumara, N. J. — An Experiment in the Use of a Special-
ized Public Health Agency for Generalized Public Health Nursing Field Instruction.
In press.
80 P.D. 34
BUREAU OF INSTITUTE OF LABORATORIES
DIVISION OF BIOLOGIC LABORATORIES
On April 2. 1951 the Biologic Laboratories joined with the Diagnostic Laboratories
to form the Institute, with Dr. Johannes Ipsen, Jr., Associate Professor, Harvard
School of Public Health, as Superintendent. Thus, after a period of almost 60
years, the Department came back to the prototype established under the able
leadership of Dr. Theobald Smith. Diagnostic services and research were then the
natural outgrowths of his early work in this new field of biologic preparation.
On July 22, 1949, Dr. Geoffrey Edsall resigned as Director. Dr. James A.
McComb was appointed Acting Director. He has continued as the responsible
head of the laboratories, assuming the directorship in 1955.
Expansion in the number of different biologies prepared, in physical resources,
including a new second-story addition to the Blood Laboratory, and greatly in-
creased distribution marked the period which this report covers. During the same
period a rapid turnover in personnel, coupled with an inability to attract highly
qualified individuals to fill certain staff vacancies, has resulted in understanding
which could be dangerous. The existing inflationary spiral, if it continues much
longer, can most certainly undermine key staff positions which form the foundation
upon which such laboratories are constructed.
Research, particularly in the field of diphtheria prophylaxis and prophylactics,
has resulted in methods which promise to be useful in succeeding years. "Serologic"
epidemiology has given results which are both encouraging and disquieting. By
doing antibody titrations on sera from discarded Wassermann specimens and other
studies, it has been shown that a high level of immunity to diphtheria and tetanus
exists in the lower age groups. This, coupled with the recent precipitous drop in
the incidence of whooping cough, seems to point to the effectiveness of "Diphtheria
and Tetanus Toxoids and Pertussis Vaccine, Combined, Aluminum Phosphate
Precipitated." Disquieting is the low level of immunity to diphtheria found in the
adult population. A study product, "Tetanus and Diphtheria Toxoids, Combined,
for Adult Use" has had a modest distribution since 1954. Its increased use is
much indicated.
The control testing of human blood fractions under the Cohn patents admin-
istered by the Research Corporation of New York City came to an end in 1952.
The Research Corporation turned the patents back to Dr. Cohn and this work was
taken over by the newly organized Protein Foundation.
Antitoxin and Vaccine Labohatory
Working with new methods and equipment, a greatly improved smallpox vaccine
has been in distribution since 1950. This vaccine is more potent and almost com-
pletely free of bacterial contaminants.
The product introduced in 1950 which has had the greatest distribution of any
product manufactured by the laboratories is "Diphtheria and Tetanus Toxoids
and Pertussis Vaccine, Combined, Aluminum Phosphate Precipitated." Figure 1
shows the number of individual doses distributed annually.
81
1950
1951
1953
1954
1955
1952
Figure 1
Annual Distribution of Doses
A ready-to-use diluted tuberculin has been in distribution since 1951 and is grad-
ually replacing the Tuberculin, Old, which requires dilution before use. Another
advantage of this product has been that it has discouraged the use of the higher
strength dilution of tuberculin which, it is felt, does not lend itself to accurate
diagnosis in this area.
The trend has been toward greater purity in such products as diphtheria and
tetanus toxoids and pepsin-digested antitoxin. A critical biological test has been
devised for determining the extent of the purity of tetanus antitoxin; it correlates
well with the reactions or lack of them when the material is used prophylactically.
Blood Laboratory
There have been many changes in this laboratory. In 1950 the American Red
Cross assumed complete responsibility for the whole blood program formerly oper-
ated by the State. Laboratory pilot studies financed by the Red Cross were termi-
nated in 1951. In that year three types of services were begun for the Red Cross
on a contract basis, namely (1) plasma separation for the local Red Cross Blood
Center, (2) irradiated plasma preparation and distribution, and (3) plasma frac-
tionation for the American National Red Cross. The local center took over its own
plasma separation in 1954. Due to a study showing the inability of irradiation to
destroy the hepatitis virus in plasma, the American Red Cross suspended this work
in 1953. Work continues in Red Cross plasma fractionation under annual contract.
Through the interest taken by the Massachusetts Medical Society and, in turn,
the hospital blood banks, increasing amounts of plasma from human bloods, out-
dated for use as whole blood, have become available for fractionation into albumin
and globulin. The albumin is returned to the participating hospitals and the
globulin is used, together with Red Cross allotments to the State, for prophylaxis
in measles and infectious hepatitis.
Working with Dr. Dwight Mulford, a former assistant director, the laboratory
has been producing pilot lots of Fibrinogen-Free Low Globulin Plasma since 1955.
The two chief advantages of this material over plasma are: (1) It will withstand
60°C. for 10 hours without significant change. This process should kill any hepa-
titis virus present. (2) Immune Serum Globulin is obtained as a by-product.
82 P.D. 34
While civil defense demands participation of our entire resources, because of the
yeoman work of the civil defense blood committee, the bulk of the planning and
work has been in connection with emergency blood, blood substitutes, and fluid
replacements. Throughout the life of this committee the laboratories have been
represented by two or three staff members.
Special Services
The increasingly wide variety of such services begs coverage by a short descrip-
tion. Distribution of Poliomyelitis Immune Globulin and later that of vaccine for
the 1954 field trials for the National Foundation for Infantile Paralysis were the
most time-consuming. Furnishing various blood fractions, purified diphtheria
antigens, and cultures of high toxin-producing bacterial strains to investigators
world-wide is considered to be a part of the contribution which we should always
strive to make in the furtherance of knowledge in these fields.
National Institutes op Health
Operating under U. S. License No. 64 since 1917, the name of the laboratories
was changed in 1951 by the National Institutes of Health for licensing purposes to
the Massachusetts Public Health Biologic Laboratories.
New licenses granted during this period were :
Diphtheria and Tetanus Toxoids and Pertussis Vaccine, Combined,
Aluminum Phosphate Precipitated, 1950.
Diphtheria and Tetanus Toxoids, Combined, Aluminum Phosphate Precipi-
tated, 1950.
Tetanus Antitoxin, 1950.
Poliomyelitis Immune Globulin, 1953.
P.D. 34
83
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85
DIVISION OF DIAGNOSTIC LABORATORIES
Diagnostic Laboratory
Increase in the amount and types of work these laboratories have performed
marks the period covered by this report. The diagnosis of enteric pathogens such
as the Salmonella is noteworthy in this respect. The wisdom of the earlier establish-
ment of the Virus Laboratory was confirmed during the 1955 epidemic of polio-
myelitis in Massachusetts. Another much neglected field, diagnosis and research
in the pathogenic fungi, was entered in 1953. Gratifying progress has been made
with this small beginning and improvements in methodology have been made.
Workshop and refresher courses for hospital technologists have been offered by
the laboratories and they have been well received by hospital personnel.
New methods have been investigated for diagnostic aids in those individuals
giving apparently false-positive Hinton tests.
The Diagnostic Laboratory is badly in need of an increased number of profes-
sional workers, a condition which has resulted largely from the unprecedented
increase to 10-fold in the number of Salmonella recoveries since the low year of 1950,
as pictured in Figure 2. In the same period the total annual samples and enteric
pathogens showed an overall increase of only about 50 per cent.
58.
7856
11,147
10,012
1952 1953
Salmonella recoveries KJ
Stool samples and enteric pathoge
a
Figure 2
Salmonella Recoveries, 1950-1956
The building in which the Diagnostic Laboratories are housed is antiquated and
inadequate, necessitating as it does the quartering of the virus laboratory and the
research mycology laboratory in other buildings. A modern, new building is
urgently needed.
Bacteriological Laboratory
Several important new activities have been added. First, in the enteric pathogens
section, all stools of cases where the age is designated as two years or less are now
screened for pathogenic Escherichia coli. This procedure is an important addition,
since it has recently been shown that certain strains of E. coli can cause severe or
even fatal illnesses in the very young. Next, in the diagnostic tuberculosis section,
cultures as well as smears are now included on all cases, whether specifically re-
quested by the physician or not, in keeping with present-day procedures recom-
mended for the laboratory diagnosis of tuberculosis. Including cultures as well
as smears on all suspected cases increases the diagnostic sensitivity of the laboratory
work.
A mycology service was begun in 1953. The work in the Diagnostic Laboratory
building has been confined to diagnostic work. In 1956 a new position was created,
making possible operation by the Commonwealth of the research mycology labora-
86
P.D. 34
tory near the Biologic Laboratories, which was formerly operated under a grant
received by Harvard University. In addition to its investigative work, the research
mycology laboratory has cooperated with the Diagnostic Laboratory by screening
for pathogenic nocardia the atypical acid-fast cultures recovered from specimens
sent to the Diagnostic Laboratory for testing for tubercle bacilli.
For several years the Diagnostic Laboratory was in active administrative and
technical charge of a Civil Defense mass blood typing program. Over 300,000 per-
sons in the Commonwealth had their bloods typed by mobile blood typing teams
and were issued blood typing identification cards to carry on their persons. Before
the program was given up for lack of funds, a small pilot training program for
volunteer blood typers was carried out successfully.
The Virus Laboratory, which began very modestly in 1948, expanded rapidly
in the 1955 summer of high poliomyelitis prevalence in Massachusetts, and was
able to perform important diagnostic services in the identification of poliomyelitis
viruses from stools and the titration of serums for poliomyelitis antibodies, which
aided greatly in the epidemiological investigation of the outbreak. Aided by a
contract with the Communicable Disease Center, and funds from the National
Foundation for Infantile Paralysis, quite adequate equipment has been secured
and the laboratory has become a very satisfactory operating unit. It is hampered,
however, by insufficient space in spite of an additional room made available by
Harvard Medical School, in the buildings of which the laboratory is located.
The laboratory approval program has continued to grow. It has effectively
expanded its services from time to time by offering workshop and refresher courses
for the hospital technologists desiring to attend, especially courses in the laboratory
diagnosis of bacterial enteric pathogens.
Table I — Numbers and Kinds of Specimens
1950
1951
1952
1953
1954
1955
Agglutinations
6,073
5,469
5,255
5,604
5,366
6,041
Blood Typing Tests:
Prenatal ....
16,981
25,312
26,619
28,033
24,668
24,019
Civil Defense
—
—
—
204
24
264
Enteric Pathogens
6,552
6,590
7,856
11,147
11,690
10,012
5,266
5,940
3,900
3,748
3,841
3,345
89
77
62
59
30
26
49
45
34
12
33
—
Throat Cultures .
5,066
4,448
4,229
3,915
3,949
5,703
Tuberculosis
9,216
9,040
9,040
9,160
8,682
8,356
Vincent's Gingivitis
-
—
-
92
85
47
Viral Serological Tests :
Cold Agglutinus
24
24
23
3
97
176
Influenza A and B, and FMi
32
126
19
52
34
130
Lymphocytic Choriomeningitis
-
-
-
-
85
96
Lymphogranuloma and Psittacosii
i -
—
-
—
107
186
Mumps Complement-Fixation
Tests and HAI Tests
360
178
164
228
445
224
Herpes Simplex
-
-
-
-
89
179
Leptospira
—
—
—
—
10
—
Heterophile Antibodies
—
—
—
—
42
6
Virus Isolation Attempts:
Poliomyelitis, Coxsackie and Echc
Viruses ....
—
—
—
-
—
226
Miscellaneous
505
456
385
441
563
445
-
-
-
-
-
536
Totals .
50,213
57,705
57,586
62,698
59,840
60,040
Wassermann Laboratory
During the years from 1949 to 1956 the Wassermann Laboratory has been engaged
in the usual routine work of testing specimens for syphilis, brucellosis in cattle,
and rabies. In this period over 3,300,000 tests were performed. Serologic tests
for syphilis comprised approximately 90 per cent of the work load. The intrastate
serologic evaluation of 134 laboratories has been carried on annually for those seek-
ing approval to perform tests for premarital, prenatal, and blood donor purposes.
Refresher courses on the serology of syphilis have been held periodically.
The laboratory has participated each year in the evaluation of the Hinton test
conducted by the United States Venereal Disease Research Laboratory and has
maintained its usual high rating for efficiency and accuracy.
P.D. 34
87
During the period from 1949 to 1956 over 1,000 specimens, including many wild
animals, have been examined for rabies. All were found negative.
In 1951, due to the curtailment of federal funds, the Wassermann and Kahn
tests were discontinued and two junior clerk-typist positions were abolished.
In 1952 total protein and globulin tests on specimens of spinal fluid were added
to the routine procedures.
On December 31, 1953 Dr. William A. Hinton, Director of the laboratory since
its establishment in 1915, was retired and Miss Genevieve 0. Stuart assumed his
duties as head of the laboratory.
During 1954 in cooperation with the United States Department of Agriculture
a new program of testing blood and milk for the eradication of brucellosis in cattle
was initiated.
During 1955 and 1956 in cooperation with the Division of Venereal Diseases
experimental work on the Treponema Immune Adherence test and Treponema
Pallidum Complement Fixation test was executed in an attempt to determine
the feasibility of using one of these techniques as an adjunct to the standard sero-
logic tests on specimens from patients suspected of giving biologic false-positive
tests.
Table II — Tests and Examinations
Kind op Specimen
1950
1951
1952
1953
1954
1955
Blood:
Number of Specimens
Tests:
Hinton .....
533,398
540,953
546,801
525,075
529,927
512,817
479,986
494,766
492,224
474,553
473,048
478,422
Rapid Hinton
7,243
—
-
-
-
-
Hinton Titr. — Penicillin
14,115
7,430
9,230
8,454
10,075
10,642
Kahn Titr. — Penicillin .
13,529
—
—
—
—
—
Davies - Hinton Micro
14,147
13,991
13,563
12,437
11,564
8,987
♦Brucella Abortus Agglutination
24,895
24,755
31,776
29,633
35,539
14,756
♦Glanders ....
11
15
8
7
13
10
Spinal Fluid:
Number of Specimens
11,057
9,974
10,336
9,767
9,369
8,914
Tests:
Wassermann
8,033
—
—
—
—
-
Davies-Hinton
11,057
9,974
10,336
9,767
9,369
8,914
Globulin ....
—
—
859
5,032
4,675
3,583
Total Protein
-
-
663
4,207
4,184
3,710
Rabies Diagnosis*:
Number of Specimens
189
168
156
182
216
167
Tests:
Impressions ....
189
168
156
182
216
167
Sections . . . .
181
158
149
172
199
152
Animal Inoculations
185
167
151
174
212
159
Total Tests . . . .
573,571
551,424
559,115
544,618
554,094
529,502
Total Specimens ....
544,644
551,095
557,293
535,024
539,512
521,898
♦Diagnostic Examinations for Division of Livestock Disease Control.
88 P.D. 34
BUREAU OF HOSPITAL FACILITIES
DIVISION OF HOSPITAL FACILITIES
Licensure
Improvement in the quality of patient care in hospitals and related facilities
may be achieved by a variety of methods. In Massachusetts and other states,
joint committees representing state hospital associations and medical societies
have been established for this purpose. Better patient care is, of course, the
ultimate goal of every hospital's medical, nursing and administrative staff. By
the same token, accreditation by the Joint Commission on Hospital Accreditation
is evidence that the approved institution has complied with a set of standards
adopted by the representative national agencies which make up this agency.
Similarly, the licensing program of the Massachusetts Department of Public Health
has, as its primary purpose, improved medical care for the patient.
Since 1941, when our licensing program was established, there have been two
major revisions of the regulations or standards adopted to implement the licensure
law. As the standard of care in Massachusetts hospitals has improved, there has
been a gradual but constant upgrading of our hospital regulations. The last such
revision occurred in 1950, and it is proposed, in this paper, to present the progress
in Massachusetts which has taken place in the institutions of the State since that
time.
Although hospital licensure was the primary objective of the program at its
inception in 1941, its scope has been broadened gradually to encompass all medical-
care facilities within the Commonwealth. Supervision of clinics and dispensaries
became the responsibility of the Division of Hospital Facilities in 1944. In 1948,
the hospital licensing law was extended to include nursing or convalescent homes
and boarding homes for the aged, as public opinion demanded better medical care
for all who needed it. Licensure of city and town infirmaries instituted by the
Massachusetts Legislature in 1953 was added to the responsibilities of the Division
of Hospital Facilities. To conform with national legislative amendments concerning
public assistance laws, approval of public medical institutions for the care of old
age patients as well as for those with permanent or total disability became an added
responsibility of this division in 1953. Similarly, when the use of blood transfusion
and of blood derivatives increased in medical practice, approval and certification
of blood banks in licensed hospitals became an added feature of the licensure
program.
Another significant aspect of the licensure law in Massachusetts is the classifica-
tion of hospitals. Thus, as new types of medical-care facilities come into existence,
they too come under the sphere of the licensing law. Institutions for the care of
noncommittable alcoholics may be cited as an example. Such institutions, prior
to State licensure, were in existence without being under the supervision of any
State or local agency. They were not even required to comply with fire and safety
laws. As these institutions were incorporated into the licensing program, improve-
ments in them became inevitable.
Although improvements in facilities and patient care in hospitals have been
constant since 1941, the most significant changes have occurred since the 1950
revision of the regulations. The major problems which confronted the staff of the
licensing division may be divided into two categories, the first being related to the
physical aspect of the hospital plant and the second to medical and nursing care.
It is conceded, however, that there is a very close tie between the two.
During World War II and the years immediately following its conclusion, hospital
construction, including major alterations, had come to a complete standstill.
Physical plants had deteriorated to varying extents. Many hospitals, over the
years, had been improvised from private dwellings. Not infrequently the buildings
were overcrowded, inadequate in patient and medical service facilities and con-
stituted real fire hazards. Because a large number of our Massachusetts hospitals
had been built at the turn of the century, obsolescence became a real problem. A
P.D. 34 89
significant proportion of all hospital beds were contained in non-fire-resistant
buildings, considered hazardous by the licensing agency as well as hospital trustees.
Problems presented themselves in all departments of the hospital. Maternity
wards were overcrowded and in some hospitals delivery suites were not segregated
as required by the accrediting agency, as well as the Department's regulations.
There were insufficient labor rooms and overcrowding was apparent in newborn
nurseries. In one nursery, for example, located on the top story of a non-fire-
resistant building, 76 bassinets for newborn infants were contained in one large area.
Problems were also encountered in surgical departments. Operating rooms
were small; floors, electric outlets and equipment in the operating room were not
in accordance with the standards aimed at the prevention of explosions. In some
instances, surgery was not segregated from other parts of the hospital. Not infre-
quently, scrub-up and sub-sterilizing areas were inadequate, while the whole operat-
ing area was subjected to extremes of temperature, too cold in the winter and too
hot in the summer, conditions unfavorable both for personnel and for patients.
Overcrowding in kitchens and subsequent lack of sanitation were noted in some
hospitals. Many ward kitchens had become obsolete and unsuitable. Utility
rooms were sometimes poorly equipped, small and inconveniently located. Patient
areas, too, were overcrowded. Beds were very often found in corridors, and in at
least two hospitals bassinets and cribs were found in rooms with beds for adult
patients.
In some instances, areas designated for laboratory and x-ray departments had
not been enlarged, as the rest of the hospital had been expanded and had become
hopelessly inadequate. Not infrequently outpatient departments had been added
in the basement or in other areas previously used for storage. Such areas consti-
tuted poor facilities for outpatient departments and resulted in the loss of usable
storage area.
Apart from physical plant, the problems presented themselves in other spheres-
Of these, inadequacies in medical records were prominent. Shortages of medical
and nursing personnel during the war had lowered the quality of medical records
in many hospitals. Having become accustomed to such a pattern, it was extremely
difficult to alter such habits. In some instances it was found that large numbers of
records had not been completed and tissue and record committees had not been
active. This problem was particularly acute in hospitals which, in the past, had
not sought accreditation by the American College of Surgeons, the agency then
responsible for this function. Shortages in nursing personnel, which had become
apparent during and immediately after the war, were aggravated as time went on.
To an ever increasing extent, nonprofessional personnel had been utilized in hospi-
tals, sometimes for professional services. Deterioration in nursing technique and
care was often the inevitable result. Complaints from patients concerning lack
of nursing care in the hospital became very common.
When the Department assumed responsibility for the licensing of nursing homes
and boarding homes for the aged, it soon became apparent that this was to be no
easy task. Although there were a number of good homes, many were obviously
poor. Among the more pressing problems in such homes were shortages of per-
sonnel, poor sanitation and patient accommodation, inadequate medical super-
vision, nursing care, nutrition and equipment. There were those who felt that lack
of adequate facilities for rehabilitation was a serious inadequacy in such homes.
While this was true in general, it became apparent to the staff of the Division that,
since the average age of patients in nursing homes and residents in boarding homes
was in the vicinity of 70 years, rehabilitation in the sense of physical restoration for
job training and employment was an unrealistic goal.
While there was an acute need for better recreational facilities in these homes,
the most urgent need was to improve the environment and to provide for a clean,
comfortable home with adequate food, nursing care and freedom from abuse.
The achievement of this goal became the immediate objective in this area.
When it was established by study that 60 per cent of the persons in nursing
homes and boarding homes were cared for by public assistance and that many
better homes could accept but a small proportion of public assistance patients
90 P.D. 34
because of the low rates paid for their care, difficulties in this regard became even
greater. If standards were to be pushed too rapidly by the Department of Public
Health, greater limitations on the number of public assistance patients would have
been imposed by home owners.
When the General Court added the licensing of city and town infirmaries, this
soon constituted a considerable portion of the Division's activities. Prior to 1953,
the Department of Public Welfare could only make recommendations to local
welfare boards regarding these infirmaries. Rarely, if ever, were this Department's
recommendations carried out. If the status of nursing and boarding homes in 1948
were to be described as poor, then conditions in city and town infirmaries in 1953,
utilizing the same standards, would have to be considered deplorable. It is difficult
to put into words the sorry conditions found in many infirmaries. In one such
institution, erected early in the nineteenth century, bricks falling from a crumpling
wall constituted a hazard not only to the residents of the home but to persons
passing by in the neighborhood. In some instances, the Department of Public
Safety had refused to issue certificates indicating compliance with minimum stand-
ards in regard to fire and egress. In one community the local board of health had
made violent protests to the welfare department in regard to the continued occu-
pancy of the local infirmary by human beings. No attention had been paid to the
pleas of the board of health, because no licensing law was in effect. Life in many
of these institutions may properly be described as bare existence.
In presenting improvements which have occurred in institutions licensed by the
Department of Public Health, it must be borne in mind that agencies other than
the Division of Hospital Facilities have had similar goals. Hospital trustees have
taken an active role in this connection. The Massachusetts Hospital Association,
too, has proceeded with its very vigorous program. Furthermore, material improve-
ment has been achieved by the efforts of the Joint Commission on Accreditation.
In this connection, it must, however, be pointed out that significant progress in
hospitals which have not sought accreditation by the Joint Commission has also
been achieved. It would appear that the Joint Commission has been devoting
considerable effort in the field of improved hospital records. It is, however, difficult
for a national agency of this type to maintain day-by-day supervision over the
wide scope of hospital activities. The Hill-Burton Program of the 79th Congress
has been another very significant factor in improving hospitals.
Activity of the Division of Hospital Facilities in the field of hospital licensure is
reflected, to some extent, by the number of closures of institutions which have been
unable to meet the Department's standards. Between 1941 and 1949 there were
a total of 30 hospital closures. Since 1950, the number has increased to 51. For
the most part, these closures have occurred among small private hospitals which
could not acquire sufficient financial resources with which to meet the Department's
minimum requirements. A certain number of proprietary hospitals have, however,
taken active measures to satisfy the regulations of the Department of Public Health
and have remained in operation. It is noteworthy that accreditation by the Joint
Commission has been acquired by at least three such hospitals during the past two
or three years.
During the past five years, 18 new hospitals have been built in Massachusetts,
while 34 additional institutions have had complete renovation of all service depart-
ments. Of the former number, 16 were Hill-Burton projects and, of the latter, 24
received Federal aid under this program. Only 19 hospitals have not undergone
major physical alteration during this period. It is considered that 17 of this number
merit attention along such lines. Encouragement by the Hospital Survey and
Construction Program has been of considerable value in such situations and will
continue to be for the duration of the program.
In several instances, hospitals, having been unable to comply with Department
regulations in the general hospital classification, have elected to eliminate maternity
or surgical sections. Hospitals from which maternity and surgical departments
have been eliminated may make application for the classification chronic disease
hospital. The need for such facilities is very urgent throughout the State. A
summary of improvements in 144 hospitals is noted in Table I. It is apparent
P.D. 34
91
that major improvements have taken place in all departments of licensed hospitals.
It will be noted, for example, that of 121 hospitals with maternity wards, 65 or
52 per cent have been brought up to standard. Of this number, 53 or 43 per cent
received Federal aid under the Hill-Burton Program. In the same manner, in 82
(68 per cent) of 121 hospitals, new additions or major alterations provided newborn
nurseries which comply with recognized standards. Of 144 hospitals with operating
suites, 89 or 61 per cent are now in accordance with minimum regulations. Im-
provements for each department are recorded in Table I.
Table I — Improvements in General Hospitals in Massachusetts by Department
Departments or Services
Number of
Departments or
Services Available
Improvements in
Services or Departments
Improvements Aided
by Federal Funds
Number
Per Cent
Number
Per Cent
Maternity Bed Areas
Delivery Suites
Newborn Nurseries .
Medical and Surgical Wards
Operating Suites
X-ray Departments .
Clinical Laboratories
OPD including Emergency
Kitchen Faciltites
121
121
121
144
144
144
144
118
144
65
76
84
119
89
95
89
51
79
52.9
62.8
68.3
82.6
61.8
65.9
61.8
43.2
54.9
53
57
57
54
59
58
58
40
52
43.9
47.1
46.3
49.3
40.9
40.3
40.3
33.9
36.1
In 1949, of a total of 17,278 general hospital beds in Massachusetts, 8085 (46 per
cent) were nonacceptable, according to standards established by the United States
Public Health Service in the regulations set up under the Hill-Burton Program.
In 1956, the total number of general hospital beds increased to 19,356 and only
5823 or 30 per cent were nonacceptable.
Apart from physical plant, upgrading has occurred in other areas. Records
have been improved, both in hospitals accredited by the Joint Commission as well
as in those which have not sought accreditation. Further progress in this area
will result from recent legislation empowering the Department to make examination
of records, as well as of staff qualifications at the expense of the hospitals. Con-
siderable attention has been paid to medical staffing patterns in hospitals by the
Division. In one instance, hospital closure by the Department was averted by a
major reorganization of the medical staff by the board of trustees of the hospital.
Improvements in other areas have also occurred. With the cooperation of the
Blood Bank Committee of the Massachusetts Medical Society, there has been a
complete revision of the Department's regulations for the operation of blood banks.
Similarly, emergency medical coverage has been stressed by the inspectional staff.
Pharmacies and central supply areas have also been improved. Results in many
other areas have been gratifying. The demand for assistance and guidance, avail-
able through the staff of the Division of Hospital Facilities, is steadily growing.
Improvement in all phases of nursing and boarding home operation has become
apparent during the past five years. This has been most marked in areas where
the inspectional staff has been concentrating its activities, namely in housekeeping,
nutrition, records and nursing care. It is expected that a recent revision of nursing
home regulations will result in additional improvement in nursing homes. Formal
revision of boarding home regulations is presently under way.
The Division has been aided in its work by the cooperation of the Massachusetts
Federation of Nursing Homes, on the one hand, and the Massachusetts Federation
of Rest Homes, on the other. Short courses and seminars have been held jointly
with these organizations, the purpose of which has been better care in these institu-
tions.
In 1955, the Department of Public Welfare increased the rate of payment for
public assistance cases. This has been of considerable value in bettering conditions
in these homes. In the administration of the nursing and boarding home program,
considerable credit is due to the cooperative efforts of the Department of Public
Safety, and local boards of health and welfare. The assistance of these, and other
agencies, has been invaluable.
92 P.D. 34
An intensive effort has been devoted by the staff of the Division to the licensing
of city and town infirmaries. Since 1953, 17 infirmaries have been closed by the
Department or have closed voluntarily. Improvement in some of these institutions
has been slow, but progress has been noted. In a small number of institutions,
major problems still exist.
In spite of the many difficulties which have presented themselves in the Depart-
ment's licensing program and in spite of the small number of workers available to
the Department for the administration of the program, achievements have been
gratifying in terms of better patient care in the many institutions licensed by the
Department. Supervision of medical-care activity is a relatively new responsibility
for public health. However, it is apparent that the public, legislators and the pro-
fession itself are gradually learning the lesson that better medical care, in the long
run, means better public health.
Hospital Survey and Construction
Developing the State Plan
The first State Plan for the administration of Public Law 725 (Hill-Burton
Program), which was published in 1947, was subsequently revised to take into
account obsolescent and substandard facilities. A certain proportion of the general
hospital buildings in the State had been constructed at the turn of the century and
were considered obsolescent according to modern standards. Some buildings were
of frame construction or substandard in other respects.
Subsequent revisions of the Plan considered not only obsolescence but the ade-
quacy of the major departments in hospitals. Consideration was given to such
items as the surgical department, the maternity department, laboratories, x-ray
facilities, kitchens, dining rooms, power plants, laundries and patients' service
facilities, including elevators, diet kitchens and utility rooms. By this method the
hospital's priority in the State Plan not only reflected its bed count, type and age
of structure, but also afforded a complete evaluation of its patient and service
facilities. This feature was unique in the Massachusetts Plan.
In addition to the priority scheme established for general hospitals, special
consideration was given in the Massachusetts Plan to certain other categories.
It was found, early in the program, that a large proportion of the federal funds
allotted to Massachusetts would be, of necessity, allocated to rural areas or to
urban centers removed from Boston, where the teaching hospitals closely allied
to the State's three medical schools are located. It was believed that the training
program of these teaching hospitals was vital to the proper staffing of the steadily
growing hospitals in the more peripheral areas of the State. For this reason teaching
hospitals, closely associated with medical schools and providing, in addition, facili-
ties for postgraduate study of interns, residents and graduates, were declared eligible
for federal assistance under a separate category designated as "Teaching Hospitals."
Further, it became evident in 1947 that obstetric departments in many general
hospitals and some maternity hospitals were inadequate from many points of view.
It will be recalled that during 1946 and 1947 extreme overcrowding on maternity
wards was associated with extensive outbreaks of diarrhea of the newborn, not only
in Massachusetts, but in many other states. The hospital survey revealed, among
other things, such inadequacies as non-segregation of delivery suites and maternity
wards, lack of sufficient labor rooms and overcrowding in newborn nurseries. Be-
cause of these conditions, it was believed that alterations and improvements of such
poor facilities should be encouraged with federal assistance. A special priority was
therefore established whereby general hospitals, not otherwise holding a high prior-
ity and requiring essential improvements in the maternity departments, were
declared eligible for participation in the hospital survey and construction program.
The survey of existing facilities revealed yet another problem. In several sec-
tions of the State it was found that frame dwellings had been converted into small
general hospitals. Some of these buildings were overcrowded and inadequate in
patient and medical service facilities and constituted real fire hazards. Fortunately,
many of these buildings were located in hospital service areas that were subsequently
found to hold high priority for federal assistance.
P.D. 34
93
After a number of conferences with federal officials regarding the significance of
several criteria used in the development of the Massachusetts State Plan (i.e.,
adequacy of hospital departments, obstetrical facilities, etc.), it was suggested that
a new basis of determining acceptability of hospital beds be used — one that would
be comparable to the standards being applied in other states.
Therefore, in developing the Plan in 1955, the number and acceptability of beds
in a given hospital facility was based on two criteria only: (1) To be classified
acceptable, a bed should occupy a hospital area of eighty square feet in a (2) build-
ing which is considered fireproof, semi-fireproof or of heavy timber construction
(Section 301, Classification of Construction, National Fire Protective Association).
The Construction Program
Funds have been distributed for hospital and health-center construction since
1948, with a total allocation to Massachusetts of $16,660,000. Except for the
fiscal year beginning July 1, 1953, when the annual appropriation was reduced to
$65,000,000, at least $75,000,000 had been allocated annually throughout the
country. In 1950 the appropriation had been doubled by an amendment to the
law to $150,000,000 annually. However, with the advent of war in Korea, the
appropriation was again reduced to the original figure of $75,000,000.
These funds have assisted 71 hospital construction projects throughout the State.
Table I shows a breakdown of the projects under Public Law 725.
Table I — Distribution of Projects Constructed Under Public Law 725, by Type of
Medical Facility
Number
Number
Bed
Bassinet
Number
of
of
Capacity
Capacity
of
Beds
Bassinets
on
on
Type of Faoility
Projects
Added
Added
Completion
Completion
Maternity hospital
Teaching hospital
Other general hospital
Totals
Chronic disease hospital
Mental hospital
Public health center
Laboratory .
Grand Totals .
2
9
46
98
702
3,082
104
87
437
122
2,940
6,171
114
389
1,264
57
3,882
628
9,233
1,767
9
1
3
1
1,002
32
-
1,803
32
_
-
-
-
-
71
4,916
628
11,068
1,767
In July 1955 Massachusetts was allocated $388,790, its first annual grant under
the so-called Wolverton Amendment providing funds for the construction of diag-
nostic and treatment centers, rehabilitation centers, non-profit nursing homes and
chronic hospital beds.
The funds were distributed among five construction projects: (1) the Boston
Dispensary Rehabilitation Institute; (2) the improvement and expansion of out-
patient departments at Beverly and (3) Lawrence General Hospitals; (4) a chronic
disease research unit at the Peter Bent Brigham Hospital; (5) a psychiatric research
unit for children at the new Judge Baker Guidance Center.
A significant milestone in interstate cooperation was achieved when Maine and
Vermont each assigned the Boston Dispensary Project $100,000, their own 1955
allotment for rehabilitation centers.
General Hospitals
Fifty-seven general hospital projects received federal assistance. Ten of these
were completely new facilities. These were in Needham, Athol, Milton, Clinton,
Palmer, Lynn, Groton, Springfield, Webster, Danvers and Nantucket. Athol had
not previously had a hospital. Almost all enjoy occupancy rates well over 70 per
cent. Of the 57 general hospitals, nine were teaching hospitals and another two
were maternity hospitals. Of the latter, one project, the Wesson Maternity Hospi-
tal in Springfield, was completely new, making it possible for two general hospitals
in Springfield to close their inadequate maternity departments.
94 P.D.34
Consideration of the regional distribution of projects shows that 58.1 per cent
of the money was allocated to the Greater Boston Region; 13.0 per cent to the
Springfield; 16.1 per cent to the Worcester; 7.1 per cent to the Beverly-Salem;
4.2 per cent to the Barnstable; and 1.5 per cent to the Pittsfield Region. It is
reassuring to note that by and large there is a fair degree of correlation between the
percentage distribution of funds and the population density. In this connection,
it must be realized that the priority scheme for general hospitals, which is based on
existing, suitable beds and other lesser factors as well as population density, might
in some instances fail to support the correlation of new hospital construction and
population density.
Most of the general hospital beds were added in intermediate urban areas sur-
rounding Boston, Worcester and Springfield. Of the 3882 general hospital beds,
446 (11.4 per cent) were built in rural areas (population less than 25,000).
The re-survey of beds in 1955 revealed that there are 13,467 acceptable general
hospital beds, the lowest reported since 1949, despite the fact that about 4000 beds
have been built with federal assistance since that time. Table II shows the tabula-
tion of acceptable and nonacceptable general hospital beds during the past seven
years.
Table II — Existing Acceptable and Nonacceptable General Hospital Beds by Years
1949 1950 1951 1952 1953 1954 1955
Acceptable . . . 13,006 13,653 15,422 15,368 15,739 16,197 13,467
Nonacceptable . . 4,990 4,990 4,581 5,705 4,344 3,817 5,998
Using the federal allowance of 4.5 beds per thousand population, Massachusetts
needs 24,078 beds, indicating an acceptable bed deficit of 10,611.
Chronic Disease Hospitals and Nursing Homes
Nine projects were approved for chronic disease hospitals. The Municipal
Hospital in Springfield is the largest chronic disease hospital to be constructed in
Massachusetts with Federal aid. The operation of this 463-bed f acuity by a com-
munity the size of Springfield constitutes a new departure in medical care. The
progress of this hospital is being closely watched.
In November 1955 a new chronic disease unit was opened in Holyoke, replacing
a typical city infirmary. This institution is providing care not only to welfare
recipients, but also to private patients in Holyoke and neighboring communities.
Large multiple-bed wards have made it possible to erect a hospital of 120 beds at
a cost slightly in excess of $1,000,000.
Other chronic disease projects consisted of additions to five existing general
hospitals providing a total of 355 beds for short-term care of patients with chronic
disease. These are located at the Children's Medical Center and the New England
Deaconess Hospital in Boston; the New England Sanatorium and Hospital in
Stoneham; the Maiden and Cape Cod Hospitals. Also 34 chronic beds were added
to an existing tuberculosis hospital in Barnstable County and 50 beds were added
to the Jewish Memorial Hospital, a long-term chronic faculty in Boston.
The same standard of acceptability was applied to chronic disease beds as with
the general hospital beds in the 1955 survey. This also resulted in a new low count
for chronic beds; namely 2628. This compares with an overall need of 9944 chronic
beds based on the federal standard of two beds per thousand population, or a deficit
of 7316 beds. Notwithstanding this substantial shortage of chronic disease beds,
there has not been much interest in the construction of chronic disease facilities.
All project applications in this category have been granted.
It is apparent that the 5332 acceptable and nonacceptable chronic disease beds
in the State provide for only a small portion of the patients requiring such care.
Nursing homes in Massachusetts presently make available 14,685 beds for
patients requiring long-term care. Only 302 of these beds are acceptable. The
P.D. 34 &5
federal standard of providing three nursing home beds per thousand population
indicates that the State has a deficit of approximately 14,000 acceptable beds in
this category.
Teaching Hospitals
Funds were made available to the majority of the teaching-hospital projects
primarily for the purchase of equipment. A few were construction projects. At
the Massachusetts Eye and Ear Infirmary, operating rooms were constructed and
22 beds were added. Projects at the Peter Bent Brigham Hospital provided 39
additional beds, six beds for intensive chronic disease research, and expanded out-
patient department facilities. At the Boston Lying-in Hospital several clinics were
added in the outpatient department, and at the New England Center Hospital
the construction of a new pathology department was started with federal funds.
The Massachusetts General Hospital is constructing a new Medical Science Build-
ing with 20 research beds under the program.
Tuberculosis Hospitals
There have hot been any beds constructed in this program for tuberculosis
patients as such.
A survey of tuberculosis beds was not undertaken in 1955, the data being taken
from a previous survey in 1953. According to the latter survey, there are 2534
tuberculosis beds in the State. This compares with a computed need of 3282
beds, based on a formula recommended by the Public Health Service which allows
1.5 beds for each of the annual number of new cases for the latest two-year period.
However, no new tuberculosis beds are being programmed in the State in spite
of the fact that many of the existing facilities are badly outmoded. Faced with a
steadily declining census, most tuberculosis hospitals are inclined to admit other
types of patients such as those with chronic disease. What this change in basic
policy entails in the way of physical plant remains to be seen.
Mental Hospitals
One mental health facility project has been assisted in this program; namely, a
four-story, 32-bed psychiatric unit for boys and girls. This is the new Judge Baker
Guidance Center being built on property adjacent to the Children's Medical Center.
State institutions for the mentally ill continue to suffer from severe crowding.
On the basis of current population estimates, the State should have 24,860 mental
hospital beds. Sixty-five per cent of this need has been met. Two of the seven
new construction projects undertaken by the State Department of Mental Health
have been completed: the project at Grafton with 297 beds and the one in Boston
with 300 beds.
It is unlikely that federal construction funds available under this program will
be used for State mental hospital facilities for some time. The need for new facilities
in this category is so great that the limited funds available in this program would
scarcely provide more than token sustenance.
Public Health Centers
It will be noted that, in spite of the dearth of public health centers throughout
the State, only three were approved, the first in Quincy and the second in Brookline;
the third, which is being planned in Amherst, will be under the jurisdiction of the
University of Massachusetts. Although such construction holds a high priority
in the State program, there has been fit tie interest in this category on the part of
city and town officials.
Diagnostic and Treatment Centers
Initial studies show that somewhat more than one-fifth of the State's population
does not have easy access to outpatient clinics. Does this mean that these people
have poorer medical services than those having outpatient clinics? Or are there
other compensating factors in these "have-not" communities?
96 P.D. 34
Until these questions can be answered communities which do not have outpatient
clinics are being rated as having a greater need for these services than those that
do have them. The formula for determining the priority in this category is there-
fore based on the average usage of existing clinics in the State and is derived from
the relative need of all communities for these services obtained by comparing the
population density with this average. Also in recognition of the value of the out-
patient clinic as a teaching tool, teaching hospitals are given a high priority in this
category.
Seventy per cent of the funds allocated to this category are being earmarked for
general outpatient clinics or services, while 30 per cent are being set aside for child
guidance and mental health clinics. These funds shall be interchangeable should
the demand in either category be less than the funds available in a given year.
Rehabilitation Centers
A survey of all rehabilitation services available in the State has been made. The
facilities include not only medical services for physical restoration, but vocational
services such as special schools, sheltered and curative workshops.
Two rehabilitation centers have been programmed to provide for the needs of
the eastern part of the State. It is anticipated that each center will be compre-
hensive in character, providing all facets of rehabilitation. The availability of three
medical schools in the Boston area offers assurance that adequate personnel will
be available to staff these centers in the several specialties. One of these centers is
already under construction. In addition, rehabilitation centers are being pro-
grammed in Worcester and Springfield to provide comprehensive services for the
western part of the State. It is expected that the availability of several large
hospitals in Worcester and Springfield will make adequate staffing of a compre-
hensive rehabilitation program possible.
Both of these cities have an established agency offering a wide variety of rehabili-
tation services. In the case of Worcester the agency's major deficiency is the
inadequacy of its facility. Springfield has an ideal facility, its deficiencies being
related more to organization and administration.
Massachusetts State Plan
All expenditures for construction under this program continue to be made on
the advice of the agency's 42-member Hospital Advisory Committee subject to
final approval by the Public Health Council.
The major planning tool or guide used by the Division of Hospital Facilities for
evaluating and approving applications for new hospital facilities is the Massa-
chusetts State Plan. This is a major inventory of all hospital and medical faculties
(profit as well as non-profit) in the State. Initially compiled by the Division of
Hospital Facilities in 1947, the status of these facilities and the utilization of their
services are brought up to date annually by field studies and statistical reports.
The State Plan enables the Division's staff to evaluate the relative need of com-
munities in the State for hospital beds and other medical facilities, and (thereby)
fulfill its role as one of the Commonwealth's central planning agencies in the field of
medical care.
P.D. 34 97
BUREAU OF TUBERCULOSIS AND INSTITUTIONS
DIVISION OF SANATORIA AND TUBERCULOSIS
The six years covered by this cumulative report, July 1, 1949 through June 30,
1956, brought into sharp focus trends and developments of tuberculosis control
whose origins were in the late 1940's. The anti-tuberculosis drugs were introduced
at that time, and since then certain trends have been accelerated. The death rate,
9.4 in 1955 for all forms of tuberculosis, declined 56 per cent since 1950, while the
case rate decreased only 23 per cent. The major decline occurred in "other forms"
of tuberculosis. Here the death rate dropped 75 per cent. The newer drugs, par-
ticularly isonicotinic acid hydrozid (INH), contributed to this accomplishment.
Tuberculous meningitis in previous years, once correctly diagnosed, meant death.
Now its sequelae persist to plague the ingenuity of the medical profession.
These six years have been exciting and challenging. Problems associated with
tuberculosis in its treatment, public health practice, rehabilitation, hospital admini-
stration, and financing created a period in which constant evaluation of past
practices was necessary. Two of the anti-tuberculosis drugs, which may be given
in pill form, placed treatment in the home. The private physician was being forced
into a field previously dominated by a small group of specialists. Newer and more
effective methods of educating the lay person and the professional in tuberculosis
control and rehabilitation were made necessary.
Standard methods of treatment such as pneumothorax, effective in the past,
were discarded. Prolonged periods of bed rest and hospitalization were no longer
necessary. The anti-tuberculosis drugs were given over longer periods of time,
one and a half to two years and longer. Surgical resection, i.e., a removal of a small
portion of the lung, developed as the preferred procedure in conjunction with rest
and the drugs.
More patients being treated for shorter periods in sanatoria, combined with a
sky-rocketing cost of hospitalization, plagued the hospital administrator and those
engaged in financing these institutions. How should the vacant beds, at times as
high as 50 per cent of capacity, be used to best advantage? Legislation was enacted
to permit the signing of appropriate contracts between various agencies. In this
way, Burbank Hospital in Fitchburg, Belmont Hospital in Worcester, the Spring-
field Health Department Tuberculosis Hospital and Brookline Tuberculosis Hospital
were closed and the tuberculous treated elsewhere.
Associated with the decline in the number of deaths was a slower decline in new
cases reported annually. Actually there was an increased prevalence of tuberculosis
in the older age groups. The tuberculin test proved that there was less infection in
school children as compared to thirty years ago. A tuberculin testing program
done in the school population of Lowell and elsewhere indicated a marked decline
in the percentage of positive reactors from 30 per cent to 2-plus per cent.
During this period it became apparent that tuberculosis was being found more
frequently in special groups — the lower socioeconomic groups, particularly males
over 40; certain racial groups, and large urban populations as compared to rural.
Large population groups are reaching adult life'without being exposed to tuber-
culosis. For this reason a significant change was necessary in tuberculosis case
finding methods. Greater attention was required in selecting groups with a higher
prevalence of unrecognized tuberculosis. Efforts were concentrated in certain
areas of the larger cities, in nursing homes, jails, hospitals, "flop houses" and in
certain racial groups.
A bill sponsored by this Division was enacted in 1951 but repealed before becom-
ing effective. It established the State as the principal agency responsible for tuber-
culosis control on a State-wide basis.
Federal grants, markedly cut during this period, still remain a vital prop in
Massachusetts tuberculosis control. Through the use of these funds tuberculosis
case registers have been established in many new communities, and there has been
a sweeping reorganization of the tuberculosis case reporting system.
98 P.D. 34
The schools for the training of licensed practical nurses, the educational programs
for affiliate nurses, in-service training and other similar programs were emphasized,
enlarged and improved. Had it not been for these programs and the subsequent
recruitment of nurses, the Departmental hospitals would have found survival
difficult indeed.
School personnel were required every three years to be certified free of tuberculosis
in a communicable form under Chapter 732 of the Acts of 1950.
Dr. Alton S. Pope, Director of the Division of Tuberculosis and Sanatoria and
Deputy Commissioner of the Department of Public Health, retired July 31, 1954,
after thirty years of dedicated service to the community. Such men as he are
irreplaceable.
The poliomyelitis epidemic in 1955, which required the mobilization of all
resources throughout the State, produced a lasting example of community responsi-
bility and consciousness in admirably meeting a prolonged and difficult crisis.
Lakeville State Sanatorium, Lemuel Shattuck Hospital, and Massachusetts Hospital
School contributed greatly to this general effort.
Departmental Institutions
Lakeville State Sanatorium
With the decline in the number of cases with orthopedic tuberculosis it was
possible to admit more patients with other crippling conditions. The needs of the
community were acknowledged when enabling legislation permitted the admission
of patients with arthritis, neuromuscular disorders, aging persons and those with
other conditions requiring physiotherapy and long-term care.
Treatment plans for the arthritics were developed in close cooperation with the
Massachusetts General Hospital. This service has proved of great value and is
steadily expanding. A limited number of patients with multiple sclerosis are
treated.
A special unit for children with cerebral palsy and an I.Q. of between 50 and 80
has been established. A service for the correction of orthopedic defects in children
confined to mental institutions has been created.
Rehabilitation has been increasingly stressed through surgery, orthopedic appli-
ances and physiotherapy. The rising trend in the average daily census of patients
at the sanatorium gives evidence of the increased demand for these services.
The appended tables (I through IV) show a 50 per cent drop in the tuberculosis
patient census, particularly in children, during this period. The remaining tables
demonstrate fluctuations in admission of other conditions with the daily patient
census increased to meet increased community needs.
Lemuel Shattuck Hospital
The Lemuel Shattuck Hospital opened for patients on October 4, 1954. The
hospital population expanded steadily until 253 beds were in operation. Further
expansion has been prevented by the lack of registered nurses.
On August 17, 1955 a temporary polio respirator unit was established, and on
November 6, 1956 this was moved to permanent quarters on the seventh floor of
the hospital.
In addition to the care of patients, special laboratories for the study of chronic
pulmonary disease, hypertension, radioisotopes, and biochemistry are in operation.
Eight research projects are now under way. Teaching and training have progressed
steadily.
The hospital was accredited by the Joint Board on November 18, 1955 and
approved for residency training in internal medicine and pathology in 1956. Resi-
dency affiliation with the Beth Israel, Boston Veterans Administration, Mount
Auburn, Massachusetts General and New England Medical Center hospitals is now
in operation. Students from Harvard, Tufts and Boston University Medical
Schools and the Harvard School of Public Health come to the hospital regularly.
P.D. 34 99
The School of Licensed Practical Nurses began operation in September 1956 and
will graduate its first class early in 1958.
Massachusetts Hospital School
In 1954 the Legislature transferred this excellent institution to the Department
of Public Health. A Resident School, in which is integrated a small hospital, admits
physically handicapped children who are unable to attend public school, whose
medical treatment would interfere with continued schooling, or whose medical care
warrants long-term hospital treatment. Admission policies of this school and of
Lakeville have been integrated so that no duplication of objectives exists. Children
from the age of three to twenty-one are treated, and remain as patients as long as
continued improvement is observed. Although improvement in the physical plant
has taken place, further expansion is necessary if the needs of the community are
to be met.
North Reading State Sanatorium
The 26-bed unit for children with rheumatic heart disease which was opened at
North Reading in April of 1949 was closed May 8, 1951. During the following
fiscal year 1951-1952 a considerable backlog of tuberculosis patients were admitted.
The daily average of patients for the period 1949 through June 30, 1956 ranged
from 149 to 140.
The age-adjusted admission rates per 100,000 are shown below.
Age Group
1936
1946
1956
0-5
7.6
6.5
8.6
5-9
14.1
8.4
5.8
10-14
19.4
3.9
4.2
15-
10.5
2.4
3.4
It will be noted that the admission rate for children 0-5 years of age has been
maintained. The rates for older children fell sharply between 1936 and 1946 and
then remained fairly constant. The reasons for this are not clearly understood.
One fact should be stressed. Adults with a greater incidence of tuberculosis are
responsible in large measure for transmitting the disease to the younger children
who are of necessity in close contact with them.
Tables I, II, III and IV show there has been no appreciable change in the number
of admissions during this period. There has been a noticeable increase in the ratio
of younger children; fifty per cent were under five years of age.
Pondville Hospital
During the years between 1949 and 1956 over two million dollars have been
spent for the renovation of old buildings and new construction to provide adequate
facilities for the expansion of the cancer control program at the Pondville Hospital.
Thanks to the local Cancer Society, $10,000 established a research facility which
was later dedicated as the Ira T. Nathanson Research Laboratory.
A Practical Nurses' Training School was created, and during this period ten
classes were graduated, thus permitting us to increase our active bed capacity to
one hundred patients. Our outpatient activity has continued to increase so greatly
that a new general clinic was added weekly.
The Volunteer Social Service Committee established and equipped a chapel which
is used for all denominations.
Numerous groups of students from the medical schools in Boston have attended
our clinics for teaching purposes, and physicians, nurses and public health workers
visited the hospital from 26 different states and 40 foreign countries.
The twenty-fifth anniversary of the opening of Pondville Hospital was celebrated
on June 25, 1952.
100 P.D. 34
In honor of our Chief of Staff, Dr. Ernest M. Daland, the Alumni Society was
formed, consisting of all former resident doctors who trained at Pondville.
Following are a few statistics for the period:
1950 1951 1952 1953 1954 1955
982
1,122
1,334
1,261
1,391
1,567
Clinic visite — new
1,444
1,386
1,379
1,578
1,604
1,555
Clinic visits — return
8,608
8,814
10,411
11,444
11,937
12,675
Average period of hospitalization
22.5
20.5
17.8
21.4
24.1
22.1*
Average number of patients .
57.5
57.9
62.8
71.6
89.3
91.6
X-ray treatments . . . .
6,908
6,398
7,242
7,442
5,261
6,007
1,113
1,445
1,574
1,404
1,579
1,579
Laboratory tests .
22,446
27,901
26,952
30,195
30,401
34,104
Rutland State Sanatorium
By 1949 we were able to evaluate some of the results of streptomycin therapy.
Two hundred and thirty patients had already been treated with this antibiotic and
the effects were remarkable. From that time on there was a sharp decline in
pneumothorax therapy. Pneumoperitoneums, however, were continued for a few
years. There are very few at present. Pulmonary function tests began in 1950
and have continued to date on an increasing number of patients.
Isonicotinic acid hydrazide came during 1952 and proved immediately to be as
effective as streptomycin. As the years went by, drug therapy was extended to
every patient and the time of administration was prolonged to a year, and then
to two years.
Thoracoplasty as a collapse measure was abandoned during the years 1950-1953.
Our Rehabilitation Service has been kept with the help of a rehabilitation director,
a librarian, a teacher and an occupational therapist. Our Social Service Department
has also been functioning most of the time.
An intensive repair program has been carried out during the past eight years in
an effort to bring the institution to modern physical standards.
Tables I and II show a marked increase in the male as compared to female
admissions, as well as an increase in the average age of males. Most of the admis-
sions were referred from general hospitals and the great majority of cases were
far advanced.
Westfield State Sanatorium
The Westfield State Sanatorium has noted during this period the following
changes : In the physical plant, since farm operations contribute nothing to patient
rehabilitation, the unprofitable farm was closed on April 19, 1951. As of Novem-
ber 17, 1955, the electrical generators were changed to alternating current and
linked with a public utility supply.
In professional training, on January 4, 1950 the School for Practical Nurses
opened. Its students and graduates have helped to keep all 191 hospital beds open
during nursing shortages. On July 1, 1953 the dental service was reorganized
around a one-year internship. Slow progress is being made toward approval through
affiliation for the residency in pathology. Approval of the three residencies in
pulmonary diseases continues. Continued approval of the three residencies in
cancer surgery hinges on making each the third-year affiliation in an approved
four-year program.
In clinical services, on November 30, 1949 the hospital added radioactive cobalt
to its cancer armamentarium. Full accreditation of the hospital was reaffirmed on
September 12, 1955.
The Tuberculosis Section showed the same general trends as Rutland, whereas
the Cancer Section showed a gradual increase in admissions, with females pre-
dominating.
P.D. 34
101
LAKEVILLE STATE SANATORIUM
Table I — Patient Census, December SI : Tuberculosis
1950 1951
1952
1953 1954
1955
Patient
Census
Dec. 31
Children:
Male
Female .
Adults
Total
17 15
14 9
78 72
109 96
14
14
59
87
12 5
13 6
39 45
64 56
6
6
33
45
Table II -
- Daily Average Number of Patients:
Tuberculosis
1950 1951
1952
1953 1954
1955
Number
. 114.7 110.9
105.6
86.6 61.4
55.5
Table III — Number of Patients Admitted and Discharged: Tuberculosis
1950 1951
1952
1953 1954
1955
Admissions
Discharges
142 144
132 157
153
162
98 88
120 95
82
93
Table IV — Diagnosis on Admission: Bone and Joint Tuberculosis
Adults
Children
Total
Percent of All
Male
Female
Male
Female
Tuberculosis
1950*
18
6
3
5
32
22.5
1951*
11
11
6
4
32
22.5
1952*
16
9
3
5
33
21.6
1953 .
15
11
7
8
41
41.8
1954 .
10
13
5
2
30
34.1
1955 .
13
11
3
3
30
36.6
Table V — Daily Average Number of Patients: Poliomyelitis
Adults
Male Female
Children
Male Female
Total
1950
1951
1952
1953
1954
1955
3.7
7.2
11.8
5.4
28.1
1.6
6.9
6.2
6.4
21.1
1.3
5.3
3.5
3.3
13.4
2.8
6.2
5.4
2.7
17.1
1.4
4.1
9.6
6.6
21.7
3.4
8.2
16.5
13.0
41.0
Table VI — Female per Male Ratio: Adults, Poliomyelitis
1950
1951
1952
1953
1954
1955
2.4
Females per male
1.9
4.3
4.1
2.2
2.9
Table VII — Stage of Disease: Poliomyelitis
Stage
1950
1951
1952
1953
1954
1955
II
III
IV
0
0
0
0
0
90
32
15
9
22
30
7
7
9
12
9
4
6
♦Vertebral column excepted.
102
P.D. 34
Table VIII — Admissions SO Years of Age and Over: Poliomyelitis
30 and over
Total All Ages
Percent 30 and over
1950
4
41
29.8
1951
6
34
17.6
1952
5
21
23.8
1953
2
31
6.4
1954
3
34
8.8
1955
20
103
19.4
Total .
40
264
15.2
Table IX -
— Condition on Discharge:
Poliomyelitis
Improved
Number Percent
Unchanged
Dead
Non-Polio
Total
1950 .
48
98.0
1
0
0
49
1951 .
35
89.7
3
1
0
39
1952 .
12
70.6
5
0
0
17
23
95.8
1
0
0
24
1954 .
27
93.1
0
2
0
29
1955 .
62
96.9
1
1
0
64
Total
207
93.2
11
4
0
222
Table X — Daily Average Number of Patients, Crippled Children (1950-1952)
Crippling Conditions (1953-1955)
Male
Children
Female
Total
Male
Adults
Female
Total
Total
1950
. 20.3
16.4
36.7
-
-
-
36.7
1951
25.9
18.0
43.9
—
—
—
43.9
1952
. 32.3
22.3
54.6
-
-
-
54.6
1953
25.9
27.2
53.1
1.5
8.2
9.7
62.8
1954
31.8
29.3
61.1
5.9
14.8
20.7
81.8
1955
29.8
31.3
61.1
7.9
21.5
29.4
90.5
Table XI — L
iagnosis on Admission,
Crippl
ed Children
(1950-1
952)
Crippling Conditions (1953-1955)
Congenital All Other
Cerebrospastic Dislocation and Crippling
Palsy Deformities Arthritis Conditions
No. % No. % No. % No. %
1950
1951
1952
1953
1954
1955
Total 1950-1955
Total 1953-1955
42
26
31
24
19
21
62.7
44.1
47.0
23.1
15.8
18.8
13
23
17
17
19.4
15.2
12.1
22.1
14.2
15.2
34
44
39
32.7
36.7
34.8
12
24
27
23
40
35
17.9
40.7
40.9
22.1
33.3
31.2
163
30.9
S7
16.5
117
22.2
161
30.5
64
19.0
57
17.0
117
31.8
98
Total
67
59
66
104
120
112
528
336
Table XII — Daily Average Number of Patients: Tuberculosis, Poliomyelitis,
Crippled Children and Crippling Conditions
Tuberculosis
No. %
Poliomyelitis Crippled Children
No. % No. %
Total
1950 .
1951
1952 .
1953 .
1954 .
1955 .
Average
114.7
63.9
28.1
15.6
36.7 20.4
179.5
110.9
63.0
21.1
12.0
43.9 25.0
175.9
105.6
60.8
13.4
7.7
54.6 31.4
Crippled Conditions
173.6
86.6
52.0
17.1
10.3
62.8 37.7
166.5
61.4
37.2
21.7
13.2
81.8 49.6
164.9
55.5
29.7 .
41.1
22.0
90.5 48.4
187.1
51.0
23.8
13.6
61.7
35.3
174.6
P.D. 34
NORTH READING STATE SANATORIUM
Table I — Admissions and Discharges: Tuberculosis
103
Admitted Discharged Deaths*
1950
1951
1952
1953
1954
1955
Total
77
85
4
.99
85
1
104
93
2
95
103
2
98
109
1
105
101
1
578
576
Table II — Daily Average Number of Patients: Tuberculosis
Male
Female
Total
1950
65
60
64
06
129
66
1951
64
66
61
94
134
91
1952
. . .73
05
81
60
154
64
1953
. • 68
82
77
16
145
98
1954 .....
. . . - 78.79
65
84
144
63
1955
.72
53
66
73
139
35
Average . .
70.58
69
55
141
53
Table III — Patients Admitted 0~4 Years of Age: Tuberculosis
Male
Female
Total
%
1950 ....
20
14
34
44
1951 ....
24
26
50
50
1952 ....
25
27
52
50
1953 ....
26
18
44
46
1954 ....
34
22
56
57
1955 ....
30
39
59
51
Table IV — Source of Referral: Tuberculosis
No.
Referred by
General Hospitals Total
% of Total Referred
1950
1951
1952
1953
1954
1955
Total
30
39.0
77
37
37.4
99
30
28.8
104
34
35.8
95
42
42.8
98
36
34.3
105
36.2
578
Table V — Reason for Initial Examination of Tuberculosis Patients Admitted
X-Ray Survey or
Other Case-finding
Activity
No. %
Contact of a
Known Case
No. %
Suspicious Signs
or Symptoms
No. %
Routine
Physical
Examination
No. %
Total
No.
1950
0
0.0
50
64.9
26
33.8
1
1.3
77
1951
0
0.0
74
74.7
23
23.2
2
2.0
99
1952
0
0.0
72
69.2
32
30.8
0
0.0
104
1953
0
0.0
67
70.5
28
29.5
0
0.0
95
1954
0
0.0
59
60.2
39
39.8
0
0.0
98
1955
1
1.0
83
79.0
21
20.0
0
0.0
105
Total
1
0.0
405
70.1
169
29.2
3
0.5
578
♦Included in number discharged.
104
RUTLAND STATE SANATORIUM
Table I — Daily Average Number of Patients
RD. 34
Male
No.
1950 142.61
1951 140.17
1952 135.60
1953 148.79
1954 163.77
1955 165.94
Total 896.88
%
Female
No. %
Total
56.9
108.17
43.1
250.78
64.7
76.65
35.3
216.72
62.7
80.70
37.3
216.30
70.7
61.57
29.3
210.36
77.1
48.52
22.8
212.29
77.2
49.10
22.8
215.04
424.61
- 1321.49
149.48 67.9 70.77
32.1
220.25
Table II — Median Age of Patients Admitted
Male Female
Total
1950
1951
1952
1953
1954
1955
40-49
20-29
30-39
40-49
30-39
40-49
40-49
20-29
40-49
40-49
30-39
40-49
50-69
30-39
40-49
50-54
45-49
45-49
P.D. 34
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106
P.D. 34
Table V — Source of Referral of Patients Admitted
Private
M.D.
No. %
San. Con.
Clinic or
O.P. Dept.
No. %
General
Hospitals
and Their
O.P. Depts.
No. %
T.B.
Sanatoriums
by
Transfer
No. %
Other
Sources
No. %
Total
No.
1950
1951
1952
1953
1954
1955
Total
MALE
1950
40
28.4
16
11.3
36
25.5
13
9.2
36
25.5
141
1951
25
18.8
6
4.5
69
51.9
5
3.8
28
21.0
133
1952
34
21.1
13
8.1
61
37.9
31
19.2
22
13.7
161
1953
50
26.9
6
3.2
90
48.4
22
11.8
18
9.7
186
1954
25
14.5
6
3.5
71
41.3
53
30.8
17
9.9
172
1955
39
19.6
1
0.5
111
55.8
27
13.6
21
10.6
199
Total
213
21.5
48
4.8
438
44.2
151
15.2
142
14.3
992
FEMALE
1950
43
38.7
13
11.7
29
26.1
1
0.9
25
22.5
111
1951
25
35.7
6
8.6
21
30.0
2
2.8
16
22.8
70
1952
23
28.0
9
11.0
30
36.6
3
3.6
17
20.7
82
1953
18
28.6
3
4.8
29
46.0
5
7.9
8
12.7
63
1954
16
30.8
3
5.8
26
50.0
2
3.8
5
9.6
52
1955
13
22.4
2
3.4
28
48.3
7
12.1
8
13.8
58
Total
138
31.6
36
8.2
163
37.4
20
4.6
79
18.1
436
BOTH SEXES
32.9
24.6
23.4
27.3
18.3
20.2
29
12
22
9
9
3
11.5
5.9
9.0
3.6
4.0
1.2
65
90
91
119
97
139
25.8
44.3
37.4
47.8
43.3
54.1
5.6
3.4
14.0
10.8
24.6
13.2
6i
44
39
26
22
29
24.2
2a. 7
16.0
10.4
9.8
11.3
351 24.6
84 5.9
601 42.1
171 12.0
221 15.5
252
203
243
249
224
257
1428
WESTFIELD STATE SANATORIUM
Table I — Daily Average Number of Patients: Tuberculosis
Male
Female
Total
No.
%
No.
%
1950 ....
. 64
48.5
68
51.5
132
1951 ....
. 63
46.0
74
54.0
137
1952
. 63
48.5
67
51.5
130
1953
. 72
55.4
58
44.6
130
1954
. 76
62.3
46
37.7
122
1955
. 69
69.0
31
31.0
100
Total ....
. 407
-
344
-
751
Average ....
. 67
8
54.2
57.3
45.8
125.2
Table II — Source of Referral of Patients Admitted: Tuberculosis
Private
Doctor
No. %
San. Cons.
Clinic or
O.P. Dept.
No. %
General
Hospitals
and Their
O.P. Depts.
No. %
Other
Sanatoriums
by
Transfer
No. %
Other
Sources
No. %
Total
1950
22
16.8
56
42.7
33
25.2
19
14.5
1
0.8
131
1951
22
20.0
60
54.5
17
15.4
10
9.1
1
0.9
110
1952
32
25.2
57
44.9
14
11.0
24
18.9
0
0.0
12V
1953
27
20.1
54
40.3
26
19.4
27
20.1
0
0.0
134
1954
23
19.2
40
33.3
21
17.5
32
26.7
4
3.3
120
1955
45
38.5
16
13.7
27
23.1
12
10.2
17
14.5
117
Total
171
23.1
283
38.3
138
18.7
124
16.8
23
3.1
739
Table III — Reason for Initial Examination of Patients Admitted: Tuberculosis
Contact with
Known Case
No. %
Suspicious Signs
or Symptoms
No. %
X-Ray Survey, Other
Case-Finding Activity
or Routine Physical
Examination Total
No. __%
1950
1951
1952
1953
1954
1955
Total
2
1
1
5
2
17
28
1.5
0.9
0.8
3.7
1.7
14.5
3.8
96
87
27
89
94
80
473
73.3
76.3
21.2
66.4
78.3
68.4
63.7
33
26
99
40
24
20
242
25.2
22.8
78.0
29.8
20.0
17.1
32.6
131
114
127
134
120
117
743
P.D. 34
Table IV — Median Age of Patients Admitted: Tuberculosis
107
Male
Female
Total
1950
1951
1952
1953
1954
1955
40-49
20-29
30-39
50-59
30-39
40-49
40-49
30-39
30-39
40-49
30-39
40-49
50-59
30-39
40-49
50-59
30-39
40-49
Table V — Daily Average Number of Patients: Cancer
No.
Male
Female
No. %
Total
1950 .
1951
1952
1953 .
1954 .
1955 .
Total .
Average
15
46.9
17
53.1
32
16
47.0
18
52.9
34
16
47.0
18
52.9
34
17
50.0
17
50.0
34
17
47.2
19
52.8
36
15
45.4
18
54.5
33
96
-
107
-
203
16.0
47.3
17.8
52.7
33.8
Table VI — Number of Patients Admitted: Cancer
Male
No. %
Female Total
No. %
1950 227 42.0
1951 335 48.5
1952 422 51.0
1953 400 48.8
1954 340 47.4
1955 277 40.6
Total 2001 46.8
314
58.0
541
356
51.5
691
405
49.0
827
419
51.2
819
377
52.6
717
406
59.4
683
2277
53.2
4278
Table VII — Stage of Disease on Admission: Cancer
Early
Moderately
Advanced
Advanced
Non-Malignant
Total
%of
>. Sex
%of
No. Sex
%of
No. Sex
%of
No. Sex
%of
No. Total
1950
Males
Females
Total
26
31
17.8
14.7
19
16
13.0
7.6
62
77
42.5
36.5
39
87
26.7
41.2
146
211
40.9
59.1
57
16.0
35
9.8
139
38.9
126
35.3
357
100.0
1951
Males
Females
Total
56
55
29.0
23.7
24
37
12.4
15.9
64
52
33.2
22.4
49
88
25.4
37.9
193
232
45.4
54.6
111
26.1
61
14.4
116
27.3
137
32.2
425
100.0
1952
Males
Females
Total
52
48
24.2
20.7
35
40
16.3
17.2
74
54
34.4
23.3
54
90
25.1
38.8
215
232
48.1
51.9
100
22.4
75
16.8
128
28.6
144
32.2
447
100.0
1953
Males
Females
Total
58
53
27.6
21.0
55
58
26.2
23.0
51
46
24.3
18.2
46
95
21.9
37.7
210
252
45.4
54.5
111
24.0
113
24.4
97
21.0
141
30.5
462
100.0
1954
Males
Females
Total
52
55
26.9
25.0
44
49
22.8
22.3
43
23
22.3
10.4
54
93
28.0
42.3
193
220
46.7
53.3
107
25.9
93
22.5
66
16.0
147
35.6
413
100.0
1955
Males
Females
Total
51
55
32.9
23.5
49
74
31.6
31.6
24
21
15.5
9.0
31
84
20.0
35.9
155
234
39.8
60.2
106
27.2
123
31.6
45
11.6
115
29.6
389
100.0
1950
to
Males
Females
Total
295
297
26.5
21.5
226
274
20.3
19.8
318
273
28.6
19.8
273
537
24.6
38.9
1112
1381
44.6
55.4
1955
592
23.7
500
20.0
591
23.7
810
32.5
2493
100.0
108
P.D. 34
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P.D. 34
109
PONDVILLE HOSPITAL
Table I — Daily Average Number of Patients: Cancer
Male
Female
Total
No.
%
No.
%
1950
32.1
53.0
28.4
46.9
60.5
1951
28.7
49.6
29.2
50.4
57.9
1952
31.0
49.4
31.8
50.6
62.8
1953
32.9
46.3
38.2
53.7
71.1
1954
36.8
41.2
52.5
58.8
89.3
1955
43.3
47.3
48.3
52.7
91.6
Average .
34.1
47.2
38.1
52.8
72.2
Table II — Patients Admitted: Cancer
Male
No. %
Female
No. %
Total
1950
1951
1952
1953
1954
1955
398
40.5
584
59.5
982
469
41.8
653
58.2
1122
589
44.2
745
55.8
1334
540
42.8
721
57.2
1261
554
39.8
837
60.2
1391
616
39.3
951
60.7
1567
Total
3166
41.3
58.6
7657
Table III — Stage of Disease on Admission: Cancer
Early
Moderately
Advanced
Advanced Non-Malignant Unknown
Sex No.
%of
Sex
No.
%of
Sex
No.
%of
Sex
No.
%of
Sex
No.
%of
Sex
Total
%of
Total
No. forYr.
Males
1950 Females
30
46
11.7
12.5
88
77
34.4
20.9
81
61
31.6
16.6
57
184
22.3
50.0
0
0
0.0
0.0
256
368
41.0
59.0
Total
76
12.2
165
26.4
142
22.8
241
38.6
0
0.0
624
100
Males
1951 Females
33
20
12.4
5.4
64
78
24.0
21.1
106
94
39.7
25.4
57
176
21.3
47.6
7
2
2.6
0.5
267
370
41.9
58.1
Total
53
8.3
142
22.3
200
31.4
233
36.6
9
1.4
637
100
Males
1952 Females
36
41
11.8
9.6
127
132
41.5
31.0
52
53
17.0
12.5
84
191
27.4
44.9
7
8
2.3
1.9
306
425
41.9
58.1
Total
77
10.5
259
35.4
105
14.4
275
37.6
15
2.0
731
100
Males
1953 Females
30
41
9.9
10.2
80
66
26.4
16.4
110
127
36.3
31.5
72
160
23.8
39.7
6
3
2.0
0.7
303*
403*
42.9
57.1
Total
71
10.1
146
20.7
237
33.6
232
32.9
9
1.3
706*
100
Males
1954 Females
36
64
12.4
14.2
59
58
20.4
12.8
114
124
39.4
27.4
67
189
23.2
41.8
9
6
3.1
1.3
289f
452f
39.0
61.0
Total
100
13.5
117
15.8
238
32.1
256
34.6
15
2.0
741 1
100
Males
1955 Females
36
37
10.2
8.1
52
78
14.7
17.1
164
134
46.3
29.3
88
194
24.8
42.4
9
7
2.5
1.5
354f
457t
43.6
56.4
Total
73
9.0
130
16.0
298
36.7
282
34.8
16
2.0
811J 100
1950 Males 201
to Females 249
11.3
10.1
470
489
26.5
19.8
627
593
35.3
24.0
425
1094
23.9
44.2
38
26
2.1
1.0
1775
2475
41.8
58.2
1955 Total
450
10.6
959
22.6
1220
28.7
1519
35.7
64
1.5
4250
100
♦Including "ppst-therapy, no recurrence" : 5 males, 6 females.
"(■Including "no disease": 4 males, 11 females.
^Including "no disease, or no recurrence": 5 males, 7 females.
110
P.D.34
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P.D. 34 ill
BUREAU OF ENVIRONMENTAL SANITATION
DIVISION OF SANITARY ENGINEERING
The work of the Division of Sanitary Engineering is carried out under four
principal engineering sections and the Lawrence Experiment Station. The engi-
neering sections consist of the water supply section, community sanitation section,
atmospheric pollution and radiological health section, and pollution control sec-
tion; under the community sanitation section are carried out the sanitary engi-
neering activities of the four public health districts. At the Lawrence Experiment
Station routine work is carried out in the chemical laboratory and the bacteriological
laboratory, with a separate laboratory for research. The facilities of the chemical
and bacteriological laboratories are available to the research laboratory. In addi-
tion to these three laboratories, the plumbing research laboratory recently estab-
lished is engaged in the demonstration of the hydraulics of plumbing and the
training of plumbers and plumbers' apprentices in the health features of plumbing;
in this connection the trainees are afforded a general knowledge of the operation
of the other sections of the Lawrence Experiment Station to emphasize the health
features of proper plumbing.
In addition, to serve the western part of the State in special sanitary engineering
activities, there is the Amherst laboratory at the headquarters of the Western
Publie Health District.
The following detailed report is arranged for the discussion of each of the several
sections referred to above.
Routine Work
The routine activities of the Division of Sanitary Engineering have been as
follows :
General advice to cities, towns and persons in matters of water supply, drainage,
sewerage and sewage disposal.
Investigations leading to the adoption of rules and regulations for protecting
sources of water supply and enforcement of such rules and regulations.
Investigations leading to removal of sources of pollution of water supplies.
Investigations relative to the efficiency of the operation of sewage treatment
works.
Investigations relative to pollution of streams, examinations of sewer outlets,
enforcement of legislation relating to pollution of certain streams and certain
coastal waters.
Investigations relative to the use of emergency sources of water supply.
Approval of the acquisition of lands for protecting sources of water supply and
lands for sewage treatment works.
Investigations as to effect of industrial wastes on sewers and sewage treatment
works.
Investigations leading to approval of plans for police stations, lockups and houses
of detention.
Investigations relative to offensive trades.
Investigations relative to the approval of the use of lands for cemetery purposes
and for the construction of mausoleums and crematories.
Investigations leading to advice to cities, towns and persons in matters of bathing
places, garbage and refuse disposal, nuisances, private water supplies and similar
problems.
Investigations relative to sources of water supply where the water is bottled and
sold or used in the manufacture of non-alcoholic beverages.
Investigations relative to pollution of water supplies by cross connections.
Investigations as to the location of public institutions.
112 P.D. 34
Preparation of plans for water supply and sewerage for institutions of the Depart-
ment and certain other State institutions.
Approval of municipal plumbing rules and regulations.
Investigations relative to the pollution of coastal waters from which shellfish
are taken.
Investigations relative to sanitary conditions of shellfish-handling establishments
and consideration of certificates of out-of-state shellfish shippers.
Investigations relative to the approval of shellfish purification plants and the
operation thereof.
Representatives of the Division have participated in the Sanitation Courses at
the University of Massachusetts. The work has included lectures, field trips and
assistance to the faculty in the preparation of courses.
Representatives of the Division have from time to time given lectures on general
sanitation matters at various hospitals throughout the State to classes of nurses
in training.
Papers on the problem and solution of stream pollution have been presented to
many civic and professional organizations throughout the State by engineers of
this Division.
General advice to the Legislature in matters of water supply, drainage, sewerage
and sewage disposal, shellfish and other environmental sanitation problems.
A representative of the Division of Sanitary Engineering has been appointed
by the Commissioner of Public Health as a member of the State Reclamation
Board, whose duties at present are largely concerned with the control of mosquitoes.
A representative of the Division of Sanitary Engineering also is appointed to
represent the Commissioner of Public Health on the Water Resources Commission.
Changes in the law placed upon the Division of Sanitary Engineering the duty
of making investigations relative to atmospheric pollution, and included within
the Division the Division of Smoke Inspection for Smoke Inspection Districts.
With the release of radioisotopes to industry, hospitals and others under license
by the Atomic Energy Commission, the Department of Public Health was given
the duty of the control of the use of radioactive materials in Massachusetts, this
duty being assigned within the Department to the Division of Sanitary Engineering.
The Division has been actively concerned in the location and condition of opera-
tion of municipal dumps, particularly in the city of Boston. A new law permits any
person aggrieved by the assignment of the location of a dump by a local board of
health to apply to the Department of Public Health for a hearing; following the
hearing the Department may revoke or amend the assignment by the local board
of health.
The Division has also been concerned in the examination of and advice relative
to piggeries at the request of local boards of health.
Special Activities
Legislative Investigations
This Division has assisted in special investigations directed by the resolves of
the Legislature during the period from 1949 to 1956.
Water Resources Board
A representative of the Division of Sanitary Engineering has been appointed
to represent the Commissioner of Public Health on this Board, which was organized
in 1956.
State Reclamation Board
During the six-year period covered by this report the State Reclamation Board,
composed of a representative of the Department of Public Health, a representa-
tive of the Department of Agriculture and a person appointed by the Governor,
P.D. 34 113
has held its regular meetings each month at which problems concerned with the
maintenance of the salt marsh ditches, the operation of the mosquito control
districts and the greenhead fly districts have been discussed and appropriate action
taken whenever necessary.
During this period Chapter 433 of the Acts of 1955 was passed in amendment
of Chapter 252 of the General Laws for the creation of a Greenhead Fly Control
District in which the Commonwealth shares the cost to the extent of one-third
based on the area of the communities involved. Two new mosquito control dis-
tricts were authorized during this period. The Norfolk County Mosquito Control
District was created under the authority of Chapter 431 of the Acts of 1956 and
was in operation soon after approval of the act by the Governor. The Bristol
County Mosquito Control District was authorized by Chapter 506 of the Acts of
1956 but never has been organized.
Civil Defense
July 1, 1950, to June 30, 1951
On July 20, 1950, His Excellency, the Governor, approved Chapter 639 of the
Acts of 1950, which provided for a Civil Defense Agency in Massachusetts, which
agency was activated by the Governor's Executive Order on August 18, 1950; and
on December 16, 1950, the Governor proclaimed a state of emergency.
The Civil Defense Agency was organized in seven divisions including the Medical
and Health Division. That Division was organized with 12 sections, one of which
was the Environmental Sanitation Section. Under the general organization the
State was divided into nine regions. The Division of Sanitary Engineering staffed
State Headquarters and each regional headquarters with sanitary engineering
personnel to operate in disaster under the Regional Medical Officers.
July 1, 1951, to June 30, 1952
The Environmental Sanitation Section held water works schools in September,
October and November, 1951, in each of the nine regions. These schools were
well attended by local water works personnel who were instructed in the use of
emergency water chlorination apparatus and as to examination and selection of
proper emergency sources of water supply should the public supplies be severely
damaged.
In March, April and May of 1952 general sanitation schools also were held in
each of the nine Civil Defense Regions.
July 1, 1952, to June 30, 1953
During this period all public water supply agencies were canvassed to determine
the amount of emergency water supply equipment. This equipment was listed
according to various types and also as to the regions in which it was located to
facilitate its dispatch from one region to another.
During this period also manuals were prepared showing:
(1) The duties and organization of the Environmental Sanitation Section.
(2) Emergency Sanitation — Water Supply.
(3) Emergency Sanitation — Decontamination of areas affected by biological,
chemical, gaseous and radiological sabotage or attack.
(4) Emergency Sanitation — General Sanitation.
(5) Milk and food sanitation, household supplies, mass feeding.
During this period also information was obtained as to local water works per-
sonnel and tabulations prepared showing those in charge of local public water
supplies together with their office and home addresses.
Water treatment training equipment was purchased under matching funds
including diatomaceous earth filters, pumps, canvass storage tanks and appurte-
nances for use in future water works schools.
On June 9, 1953, the Worcester tornado occurred and the Environmental Sani-
tation Section concentrated its field engineers in the Worcester area to assist in
114 P.D. 34
water supply problems and to determine the amount of damage to water works.
This included examinations in the city of Worcester and in the towns of Petersham,
Barre, Holden, Rutland, Shrewsbury, Northborough, Westborough and South-
borough and at the Rutland State Sanatorium of the Department of Public Health.
The damage consisted of breaks in house services in damaged areas and loss of
electric power. Adequate amounts of water were in storage on public water supply
distribution systems so that early repair of power lines solved the problem of ade-
quate water supply. In one instance, however, in the town of Northborough, the
power failure made it impractical to operate the pumps and emergency pumps
were obtained from the list of emergency equipment previously prepared by the
section. In addition to examination of water supplies in the Worcester area exami-
nations were made of the facilities for emergency feeding. No unsanitary practices
were observed.
During this period also training in radiological monitoring was carried on by
the Monitoring Section to which an engineer from the Division of Sanitary Engineer-
ing had been assigned. Regional monitoring consultants were trained in the use
of monitoring equipment, and field exercises were carried out in the training of
monitoring teams.
July 1, 1953, to June 30, 1954
During this period the Environmental Sanitation Section attended Civil Defense
exercises at Civil Defense Headquarters at the Framingham State Police Training
School in September, November and December, 1953, and on January 4, 1954.
In addition, on January 4, 1954, the Environmental Sanitation Section lectured
at a meeting of the Massachusetts Public Health Association in Worcester to
explain the functions of the Environmental Sanitation Section in Civil Defense.
On June 14 and 15, 1954, Operation Alert 1954 was held at Civil Defense Head-
quarters. The State and Regional Headquarters were staffed for this exercise by
the Environmental Sanitation Section under the Medical Services.
July 1, 1954, to June 30, 1955
The Environmental Sanitation Section was called into service on August 31,
1954, with the appearance of Hurricane Carol and again on September 11, 1954,
with the occurrence of Hurricane Edna.
On January 3, 1955, the Civil Defense Agency was reorganized. Under Executive
Order No. 25 and Administrative Order No. 23, as amended, the Water Service
was removed from the Medical Service and placed in charge of the Division of
Sanitary Engineering of the Department of Public Health, the Chief Sanitary
Engineer being appointed as Chief Water Officer. Under the reorganization the
former nine regions were done away with and the State was redivided into four
civil defense areas. The State Headquarters and each of the areas were staffed
three-deep with waterworks personnel under the Chief Water Officer. The Sani-
tation Section under the Medical Service was also staffed for duty at the State
and area headquarters in case of emergency.
The personnel of the Division of Sanitary Engineering in the Water Service and
in the Sanitation Section of the Medical Service took part in Operation Alert 1955
on June 15 and 16, 1955.
July 1, 1955, to June 30, 1956
During this period whenever possible the Division of Sanitary Engineering in
the two services attended weekly conferences at State Headquarters. The staff
of the Division of Sanitary Engineering under the Water Service prepared maps
showing present public water supplies in Massachusetts, rearranged according to
Civil Defense areas the tabulation of emergency water supply equipment, prepared
a complete revision of the fisting of public water supply personnel and prepared a
new manual of emergency water supply.
Again, in 1955, Massachusetts was visited by three hurricanes; on August 13 by
"Connie," on August 17-19 by torrential rains accompanying Hurricane Diane
P.D. 34 115
and by heavy rains occurring in October in company with Hurricane Edna. The
torrential rains in August resulted in major damage in the central portion of the
State and the Connecticut River Valley. The Division of Sanitary Engineering
personnel assigned to the Water Service and Medical Service were in the field much
of this time advising as to the rehabilitation of public water supplies and the eradi-
cation of nuisance conditions.
Operation Alert was planned for June, 1956, but was postponed to July 20 and
23, 1956.
Prior to Operation Alert 1956, a test was conducted on a token evacuation of
Beacon Hill to the Framingham area.
Water Supply Section
Special Activities
During the post-war years the Water Supply Section took part in activities
sponsored by the Massachusetts Civil Defense Agency. Following a reorganization
of that agency a new section known as "Water Service" was established with a
representative of this Division designated as Chief of that section. Several training
schools have been conducted for water supply personnel throughout the State in
an endeavor to work out a program to be used in the event of disaster, either by
natural causes or by enemy action.
In 1954, two natural disasters occurred, the hurricane of August 31 and that of
September 11. These both caused considerable damage to water supply installa-
tions. Many communities were without power for several days. The storms
demonstrated the necessity of auxiliary pumping equipment for sources of supply
which were supplied only with electric power. The personnel of the Division was
on 24-hour standby duty during both disasters. Laboratory facilities were taxed
and a large number of special samples were examined to determine that none of
the public water supplies had become polluted.
In 1955, serious flooding occurred over a large part of the State as a result of
heavy rainfall accompanying hurricane Diane in August. Damage to public water
supplies, as a result of these floods, in the lower Connecticut River Valley exceeded
$1,000,000. The damage to water supply systems throughout the State brought
the total damage to about $2,500,000. During the flood and the rehabilitation
following it, the Division assisted the damaged communities in providing safe
water supplies by the installation of chlorinating apparatus and the transportation
of water for drinking. Close contact was maintained with the Flood Relief Board
in connection with the repair of damage to water supply systems.
Water Shortages
Following the severe drought of the year 1949, steps were taken by many com-
munities to develop additional sources of water supply to meet increased water
needs. However, shortages continued at a lesser rate during the years 1950-56,
and in many instances the provisions of General Laws, Chapter 40, Section 41A,
were invoked to give the right to public water supply agencies to shut off the water
to consumers not showing cooperation in water conservation measures.
Public Water Supplies
On June 30, 1956, 273 of the 351 cities and towns of the Commonwealth were
provided with public water supplies. However, there were 306 agencies engaged
in this service, including municipal water departments, water districts, and water
companies (Figure 1). There still remained 78 muncipalities not considered as
having public water supplies, although in some of these there are public institutions
which provide water to patients and employees, accounting for a considerable
portion of the population of these communities. About 98 per cent of the popula-
tion of Massachusetts reside in communities having public water supplies.
16
P.D.
34
200
177
130
30
85
81
150
iinn
■'// :.:■'::
KEY SOURCE OF SUPPLY
E3 — Surface Source
EE9 — Ground Source
' 1 — Surface & Ground Source
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4
33
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23
tl
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0
Munit
•ipal Watt
Deportments
r
Water
Districts
Water
Companies
FlGUHE 1
Water Supply Agencies by Type and Source
P.D. 34 117
The growth of public water supply service in Massachusetts from 1870 to 1955
is shown in Figure 2.
PoPUL. A TION IN Ml L LIONS
v>
So
a
a
g
3
1
c
!
GO
1=
78 70
/S80
7090
7900
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*
/960
118
P;D. 34
The following tabulation shows the public water supply systems which were
established during the years 1950 through 1956:
Recent Establishment of Public Water Supplies
Boylston — Morningdale Water District
Burlington — Burlington Water District
Raynham — North Raynham Water District
Raynham Center Water District
Sutton — Manchaug Water District
Swansea — Swansea Water District
Templeton ....
Dighton — Dighton Water District
Blackstone ....
Boylston — Boylston Water District
Tewksbury
North Reading ....
Leicester — Hillcrest Water District
Norwell .....
Gravel-packed well
Tubular wells .....
Tubular wells .....
City of Taunton Supply
Stevens Pond (tests for ground water supply)
Gravel-packed wells . . ;.
Gravel-packed well . .
Tubular wells .....
Gravel-packed wells ....
Gravel-packed wells . . ....
Gravel-packed wells . . .
Gravel-packed and tubular wells
Drilled well
Gravel-packed well ....
1950
1950
1950
1950
1950
1950
1950
1951
1952
1952
1952
1954-1955
1955
1956
The availability of sources of water supply of the Metropolitan District Com-
mission has resulted in the towns of Brookline and Marblehead, the city of Newton,
the Lynnfield Water District, and the South Hadley Fire District No. 1 abandoning
their local sources and obtaining water from the Metropolitan District Commission,
The following tabulation shows the number of additions to existing water supply
sources during the years 1950 through 1956.
Classification of Source of Supply for Additions
to Existing Water Systems
Year
No. of Additional
Ground Water Sources
Developed
No. of Additional
Surface Water Sources
Developed
(Artificial Reservoirs)
1950
1951
1952
1953
1954
1955
1956
16
14
5
24
19
21
17
Consumption of Water
Figure 3 shows the estimated total water consumption of the Metropolitan
District Commission and all the public water supplies in the State, together with
the estimated total of the safe yield of all the present sources of water supply.
P.DV34
119
3
o
o
GO K
S, 00
CD
W
CL
91
N& O
li 3
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o °
c
2)
I
\
Million
Gallows
*T
*l£\
*%v
*4-
51
ve I
oil
per Day
120
P.D. 34
Fluoridation of Public Water Supplies
The water supplies of Massachusetts are deficient in the amount of fluorides
necessary to prevent excessive dental caries, and following the recommendations
of the Department some 20 communities now treat their water supplies by the
addition of a fluoride compound to bring the fluoride content to an optimum value
Populotion
en
O
O
o
o
o
o
b
o
o
en
O
b
o
o
o
o
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P.D. 34
121
of one part per million. In spite of the fact that the city of Northampton and the
towns of Hudson and Williamstown adopted a fluoridation program and later
abandoned it by vote, there has been a steady although rather slow increase in the
population served with fluoridated water (Figure 4).
Climatological Data: Precipitation
The average annual rainfall in Massachusetts has been well above normal in
all but two years of the period 1950-1955 (Figure 5). The total rainfall excess for
the six-year period amounted to 27.56 inches, or about half of the normal annual
precipitation.
1955
Figure 5
Precipitation in Massachusetts, 1950-1955
The following table shows the normal monthly rainfall as deduced from the
records of seven long-term stations located at Amherst, Boston, Dalton, Fitchburg,
Lowell, New Bedford and Northbridge; also, the monthly rainfall for the years
1950-1955, inclusive:
Month
Monthly Rainfall in Inches fob Yeabs 1950-1955
Normal 1950 1951 1952
1955
January
February
March
April .
May
June
July .
August
September
October
November
December
Totals
3.59
4.39
3.61
4.66
6.23
2.69
0.88
3.33
3.87
4.64
3.64
3.49
2.66
3.71
3.84
3.64
4.89
3.64
8.60
3.58
4.24
3.63
3.32
3.24
4.21
6.16
4.68
3.92
3.64
2.54
4.26
4.22
4.77
7.37
1.63
3.50
2.59
3.03
3.93
1.55
3.02
3.42
3.76
2.27
3.99
2.01
3.12
2.83
2.26
4.15
3.57
3.57
6.20
2.32
5.53
13.57
3.56
1.71
2.42
2.96
1.78
8.17
2.58
3.49
2.16
4.44
1.21
5.18
2.84
8.41
3.89
6.49
7.04
2.20
4.36
5.91
4.80
3.58
3.88
4.86
3.94
4.72
4.99
1.07
43.96 40.43 49.99 42.82 52.28 54.27 50.49
122
P.D. 34
Cross Connections
The cross-connection program of the Department operates under the authority
of Section 160, Chapter 111 of the General Laws of the State. The rules and regu-
lations pertaining to cross connections were originally adopted on February 9, 1937.
They were amended on May 12, 1942, to facilitate the successful prosecution of
the war effort. After the national emergency was over the rules and regulations
were readopted in their original form on February 8, 1949. On October 9, 1951,
the rules and regulations were revised once more so that they continued in their
primary purpose of protecting the public water supply and yet gave the Depart-
ment more discretionary power to allow properly constructed and properly pro-
tected cross connections where it was felt that the public good would be served.
In essence the new rules and regulations forbid the physical cross connection of
any other water supply with the distribution system of a public water supply unless:
(a) The secondary water is proved to be of safe and sanitary quality.
(b) The connection includes adequate backflow preventive devices such as
check valves, properly installed so that they may be tested.
(c) The entire design and installation meets the approval of the Department
of Public Health.
The following table shows the distribution and number of approved double-
check valve installations which have been permitted in accordance with these
rules and regulations.
Period Ending
Number of Municipalities Number of
having Industrial Plants Industrial Plants having
with Double -Check Valve Double-Check Valve
Installations Installations
Number of
Sets of A«tive
Double-Check Valve
Installations in State
December 31,
1949 .
134
December 31,
1950 .
134
December 31,
1951 .
133
December 31,
1952 .
134
December 31,
1953 .
134
December 31,
1954 .
132
December 31,
1955 .
129
December 31,
1956 .
130
659
1004
650
1005
650
999
654
1002
634
980
628
988
619
989
616
993
Like all mechanical devices, check valves are subject to failure, and to minimize
the dangers inherent in faulty checks the Department requires periodic inspections.
The Department has endeavored to educate the local water companies to allow
at least one man to become familiar with the testing and overhauling of the check
valve installations within their district and to have this designated individual make
routine inspections every three months. This individual would make out regular
inspection forms and send the Department a copy so that it would be informed at
all times. If any check valves were found to be faulty or in need of repair the matter
could be attended to immediately.
Once each year an engineer from the Department visits each plant and super-
vises the testing and overhauling of the check valve installations. Iron-bodied
check valves (a type no longer permitted under the Department's rules) are opened
at the annual inspection every year, whether they hold or not, and are thoroughly
reconditioned. Bronze-bodied check valves are tested for tightness and if they
work properly are not usually opened for inspection. Once every five years, how-
ever, the bronze-bodied checks are opened for a complete overhauling, cleaning and
lubrication.
Within the last few years the Department has embarked upon a program of
replacing the hard-rubber discs, usually supplied as standard equipment with the
check valves, with a disc made of a softer, more pliable rubber. These softer discs
seem to work much better and they substantially reduce the number of small installa-
tions which fail to meet the initial test for tightness. In addition, the Department
has published informative and descriptive literature for distribution to water
supply officials, plant mechanics in charge of double-check valves, and other inter-
ested persons.
P.D. 34 123
Illegal and /or improperly protected cross connections constitute a public health
menace whose potential danger cannot be minimized. It is encouraging to note
that since the inception of the law relating to cross connections in 1937 there have
been no known cases of sickness or disease traceable to a cross connection approved
and regularly inspected by a Department engineer.
Community Sanitation
Camp Sanitation
During this seven-year period this Division has continued to make examinations
of recreational camps, overnight camps or motels and trailer coach parks under
authority of Sections 32 B-L of Chapter 140 of the General Laws as amended.
This law requires the board of health to license annually those camps and parks
which come under the provisions of the law. The law further specifies that the
Department shall be notified of the granting of such licenses and shall have juris-
diction to examine water supplies and methods of sewage disposal.
Since 1939, the camp law has been amended as follows:
Chapter 396 of 1941
Chapter 153 of 1945
Chapters 326 and 802 of 1950
Chapter 74 of 1951
Chapter 583 of 1952
Chapter 130 of 1953
Chapters 134 and 410 of 1954
Chapters 162 and 444 of 1956
As recently as 1940 it was found that only 30 per cent of the recreational camps
had satisfactory sources of water supply or methods of sewage disposal or both.
In 1952 it was found that the percentage of recreational camps meeting satisfactory
standards for water supply and sewage disposal had increased to 70 per cent.
The total number of camps licensed under the provisions of this law has increased
steadily since 1949. In 1953, 1,056 camps were examined by the sanitarians and
sanitary engineers of this Division.
In recent years because of the increasing number of camps and a smaller staff
of sanitarians, it has been necessary to limit the examinations to three classes as
follows :
(1) All recreational camps including day camps (350-400 annually)
(2) All new motels, overnight camps and trailer parks or those that have not
been previously examined (75-100 annually)
(3) All camps not approved for water supply and sewage disposal following
the last examination (35-50 annually)
Bathing places at recreational camps are examined only upon request.
A pamphlet entitled "Camp Sanitation" has been prepared by the Division for
the use of local sanitarians and camp operators.
Housing
With more communities recognizing the problems of blight and physical decay
of substandard areas, it was felt that enabling legislation should be provided so that
minimum housing standards could be drafted for municipalities to adopt and to
enforce.
Chapter 631 of the Acts of 1947 directed the Department of Public Health to
draft regulations establishing minimum standards of fitness of dwellings and also
for the Board of Standards in the Department of Public Safety to draw up minimum
standards for construction, alteration, repair and use of buildings, with the assist-
ance of the Commissioner of Public Health.
Regulations establishing minimum standards of fitness for human habitation
under Section 128 of Chapter 111 were adopted by the Department in 1949. Several
communities adopted the minimum standards, but they proved to be difficult to
enforce because of the ambiguous wording. During the latter part of this seven-
124 P.D. 34
year period, two new laws, Chapters 209 and 447 of 1954, were passed which repealed
Section 128 of Chapter 111 and substituted Sections 128B, 128C, 128D, 128E and
128F. New problems covered by this legislation were home accident prevention
and mobile dwelling places.
The new law invalidated the earlier minimum standards. Accordingly, new
standards were adopted by the Public Health Council on March 8, 1955, and filed
with the Secretary of State on March 22, 1955. Local standards adopted by action
of the city council or town meeting under Section 128 also were invalidated, requir-
ing therefore the adoption of new standards. Minimum standards that were
adopted under Section 31 of Chapter 111 remain in force.
For the assistance of local boards of health two pamphlets have been prepared
by the Division: "Housing Rehabilitation" and "Minimum Standards." The
latter pamphlet explains the mechanism by which municipalities may adopt mini-
mum standards relative to housing.
Refuse and Garbage
The Department has continued to advise communities relative to the correction
of objectionable conditions caused by odors, insects, rodents, smoke and fires at
dumps.
The Division also examines proposed refuse disposal sites upon the request of
the local boards of health. In 1952 a hearing was held by the Department under
Chapter 111, Section 152 of the General Laws following receipt of a petition from
residents complaining of insanitary conditions resulting from the operation of an
open-face dump. Events following this hearing emphasized the lack of authority
on the part of the Department to correct unsatisfactory conditions resulting from
the operation of a municipal dump.
The Legislature gave additional authority to the Department under Chapter 310
of the Acts of 1955 to control garbage and refuse disposal in communities. Accord-
ing to this law, no dump or incinerator shall be established or operated "unless such
place has been assigned by the board of health of the city or town." The Depart-
ment shall advise upon the request of any board of health as to the assignment
of a place and upon appeal may, "after due notice and public hearing" rescind or
suspend such an assignment.
Under the Acts of 1952, Chapter 559, provisions were made for the construction
and operation by the Metropolitan District of refuse disposal incinerators. Five
such incinerators were to be constructed to serve the Metropolitan area. No action
has been taken by any of the Metropolitan cities under this act.
The towns of Brookline, Framingham and the city of Worcester have constructed
incinerators which are currently being operated. The city of Boston has plans and
proposals for an incinerator in the South Boston area.
During this period, vesicular exanthema, a disease found in hogs, became wide-
spread in Massachusetts for the first time. While generally non-fatal to hogs and
while not a disease of man, it is serious since it cannot be differentiated from hoof-
and-mouth disease without exhaustive laboratory analyses.
To control the spread of this livestock disease, the Legislature enacted Chapter
655 of the Acts of 1953, a law requiring hog producers who are feeding garbage to
hogs to secure a permit from the Director of the Division of Livestock Disease
Control. This law required that after January 1, 1954, all garbage fed to hogs shall
be cooked for at least 30 minutes at a temperature of 212°F. From the public
health viewpoint, this law is significant in that trichinosis, a disease of man, is
under some form of control.
A pamphlet entitled "Refuse Disposal Methods" has been prepared for the
guidance of local boards of health and other interested agencies.
Lockups
In accordance with the provisions of Section 22 of Chapter 111 of the General
Laws, the Department continues to make examinations and to approve plans for
jails and lockups.
P.D. 34 125
During this period the Department has approved plans for eight new lockups and
renovations for one existing lockup. Upon request the Department has consulted
and advised communities relative to conditions in existing lockups. District sani-
tarians make annual examinations of lockups and jails as delegated by the District
Health Officer.
Nuisances
The Department has investigated numerous nuisances under the classification
of miscellaneous nuisances or under the so-called "noisome-trade laws." In all
cases where the request and complaint pertains to local nuisances, the Department
has referred the matter to the community for appropriate action under the law.
These complaints vary from the prevalence of leeches in ponds to insect bites
suffered by workers in commercial firms. Some others vary from drainage condi-
tions to disposal of night soil by private contractors.
Cemeteries
The Department has continued to advise communities on the location and estab-
lishment of cemeteries and the extension of existing cemeteries. For this period
advice was rendered in the establishment of six new cemeteries and for extension
of one old cemetery.
Local and State In-Service Training
The Division has been successful during this period in organizing meetings with
local and State health officials to discuss mutual sanitation problems affecting both
agencies. One such activit}- was the establishment of one-day State municipal
environmental conferences held in different localities throughout the State.
Sanitarians and sanitary engineers from this Division made up part of the staff
for these conferences. Some of the subjects covered were : new public health legisla-
tion, water supply, sewage disposal, housing rehabilitation, swimming pool sanita-
tion, restaurant sanitation, poultry sanitation and camp sanitation.
The main objectives for these meetings are defined as follows:
(1) To clarify responsibilities of State and local agencies in matters of environ-
mental sanitation ;
(2) To discuss new programs and modern accepted practices in the control of
environmental hazards.
The Division has continued to cooperate with the New England Field Training
Center at the University of Massachusetts by providing speakers for the 12-week
course for sanitarians and for one-week courses on specialized subjects. An eight-
week course is also presented for graduate sanitarians receiving supervised field
training.
During the early period of this report over 89 communities were given ratings
of their eating establishments by the Department as a result of surveys conducted
by the district sanitarians. In an endeavor to raise these standards the district
sanitarians have assisted the local boards of health in organizing schools for food
handlers in the technique of proper food sanitation. These training courses are
also presented for the food handlers from institutions.
Insect and Rodent Control
Many requests for information and advice on problems of control of insect and
rodent infestations are handled by the Division. In 1953 the Division cooperated
with the Public Health Service in presenting a five-day training course in rat control
for representatives of local health departments in Massachusetts.
A member of the Division was assigned for several months in 1950 to a field
investigation of methods of control of the eastern dog tick (Dermacentor variabilis).
126 P.D. 34
Home Accident Prevention
In recent years, as illness and death resulting from communicable disease have
been markedly reduced, health departments have taken a new look at the problem
of accident prevention.
On August 1, 1953, the Home Accident Prevention Project was established as
an integral part of the Division of Sanitary Engineering, financed through a grant
of $96,660 from the W. K. KeUogg Foundation. For the first two years the entire
cost of the program was borne by the Foundation, but part of the cost is now being
financed by the Division. Massachusetts was one of eight states to receive funds
for demonstration projects in this field.
The project has undertaken a three-year study of home accidents reported by a
selected group of hospitals and physicians throughout the Commonwealth. Pre-
liminary reports of the results of this study have been prepared and it is planned
to publish the results of the analysis of about 15,000 injury reports. This report
should provide valuable information regarding the types of injury and the environ-
mental hazards associated with these injuries as weU as other data that may be
useful in planning future home accident prevention activities.
In-service education programs for nurses and sanitarians have been conducted
in several areas of the State. The project staff have worked with local boards of
health, service clubs, and other agencies interested in developing home accident
prevention activities. Lectures and demonstrations have been given to many
interested groups, and exhibits have been shown at several meetings of public
health groups and at local health department meetings.
A number of pamphlets and leaflets were prepared by the staff and have had
wide distribution. News release material has been developed and mailed to selected
boards of health, radio stations, and newspapers for local release.
Atmospheeic Pollution Control and Radiological Health Section
This division in past years has been called upon to assist communities in atmo-
spheric pollution problems and, in more recent years, in problems involving possible
exposure to ionizing radiation. Increased industrialization and population growth,
together with the more and more frequent incidents of inversion phenomena
throughout the United States, have made both the public and public health officials
increasingly conscious of the need for methods to control air pollutants to insure
a continued safe and comfortable environment.
As a result, the demands on this division for the solution of problems involving
atmospheric poUution have kept pace with this ever-increasing awareness. During
the period covered by this report, legislation was passed whereby the Department
of Public Health, under the provisions of Chapter 672 of the Acts of 1954, was
vested with the control of all types of air pollutants being discharged to the atmo-
sphere within the Commonwealth. This enabling act now allows for the adoption
of rules and regulations designed to specificalhy control air pollutants, whereas
heretofore control was possible only through the broad interpretation of existing
nuisance and noisome-trade laws.
In a similar way the demands upon the Department for both information and
control of pollution of our land, water, and air by ionizing radiation have increased
through public awareness and through the release of government-controlled radio-
isotopes for peacetime use. Again, during the period covered by this report,
enabling legislation has been passed authorizing the Department of Public Health,
under the provisions of Chapter 335 of the Acts of 1955, to regulate methods of
production, handling, and disposal of radioactive materials which may affect the
public health.
As a result of these legislative acts an Atmospheric PoUution Control-Radio-
logical Health Section has been established within the Division of Sanitary Engi-
neering. This section is headed by a sanitary engineer and includes two additional
sanitary engineers and a biologist, who have been trained and will receive further
training to allow them to effectively and reasonably develop and administer pro-
grams to insure the continued highest use of our environment.
RD. 34 127
To supplement the field work being done two laboratories staffed with trained
technicians have been established at the Lawrence Experiment Station, one for
radiological health and one for atmospheric pollution control. In addition to
routine analyses a major portion of the work is being devoted to fundamental
research in the development and standardizations of methods of analysis.
The current activities and duties of this section are as follows :
(1) Oversight of the activities of the Division of Smoke Inspection, which was
transferred, under the provisions of Chapter 672 of the Acts of 1954, from the
Department of Public Utilities to the Department of Public Health.
The Division of Smoke Inspection is authorized by Chapter 651 of the Acts of
1910 to regulate visible smoke emissions from stationary locomotive and marine
stacks within the 31 cities and towns which comprise the Greater Metropolitan
Smoke District.
(2) To prescribe and establish minimum rules and regulations to prevent pollu-
tion or contamination of the atmosphere within the Commonwealth (Chapter 111,
Section 142A).
(3) To advise local boards of health and render technical assistance in all matters
of atmospheric pollution (Chapter 111, Section 31C).
(4) To assist in drafting, and reviewing for approval, minimum rules and regula-
tions that may be adopted by local boards of health for the control of atmospheric
pollution (Chapter 111, Section 31C).
The Division has drafted a suggested set of rules and regulations for the control
of visible smoke, dust, soot and fly ash in the city of Holyoke.
(5) To assume joint jurisdiction to regulate and control such causes of atmos-
pheric pollution adversely affecting one town but arising in another, and may exer-
cise all powers of the local boards of health or other legal authority (Chapter 111,
Section 31C).
In conformance with the provisions of this section of the law, an investigation
and survey of the Salem-Marblehead area in the vicinity of Naugus Head is being
made at the request of the Marblehead and Salem boards of health. Four air-
sampling stations have been established and are currently being operated to deter-
mine the extent of alleged heavy outfalls in this area.
(6) To conduct special atmospheric pollution surveys in municipalities upon
request of the municipality and upon receipt, in advance, of the estimated cost
thereof. (Current provisions of Supplementary Budget.)
Such a survey was begun in the town of Milford and will entail source sampling,
air sampling and in-plant surveys and investigations. Upon completion of this
program suggested rules and regulations for the control of atmospheric pollution
in Milford will be submitted to the municipality for consideration and adoption.
(7) Independently, or in cooperation with federal and other State agencies,
to conduct special or general atmospheric pollution studies and surveys throughout
the State.
In January 1955, at the request of the Pittsfield Public Safety Committee, a
special preliminary air pollution survey of the Pittsfield area was made. As a
result of this survey it was judged necessary to establish air sampling stations in
and about areas adjacent to the industrial complex of Pittsfield to determine levels
of heavy particulate outfall, suspended particulate matter and mineral content of
the atmosphere in the Pittsfield area.
To evaluate the possible increase in levels of particulate pollution that may
result from discharges from the proposed 600-ton-per-day Boston municipal
incinerator, the Division is presently selecting sampling sites in areas adjacent to
the proposed site. Sampling will begin in the very near future to determine the
existing levels before work on the incinerator begins.
Other special sampling surveys now in progress, and to be continued over an
extended period of time, to determine background levels of air-borne pollution
are as follows :
128 RD. 34
In October, 1954, in conjunction with the Robert A. Taft Sanitary Engineering
Center of the Public Health Service, an air sampling program of the Metropolitan
Boston area was initiated. Under this program 24-hour high-volume air samples
are taken simultaneously each week from sites in Boston, Everett and Newton.
Suspended particulate matter is coUected on a glass fiber filter which captures
particles down to 0.3 microns in size. The filters are then forwarded to the Sanitary
Engineering Center for analyses of the total particulate content, extractible organics,
mineral and radioactive analyses.
In October, 1954, a soot and dust fall study was begun in eastern Massachusetts
to determine levels of pollution due to the outfall of large particulate matter.
Stations were selected for convenience and in areas that will give levels of industrial,
commercial and residential air pollution due to heavy particle outfall. These
stations, selected to give background data only, are seven in number and are
located in the Metropolitan Boston and Lawrence-Andover areas.
In the field of radiological health, the section presently is concerned with:
(1) Prescribing and establishing rules and regulations to control the transporta-
tion, storage, packaging, sale, distribution, production and disposal of radioactive
materials which may affect the public health or the health of persons exposed to
radioactivity or ionizing radiation (Chapter 111, Section 5B).
(2) Maintaining liaison and cooperating with other State departments and
other divisions of this Department in matters relating to radiological health.
(3) Maintaining liaison with governmental and non-governmental agencies
(such as the Public Health Service and the Atomic Energy Commission) and inter-
state commissions and groups (such as the New England Interstate Water Pollu-
tion Control Commission and the Regional Coordinating Committee on Radio-
logical Health) in matters relating to radiological health.
(4) Conducting special surveys, independently or in cooperation with other
State of federal agencies, relative to environmental radiological health matters
pertaining to water, air, or persons exposed to radioactivity or ionizing radiation.
The Department is currently making arrangements to participate with the
Federal Government and other State agencies in the operation of a National Radia-
tion Surveillance Network. This network is being established to determine levels
of radioactive fallout resulting from atomic bomb detonations.
(5) Cooperating with medical, radiological, health physics, educational and
engineering professions, industries, and institutions in special problems and in
studies relating to sources of ionizing radiation and its relation to the health of the
public and to pollution of the atmosphere, water, soil, and the general environment
from and by radioactivity and radioactive substances.
(6) Cooperating with and assisting the Civil Defense Agency in certain problems
of staffing, training, services, equipment, and facilities in time of certain disasters
or programs pertaining to radiological health.
Division of Smoke Inspection
During the period of this report the Division of Smoke Inspection was transferred
from the Department of Public Utilities to the Division of Sanitary Engineering
of the Department of Public Health under the provisions of Chapter 672 of the
Acts of 1954, effective September 8, 1954. This division is financed by a special
assessment on the municipalities within the district, which is known as the Metro-
politan Boston Smoke District (Figure 6) and includes a director, supervising smoke
abatement inspector, six assistant smoke abatement inspectors and one principal
clerk.
P.D. 34
129
Figure 6
Metropolitan Smoke District
The Division is authorized by Chapter 651 of the Acts of 1910, as amended, to
regulate visible smoke emissions from all stationary, locomotive, and marine stacks
within the thirty-one cities and towns that comprise the Metropolitan Boston
Smoke District. The district includes the municipalities of Arlington, Belmont,
Boston, Braintree, Brookline, Cambridge, Canton, Chelsea, Dedham, Everett,
Lynn, Maiden, Medford, Melrose, Millis, Milton, Needham, Newton, Peabody,
Quincy, Revere, Saugus, Somerville, Stoneham, Wakefield, Waltham, Watertown,
Weymouth, Winchester, Winthrop and Woburn, with an approximate population
of 2,000,000 covering an area of 320 square miles.
The allowable duration and density of visible smoke emissions as determined
by the Ringelmann Chart vary according to the types and diameters of the stacks.
In addition, the law provides that the Division may conduct investigations, hold
hearings and issue orders for abatement.
130 P.D. 34
From the effective date of transfer to this Department through June 30, 1956
the activities of the Division were as follows :
Plant inspections made as result of complaints and violations . . 1436
Office conferences held with industrial representatives relative to com-
plaints and violations ......... 90
Formal hearings conducted under the provisions of Chapter 651 of the
Acts of 1910, as amended ....... 35
Orders to abate issued under the provisions of Chapter 651 of the Acts
of 1910, as amended ........ 14
Excessive emissions and violations of orders to abate .... 780
Complaints received relative to stack emissions ..... 523
Total of stack observations ...... . 254,833
Water Pollution Control
Examination of Rivers
The Department has been designated a Water Pollution Control Agency of the
Commonwealth and maintains general oversight over all of its surface waters.
In this connection the Division of Sanitary Engineering has a Water Pollution
Control Section which handles matters pertaining to the quality of surface waters,
sewage disposal, industrial waste disposal, shellfish sanitation, and bathing in
natural waters. Massachusetts cities and towns were originally established on the
seacoast or our principal rivers. Industries were located on streams to take advant-
age of the abundant supply of soft, clear water, direct water power and also to
dispose of liquid wastes. As our public water supplies have generally been taken
from upland waters where it has been possible to protect the source, there was
originally very little public health significance to our methods of disposal of surface
and industrial wastes directly to the streams. As the population and the number of
industries has increased, the condition of our streams has deteriorated so that in
many instances nuisance conditions have prevailed. In certain instances, notably
Lawrence and more recently Billerica, it has been necessary to turn to polluted
water courses as sources of domestic water supply. In these instances, adequate
water filtration plants have been constructed to provide a safe, potable water.
The Department maintains approximately 260 river sampling stations throughout
the Commonwealth. Samples of water are collected periodically for chemical
analysis and bacterial examination. At the same time, samples are taken from the
effluents of sewage treatment plants discharging into these waters in order to have
a more complete record of the cause and effect of these wastes on stream quality.
In general it may be said that the small streams of the Commonwealth are not
polluted but the main threads of the streams receive sewage and industrial waste
either directly or after treatment. Certain of the streams, notably the Nashua
River below Fitchburg, the Housatonic River below Dalton, the Hoosic River in
North Adams, and the Merrimac River below Haverhill, are occasionally in a
nuisance condition. As a result of the construction of industrial waste treatment
plants in Mansfield and Foxboro, the Rumford River, formerly very seriously
polluted in the town of Mansfield, is now in a suitable sanitary condition. Con-
struction of waste treatment plants serving the paper mills in the city of Fitchburg
has improved the quality of the water of the Nashua River to some extent. How-
ever, that stream continues to be in an unsatisfactory condition due largely to the
discharge of de-inking wastes in the Fitchburg and Leominster areas.
The New England Interstate Water Pollution Control Commission held its first
meeting on November 25, 1947. Massachusetts, Rhode Island and Connecticut
were signatory to the compact at that time. New York entered the compact on
August 19, 1947, Vermont on June 29, 1951, New Hampshire on July 13, 1951 and
Maine, the last eligible state, on August 31, 1955. Thus all of the New England
states and New York entered into a compact to classify the interstate waters and
to work for the alleviation of pollution of these streams. The compact has adopted
water quality standards for interstate waters. In general, it may be said that
Class A waters are suitable as a source of drinking water without further treatment
and for the cultivation of market shellfish. Class B waters are suitable for bathing.
Class C waters are suitable for recreational purposes, boating, fishing, industrial
water supplies and for the propagation of fish indigenous to the areas. Class D
P.D. 34 131
waters are suitable primarily for the transportation of waste without nuisance
and for power and industrial loading. Class E waters are those in which nuisance
conditions prevail either regularly or occasionally.
Meetings of the Commission have been held regularly. Subcommittees of the
technical advisory board have conducted studies of the quality of waters of various
interstate streams leading to the classification of the following streams:
Connecticut River Taunton River
French River Ten Mile River
Quinnebaug River Salmon Brook
Studies are under way relative to the classification of the following streams:
Housatonic River Beaver Brook
Deerfield River Spicket River
Hoosic River
Cooperation with the Public Health Service
The first federal water pollution control act was Public Law 845 of the 80th
Congress, second session. Under the provisions of the Act certain funds were
made available to state and interstate agencies for investigation relative to industrial
waste disposal, during fiscal years 1949 and 1950. Subsequently, no federal funds
were made available for that purpose. As of June 30, 1956, Congress enacted
Public Law 660, continuing and strengthening the Federal Water Pollution Control
Act. Under the provisions of this law, Congress is authorized to provide grants-
in-aid to communities for the construction of sewage treatment facilities and to
state and interstate agencies for water pollution control studies. Although the
budget was not passed until later in the season, funds for these purposes were made
available. Thus, for the first time, cities and towns became eligible to receive
grants for the construction of sewage treatment facilities.
The Department cooperated with the United States Public Health Service and
other federal agencies in preparing a report of the water resources of the New York
and New England area. The report of the joint committee is available and on
file in the office of the Division of Sanitary Engineering. The report contains
information relative to sources of pollution, the sanitary condition of our streams,
and the needs of all comnumities and industries relative to sewage and industrial
waste disposal.
Prevention of Stream Pollution
Chapter 615 of the Acts of 1945 amended Section 5 of Chapter 111 of the General
Laws, authorizing the Department to promulgate rules and regulations for the
sanitary protection of our rivers, lakes, ponds and other watercourses. Such rules
and regulations were adopted by the Department on August 14, 1945, and approved
by the Governor and Council on September 19, 1945. In general, these rules and
regulations provide that no sewage, human excrement, house slops or sink wastes,
garbage, manure or putrescible matter, manufacturing refuse, waste product or
any polluting liquid poisonous or injurious to humans or animals shall be dis-
charged into any waterway within the Commonwealth except as it may be approved
by the Department of Public Health when in its opinion the best practicable and
reasonably available means to render the same harmless have been provided in
accordance with plans approved by the Department.
These rules and regulations become effective upon publication in any community.
The Department has found it necessarjr to publish or post such rules and regulations
in 72 communities.
After some experience, it was found that Section 5 of Chapter 111 as amended
did not prove effective in preventing pollution of our waters from municipal sources.
In order to correct this situation, the Legislature enacted Chapter 552 of the Acts
of 1951, which amended Chapter 111 by adding Sections 1A and IB. Under the
provisions of this act, the stream pollution control law became effective in cases of
sources of pollution from municipal or state institutions. However, in cases of
municipalities, the Director of the Division of Accounts of the Department of
132
P.D. 34
Corporations and Taxation must hold a hearing in the political subdivision affected,
and no political subdivision may be required to expend an amount in excess of that
determined by the Division of Accounts to be within its ability to finance for the
construction of sewage abatement facilities.
Municipal Sewage Treatment Plants
The Division of Sanitary Engineering inspects municipal sewage treatment plants
from time to time and collects samples of raw sewage and plant effluent for analysis.
Of the 351 cities and towns of the Commonwealth, 136 municipalities are now
served by public sewerage systems. The population of such communities as based
on the 1955 census is 4,139,350. Sewage from 67 municipalities, representing a total
population of 1,716,433 persons, is discharged to sewage treatment works; 215
municipalities have no recognized public sewerage systems. These represent a total
population of 698,295 persons. New sewerage systems and sewage treatment plants
constructed subsequent to July 1, 1949 are as follows:
New Sewage Treatment Works
City or Town
Year
Sewage or
Effluent Discharged into
Andover (Ballardvale)
Attleboro ....
1955
1950
Bridgewater
1950
Dudley ....
1951
Fall River
1952
Middleborough .
1951
Taunton ....
1951
Webster ....
1952
South Metropolitan District
1952
Imhoff Tank and Trickling Filter . . Shawsheen River
Screens, Grit Chamber, Sedimentation Tanks
and Sludge Beds ..... Ten Mile River
Bar Racks, Imhoff Tanks, Trickling Filters,
Secondary Sedimentation, Sludge Bed . . Town River
Grit chamber, Comminutor, Sedimentation
Tanks, Chlorination, Sludge Digestion, Sludge
Beds ....... French River
Screens, Grit Chamber, Sedimentation Tanks,
Chlorination, Sludge Digestion, Elutriation
Vacuum Filtration and Incineration Mount Bay Hope
Comminutor, Sedimentation, High Rate Trick-
ling Filters, Secondary Sedimentation, Sludge
Digestion and Sludge Drying Beds . Nemasket River
Grit Chamber, Comminutor, Grease Tanks,
Primary Settling Tanks, Chlorination, Sludge
Digestion and Sludge Beds . . . Taunton River
Bar Racks, Primary Sedimentation, Sludge Di-
gestion, Sludge Beds and Chlorination . French River
Coarse Screening, Grit Removal, Comminution
and Fine Screening, Aeration, Sedimentation,
Chlorination, Sludge Digestion . . . Boston Harbor
City or Town
Year
Ayer
. 1952
Concord .
. 1955
Gardner .
. 1952
Marion
Saugus
. 1952
Spencer
. 1950
Improvements or Additions to Sewage Treatment Works
Sewage or Effluent
Discharged Into
New Settling Tanks and Sludge Beds
New Imhoff Tank
Reconstructing Sludge Beds ....
Rehabilitation of Plant and New Chlorination
New Comminutor at Pumping Station
Additional Settling Tanks and Sludge Beds,
Renovation of Sand Filters . . . Seven Mile River
Shellfish
The Division of Sanitary Engineering, in determining the suitability of shellfish
areas for the taking of shellfish, examines roughly 2000 miles of Massachusetts
coast line, which encompasses some 50 cities and towns. In 1950, Massachusetts
occupied second place among the nation's leading soft shell clam producers. It has
been estimated that some 20,000 acres of flats in the State at one time were pro-
ducing shellfish. In Boston Harbor alone some 2,000 acres have been reduced to
about 15 per cent of their former productivity. Various studies have failed to reveal
the actual causes for the depletion of shellfish in areas formerly highly productive,
but suspicion has been cast on the deleterious effects of sewage pollution on the
flats and the decimating effect of natural predators on the shellfish population as
possible contributing factors. At the present time the number of closed shellfish
P,D. 34
133
areas, located in some 30 communities and ranging from entire harbor areas to
small portions of coast line and estuaries, totals approximately 35. The number
of areas from which shellfish may be taken for purification purposes only, designated
as moderately polluted areas, totals approximately 40.
Under Massachusetts law the Division regulates the following aspects of the
Massachusetts shellfish program:
(1) The classification and the approval of harvesting areas from which shellfish
may be taken for food purposes.
(2) Approval of the construction, operation and maintenance of shellfish
purification plants.
(3) Approval of out-of-state shellfish certificates.
In approving shellfish harvesting areas, the Division performs various and nume-
rous examinations dealing with the sanitary quality of the shellfish and overlying
waters. Sanitary surveys are conducted of the watersheds tributary to the shellfish
growing areas to establish to what extent the growing areas are subject to pollution.
Representative samples of the shellfish and overlying sea water under varying
conditions of tide and wind are collected and analyzed for bacterial content at the
Lawrence Experiment Station.
The number of bacterial examinations of shellfish samples made at the Lawrence
Experiment Station is as follows:
Fiscal
Shellfish Samples
Year
Examined
1949-1950 ....
913
1950-1951 ....
1,183
1951-1952 ....
1,285
1952-1953 ....
1,227
1953-1954 ....
3,335
1954-1955 ....
1,217
1955-1956 ....
1,654
The construction, operation and maintenance of shellfish purification plants are
subject to the approval of the Department of Public Health under Chapter 130
of the General Laws, as amended by Chapter 598 of the Acts of 1941, and the rules
and regulations adopted by the Department of Public Health on May 10, 1949.
Research has been conducted relative to the purification of shellfish, which has
led to the establishment of the method presently employed at the Newbury port
Shellfish Treatment Plant. Weekly inspections of the plant are made in order to
appraise operating conditions.
The numbers of barrels of clams treated at the Newburyport Plant during the
years 1949-1956 are as follows:
Fiscal No. of
Year Barrels
1949-1950 .
1950-1951 .
1951-1952 .
1952-1953 .
1953-1954 .
1954-1955 .
1955-1956 .
22,704
31,002
28,090
19,300
14,176
22,104
17,002
Yearly Average
22,054
The average number of barrels treated during the years from 1941-1949 was
15,597. Therefore, 1949-1956 showed an increase of 41.4 per cent over the previous
years. In order to handle the increased load at the Newburyport Plant, a new
addition was constructed in 1952 containing six reinforced concrete tanks. The
134 P.D. 34
tanks are divided by two baffles so that continuous aeration and recirculation of
water may be practiced if desired. As yet, no washing mechanism or conveyor belt
to facilitate culling of broken clams has been installed, although it was planned
to have this upon the completion of the new building. It is hoped to install this
equipment in the near future.
New legislation passed in recent years concerning the sanitary control of shellfish
areas has assisted the Division considerably in regulating its shellfish sanitation
program. Section 74 of Chapter 130 of the General Laws, as amended by Chapter
243 of the Acts of 1954, directs that the Department no longer need examine all
contaminated shellfish areas yearly but shall examine them for contamination from
time to time as conditions may require, but not necessarily more frequently than
once in two years. Prior to the passage of this legislation, the Department was
performing the arduous task of conducting examinations annually of all contami-
nated shellfish areas. These examinations, annual advertising and posting have
been a drain on both the finances and personnel of the Department.
Section 74 of Chapter 130 of the General Laws, as amended by Chapter 288 of
the Acts of 1956, which authorizes the Department immediately to designate shell-
fish areas as contaminated in the event of emergencies, assists the Department
substantially in guarding the public health against possible infection from water-
borne diseases transmitted by contaminated shellfish.
Section 81 of Chapter 130 of the General Laws, as amended by Chapter 711 of
the Acts of 1955, provides that no action is necessary on the part of the Department
of Public Health in the matter of importing shellfish into Massachusetts from a
foreign country or province, provided that such foreign country or province has
approved certification from the United States Public Health Service.
Lawrence Experiment Station
The period from 1949 to 1956 was marked by the closing of the Water and Sewage
Laboratory, which had been operated on the top floor of the State House since
January, 1897, and of the old Experiment Station in Lawrence, which had been
the site of the research work as well as much of the analytical work of the Division
of Sanitary Engineering since 1886. October, 1952 saw the laying of the corner-
stone of the new station, and in March, 1954 all the laboratory and research facilities
of the Division, with the exception of the district laboratory in Amherst, were
consolidated in the new Lawrence Experiment Station.
The new building with its ample modern faculties and the long-needed working
space houses not only the analytical laboratories and the research on water, sewage,
and industrial wastes, but also the radiological studies, which first began at the
old station in 1951; the plumbing laboratory, which first functioned in 1955; and
the laboratory work on air pollution, which also first began in 1955 and reached
full-scale operation in 1956.
Although much new laboratory apparatus was purchased for the new station,
a considerable amount of equipment was salvaged from the old laboratories, and
the moving and arrangement of both old and new facilities was a formidable task.
Careful scheduling made it possible to keep complete equipment in operation at
one site or another, so that the necessary analytical work of the Division was con-
tinued without interruption and the normal schedule of samples from the cities
and towns of the Commonwealth was always maintained. The longest interruption
in examination of the water samples current in the bacteriological laboratory was
spent in the transportation of cultures from the old station to the ample and care-
fully controlled incubator room in the new building.
The following table summarizes the samples examined by the combined labora-
tories during the period 1949-1956:
Chemical samples in connection with the investigation of
the disposal of domestic sewage, treatment of water, and
inspection of rivers and bathing places . . . 56,645
P.D. 34
135
Chemical samples in connection with the investigation of
industrial wastes ....... 16,778
Chemical and mechanical analyses of sand and other filter-
ing materials ........ 2,193
Total chemical ....... 75,616
Bacterial samples in connection with water supplies, bath-
ing places, stream pollution and other work of the Depart-
ment 116,970
Bacterial samples in connection with shellfish . . . 12,170
Total bacterial 129,140
Microscopic examinations ...... 7,716
Radiological examinations ...... 3,704
Grand total 216,176
In addition there were about 1,000 air samples up to the end of June, 1956. At
present the rate of such samples approaches 1,000 per month.
In addition to the regular professional staff of this station, from one to five
sanitary engineers have been assigned to work out of Lawrence supplementing
the work of the district engineers, and particularly caring for most of the field work
on stream pollution, industrial wastes and special problems involving water supply
and sewage disposal. In many cases on special assignments members of the regular
personnel of the Station are assigned to work in the field with these engineers or
with other engineers assigned from the main office or from the district headquarters.
In connection with public water supplies, the Division maintains a constant
check on every water supply in the State. In carrying out this work three chemical
samples from every water supply are examined each year; and from other cities
and towns, particularly those considered as critical areas from a standpoint of civil
defense, samples are taken more frequently. In all, this accounts for about 2,500
chemical samples each year. In addition, during the past seven years special
problems of one kind or another involving 62 water supplies have resulted in special
samples at the Station, and many times these investigations required special
experimental work. Such samples totaled nearly 3,000 during the seven-year
period. The great majority of these samples were collected by members of the
engineering staff, but in very many cases again Lawrence personnel assisted in
the collection of samples and particularly in field analysis and other special work.
One of the causes of these special samples was the growing interest in the correction
of corrosion. As more and more supplies utilize the addition of alkalies, or of special
chemicals like sodium hexametaphosphate, the problems for all of these water
supplies become more important and involved. In almost every case this station
is required to determine by means of the Langelier test the optimum concentration
of chemicals which should be added and, after treatment has begun or is being main-
tained, it is very frequently necessary to examine large numbers of samples from
the distribution system in order that the best effects may be obtained from such
treatment.
Other special work results from natural causes, including, of course, the hurricanes
which were experienced several times during this period. During these natural
disasters it is generally necessary to send out personnel from the Station to supple-
ment the field work of the engineers, and especially to assist them in the installation
of emergency chlorinators or other equipment, all of which is normally stored at the
Experiment Station. On two occasions during this period fire destroyed chlorina-
tion equipment, and emergency apparatus at the Station was installed in a very
short time. Frequently also water shortages compel cities and towns to use auxiliary
supplies or to make temporary connections to other supplies, and in each such
case extra samples are analyzed and personnel are sent out to do such work.
In addition to the usual sanitary analyses on water supplies, there is a frequent
demand for special determinations, such as those involving the use of water for
boiler purposes, the possibilities of corrosion, and the usefulness of the water in
136 P.D. 34
certain industries. In order to keep such information current a program has been
set up under which a very complete mineral analysis is made on every water supply
about once every two and a half years, with more frequent examination of some of
the supplies from which numerous industries make demands.
Almost continuously the Station is requested to give assistance in regard to tastes
and odors in water supplies. Sometimes these are associated with corrosion or
other problems discussed above, but frequently they are the results of the presence
of algae or other organisms. The Station makes regular and frequent microscopical
examinations of most of the water supplies in the State, and in addition makes
special determinations if taste and odor problems arise, with a view to indicating
the proper kind and degree of treatment and the success obtained by such treatment.
In addition, about a dozen municipalities have made intensive investigations to
improve the tastes and odors in their supplies, and in several cases this has involved
hundreds of samples being received and examined at the Station.
One of the most important of the newer parts of the work of the Station has
resulted from the growing use of fluorine to reduce dental caries. Every water
supply in the State has been examined several times to determine its normal fluoride
content, but whenever a supply receives additional fluorides the Department
requires that examinations must be made daily by the water department, and in
addition analyses are made several times a month by the Experiment Station. In
this way a check is maintained on the local determinations. The method now in
use is one which was devised by the personnel of the Station, to be as simple as
possible while still giving accurate results in the hands of normal water plant per-
sonnel. In order to make sure of uniform procedure all of the equipment and all
of the chemicals used by the water departments are furnished from the Experiment
Station and these are renewed very frequently. In addition, the Station, upon
request, examines supplies of fluoride and tests equipment and apparatus used in
the fluoride treatment. In addition, to check determinations of the simpler method,
every supply is examined by more delicate means quite frequently. Almost since
the beginning of the use of fluoride the Station has maintained almost constant
research on improvement of methods for very exact laboratory work and for the
field. As part of the training program always being carried on at the Station,
representatives of practically all of the water departments now using fluoride have
received more or less special training at the Experiment Station.
In addition to the chemical samples received from the water supplies, the Station
sends out and receives every four weeks from one to ten bacteriological samples
on every supply in the State. A few samples from nearby supplies are brought in
to the Station, but the great majority are received by mail or express. The average
number of samples thus received is almost 7,000 each year. Practically all of the
water supplies of the State are free from coliform bacteria, but in case such organ-
isms are found the engineering forces are promptly notified so that remedial measures
may be taken and repeat samples be examined. In addition, of course, in cases of
emergency many more than the normal number of samples are received.
Particular assistance has been given in regard to cities and towns using various
methods of filtration in procuring their water supply. Many of the personnel
engaged in coagulation and filtration work have received training at the Station.
However, the constant use of new chemicals and unusual weather conditions many
times make it necessary to give special assistance, either by analysis or field work,
for the best solution of these problems. As an example, over a dozen of these water
supplies from time to time have used special filter aids and in each case the assist-
ance of the Station was required. In addition, the Department continues to make
analyses of sands and other filtering material for water filtration as well as for
sewage work.
A very considerable amount of work results also from the use of weed killers
in water supplies or in their tributaries and in areas surrounding watersheds. In
almost every case these materials result in taste and odor problems.
In addition to the work on public water supplies, each year several hundred
P.D. 34 137
samples for chemical and bacteriological examination are received from semi-public
supplies, such as camps, schools, and bathing and other recreational areas. The
law in regard to most of these areas requires an approved water supply, and analyses
of samples from such sources are made at the Experiment Station.
As mentioned above, a great part of the work of the Division on pollution of
streams was conducted from the Experiment Station, and for the past several years
practically every important river basin in this State has been examined monthly
or more often. In addition to the usual sanitary chemical and bacterial samples
involved, in many cases special determinations have been made, particularly in
connection with the discharge of sewage or industrial wastes into the streams.
In this connection this Station has assisted the Department in its cooperation with
the work of the New England Interstate Water Pollution Control Commission, and
representatives of the Station have assisted on the technical committees of this
organization.
Chemical Research
Many of the special problems on both drinking water and polluted streams
require more or less detailed research in the Chemical and Research Laboratories
of the Station. All analytical work is done in accord with Standard Methods, but
in preparation of samples, and especially when dealing with pollutants or metals
in very low concentration in waters high in organic matter or otherwise grossly
polluted, adaptations are often necessary. Practically all the methods for metals
include the use of electronic determinations. Among the important tests for
which special means have been developed are the following: — cadmium, chromium,
copper, for which there are three methods, iron (in many forms), lithium, phos-
phorus, potassium and sodium. Two special methods for the very difficult
determination of sulfates in small concentrations have also been developed. In
addition, methods have been adapted for the determination of the many different
kinds of detergents which are now encountered in the work on streams. A special
method of determination was evolved for the presence of phenols and similar
compounds, which may cause undesirable tastes and odors in concentrations
of only a few parts per billion. Other special analyses evolved or adapted include
those for DDT, several herbicides, and oils, pigments and carriers resulting from
the discharge of paint and oils into the water.
In connection with the representation of the Station on the Standard Methods
Committee in the Federation of Sewage and Industrial Wastes Associations,
a large amount of research work has been done in regard to the more accurate
determination of chlorine and chlorine compounds and of chlorine dioxide and
other oxidizing agents in very small concentrations in water. This work also
involves the study of tastes and odors associated with oxidizing materials. Similar
work has resulted from the use of chlorine-bearing starches and other organic
materials.
Another special series of determinations was made in regard to more accurate
methods for the determination of fats, oils and grease in sewage sludges. As a
result of this work it was concluded that for most purposes the method in use at
the Experiment Station since 1890, which consists of evaporation barely to dryness,
followed by extraction with hexane or occasionally some other solvent, gave results
at least as good as proposed methods of extraction, followed or preceded by freezing,
centrifuging and similar assistance.
The use of the polarograph in many determinations, but particularly in regard
to the determination of dissolved oxygen, especially in connection with determi-
nations of B.O.D., has resulted in the preparation of methods which are very
valuable in certain cases where extremely accurate work is required.
Other work involves the study of the effect of acetic acid and other similar organic
acids on the determination of B.O.D. It is believed also that determinations of
B.O.D. as presently made are essentially much more accurate and much more
representative because of the intensive study on adequate methods of seeding.
138 P.D. 34
Bacterial Research
During the past seven years the Bacteriological Laboratory has examined a total
of almost 130,000 samples. Many of these were in connection with the sanitary
control of water supplies and of other waters in the State and in connection with
stream pollution work. In addition a very large amount of work has been con-
ducted in connection with the research in regard to the purification of sewage and
biological treatment of industrial wastes or sewage containing such wastes. Since,
as will be discussed more fully later, a very large part of the wastes upon which
investigations are made are of a somewhat toxic or inhibitory nature, it is often
found difficult to bring about the formation of adequate flora for biological treat-
ment. More and more, therefore, it has been found valuable and useful to enlist
the assistance of the Bacteriological Laboratory in all stages of treatment of
industrial wastes.
In addition, it is constantly necessary to continue examination of the methods
in use in determining bacterial content of waters. Since the Station is represented
on the committee responsible for bacteriological procedures under Standard Methods,
all of the determinations made at the Bacteriological Laboratory follow these
standard procedures. However, there are many methods other than those
considered standard which are presented for evaluation. Several times previously
it has been found that, in general, media and methods intended to assist bacterio-
logical personnel in differentiating the various members of the indicator coliform
group and of other organisms commonly found in water and sewage tend to retard
or prevent the growth of the characteristic organisms which are being sought.
In this respect the Station in cooperation with other laboratories has conducted
a series of tests involving many thousands of cultures. As a result of this work
the Station and the bacteriological laboratories of many other very important
states are convinced that for the present our methods called "Confirmed" and
"Completed" are sufficiently accurate and represent, when properly carried out,
adequate pictures of the sanitary quality of the water under examination with
regard to the present standard for the presence of coliform organisms, which is one
such organism per 100 ml. of the water examined.
It is felt strongly that any attempt to use only certain members of the coliform
group or to depart in any material way from the present standard would result
either in the acceptance of waters somewhat below the present standard of purity
or undue efforts on the part of certain water supplies to reach an unnecessarily
high standard. At the same time the Station has continued to urge water depart-
ment personnel who can do so to produce water containing bacteria far below
the present standard.
On many water supplies, oftentimes in connection with work involving tastes,
odors and colors, the Bacteriological Laboratory has made examination of slimes
found in the distribution systems, and especially in dead ends or in parts of the
systems with relatively little flow. Differentiations of organisms found in some
of these sites have shown that in many cases these organisms must be regarded
as degraded members of the coliform group. It has also been found that these
organisms tend to resist dosages of chlorine which are almost completely fatal
to normal coliform organisms. It is felt that these resistant organisms in general
cannot be considered as true indicators of bacterial quality, but that they must be
regarded as undesirable since they may indicate improper design or inadequate
treatment.
For a great many years lactose broth has been the only standard medium for
determining the presumptive presence of coliform organisms in drinking water.
For a great many years the Station has conducted investigations into other pre-
liminary media and a special value has been attached to a Lauryl tryptose broth,
which is particularly valuable because of the presence of surface tension reduction
agents and the products of digestion of meat which are particularly valuable in
rapid growth of coliform organisms and tend to reduce the growth of non-coliform
organisms to a somewhat greater degree than does standard lactose broth. Under
the leadership of the Experiment Station, a detailed comparison for these two media
P.D. 34
139
was conducted. The results were presented at a meeting of the APHA, and as a
result of this work Standard Methods now permit the use of the LT media in
primary water examination.
Another intensive investigation was in regard to dehydrated media. It was
found that practically all of the dehydrated products now available in the market
are very high in quality. It was also found that many small laboratories tend
to purchase dehydrated media in large-sized packages for the sake of economy,
and since such packages may not be used for a period sometimes in excess of a year,
serious deterioration was experienced, with disastrous effects on bacteriological
determinations. In this same connection it was found that media prepared from
these dehydrated products and stored for several weeks or months tended to show
undesirable changes which interfered with the best determinations. As a result
of this work by the Experiment Station and by other laboratories, Standard Methods
require the use of dehydrated media in all but the very large laboratories. In
Massachusetts all laboratories approved for examination of water must purchase
dehydrated media in sufficiently small quantities to avoid the difficulties due to
excessive storage.
As stated above, a very great majority of samples from public water supplies
are sent to the Experiment Station by mail or by express and are necessarily in
transit for periods up to, but generally not exceeding, 24 hours. This is also true
of the laboratories of the United States Public Health Service and of most of the
larger states, and for many years personnel in charge of these laboratories have
been concerned over the possibility of changes during such periods of storage or
transit which might interfere with the laboratory's returning the proper picture
of the waters under investigation. For several years, under the auspices of the
Standard Methods Committee for the Examination of Water, investigations have
been under way and the Experiment Station has conducted several such surveys.
In 1955, a paper was prepared by the Experiment Station analyzing the results
of samples collected and examined over the period of a year by the New York and
Massachusetts Departments which had been stored both at room temperature and
at refrigerated temperature for 24 hours.
The conclusions reached after this examination of several thousand such samples
were that under normal circumstances, and except possibly in extremely hot or
extremely cold weather, samples of normal surface water supplies which were
received at a laboratory within 24 hours after collection could be accepted as
presenting a proper picture of the sanitary quality of the water at the time of
collection. There still remains the problem of samples remaining under excessive
temperatures and for periods longer than 24 hours, and at the present time efforts
are being made for a federal grant to permit an intensive study of samples at the
Experiment Station.
COMPARISON OF THE MEDIAN RATIOS OF STORED MPN TO
INITIAL MPN
Table I — Massachusetts Water
No. of
24-hr. Room Storage
24-hr. Refrigerator Storage
Samples
MPN to Initial MPN
MPN to Initial MPN
Median
95% Confidence
Median
95% Confidence
Ratio
Limits
Ratio
Limits
Year ....
190
.915
.77-1.00
.86
.76- .97
Summer (May-October)
100
.74
.63- .92
88
.77-1.10
Winter (November-April)
90
1.12
.85-1.20
825
.73- .93
MPN — 23 or less
59
1.07
.90-1.8
89
.63-1.3
24-79
53
1.02
.75-1.39
92
.78-1.21
80-230 .
52
.71
.53- .92
755
.46- .97
over 230
26
.61
.31-1.1
77
.50-1.0
Table II
— New York Water
Year ....
69
.66
.51- .96
.74
.60-1.00
Summer (May-October)
32
.67
.39-1.28
.78
.52-1.23
Winter (November-April)
37
.66
.50- .96
.67
.48-1.00
MPN — 23 or less
27
1.02
.65-1.49
1.00
.67-1.77
23-230 .
23
.51
.29- .97
.67
.42-1.22
over 230
19
.51
.39- .74
.52
.45-1.09
140 P.D. 34
Another field in which the Experiment Station has conducted a very significant
research is in regard to the membrane filter which has been under study to a con-
siderable extent ever since it was in use in Germany during the late World War.
Methods of manufacture have now made it possible to produce uniform membranes
of any desired porosity and the mechanical equipment for using the membranes
has been highly developed. However, although many attempts have been made to
produce a standard medium for determining the presence of coliform bacteria
with these membranes, there still remains a very considerable degree of question
as to the results obtained. For the past four years the Experiment Station has
conducted more intensive work with the MF in an effort to overcome some of the
difficulties.
In 1955, a compilation was made and presented to the APHA entitled "Compara-
tive Densities by the Membrane Filter Test and by the Multi-tube Technique of
Standard Methods." This paper presented the results of a study of several thou-
sand samples and showed the inaccuracies or inconsistency also affected by time
of incubation, type of water, and methods of counting and other examination, all
in addition to difficulties encountered from apparently inadequate medium. It was
particularly pointed out that best results were obtained when coliform contamina-
tion was relatively fresh and unmixed with other organisms but that results as
compared with the Standard Methods became progressively worse with time of
storage of waters or the influx of relatively large numbers of soil or other organisms
(Figure 7). It was also shown that under optimum conditions it was possible to
obtain results from the membrane filter method practically identical with those
from the Standard technique, but that the two methods would not necessarily
determine the same types of organisms. It was also indicated that none of the
media available were entirely satisfactory. This work like that of other investiga-
tions shows that if the membrane filter should be substituted for the Standard
technique a new standard of bacterial purity would have to be used and that at
present our information is not sufficient to set such a standard. Work on the mem-
brane filter has continued during the year following the presentation of this paper
and it is obvious that improvements as a result of our work and that of other investi-
gators are being made, but there still remains a very considerable amount of investi-
gation. Requests for a grant to continue this work are also being made.
For the past seven years, in connection with the approval of other laboratories
by the Department, approval has been given several laboratories for the determi-
nation of coliform bacteria in water supplies. The examination and approval of
such laboratories has been a function of the Experiment Station and at the present
time there are over 40 laboratories approved. It is felt that, as a result of standards
for equipment, personnel and such details as the required use of dehydrated media,
the work of the smaller laboratories has definitely improved during the past few
years. It is believed to be particularly useful that these approved laboratories have
been urged to record and report their work in a form as close as possible to that
used in the Experiment Station so that the work of these laboratories on public
or private water supplies may be readily compared with that of the Station.
Shellfish Research
During the past seven-year period the Station has continued to exercise super-
vision over the Newburyport Shellfish Treatment Plant by means of frequent
visits and inspections, and check chemical and bacterial examinations. Further
studies on the methods of cleaning have been carried on, in conjunction with the
engineers of the Division, and a procedure which promises much improved efficiency
is ready for use whenever the proper treatment faculties are provided.
The Station has continued to receive and analyze samples of water and shellfish
from all of the areas of the State.
Research into methods of analysis has been practically continuous. The nation-
wide approved method of sample preparation calls for maceration of the shellfish
meats. The type of emulsion thus prepared varies widely with the species, the size,
and the freshness of the shellfish, with probable additional variation from one
P.D. 34
141
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142 P.D. 34
season of the year to another; in addition macerators apparently quite identical
may produce different sample preparations. For the determination of the coliform
group, which is the most common indicator of pollution, present Standard Methods
permit the use of lactose broth or lauryl tryptose broth. When portions of samples
prepared in accordance with Standard Methods are inoculated into either medium
the relatively high content of muscle sugar in soft clams and quahogs, the shellfish
most commonly received in our laboratory, as compared to oysters, which are more
common in most other parts of the country, tends to upset the intended concentra-
tion of the medium and to produce false results.
These conditions have been carefully reported to the APHA Committee on
Standard Methods for the Examination of Shellfish, on which the Station is repre-
sented, and it is hoped that the forthcoming edition of Standard Methods will
permit sufficient tolerance in procedure to give optimum results in the examination
of shellfish most important to New England.
The relative significance of E. coli and of the whole coliform group also appears
to be different in our soft clams than in oysters, especially those grown in the
warmer southern beds. For this reason the Station has consistently opposed the
use of E. coli alone as an indicator of pollution.
Partly because of confusion regarding coliform significance, the use of coccal
forms, especiaUy of fecal streptococci, has been suggested to replace or supplement
conforms as indicator organisms. Although methods available for the determina-
tion of fecal streptococci have greatly improved as a result of studies in which the
Station has participated, it still is not the opinion of the Station that the use of
these organisms for anything but supplementary information is justified.
For many years the problems of serious deterioration, and especially greatly
increased coliform content in clams and particularly in mussels shipped from Maine
to Massachusetts or New York, or from Massachusetts to New York, have troubled
the various agencies involved. As a result of conferences of New York and New
England States, held at the Experiment Station, cooperative shipping and analytical
experiments were conducted, as a result of which it appeared possible to state that
soft clams could be shipped anywhere and anytime within the New England States
and to New York with adequate care in regard to handling at the source, containers,
refrigeration and ventilation without significant effect on quality and particularly
the coliform content; but that during the summer months it was not probable that
mussels shipped to New York would be acceptable unless prohibitively costly
methods were empk^ed.
The Station was invited to participate in a national conference in Washington,
sponsored by several Federal agencies, on mussel poisoning, which had become
prevalent in Alaska and on the West Coast. A long series of analyses by the Station
in 1943 had shown that the disease was not present along the New England coast,
and this is still true. However, the Station will be expected to resume its testing
program if the poisoning should appear along the Atlantic, and we have informa-
tion and most of the apparatus necessary for such testing.
Other shellfish work included participation in studies of the sanitation of lobster
and crabmeat opening and packing, including experiments at the Station. The
Station also developed a satisfactory method for dyeing soft clams presumably
dug for bait to prevent their being sold for food. A series of experiments indicated
that aureomycin could not be satisfactorily used to reduce the bacterial content
of soft clams or to maintain their freshness.
Sewage Treatment Research
In connection with sewage disposal the standard procedure up to 1955 was to
examine a series of samples from each treatment plant in the State several times
each year. In the past two years, this practice has been supplemented or replaced
by a one or two day inspection by one or more engineers, generally those stationed
at Lawrence, which includes the collection of samples over a period of at least 24
hours. This work has been integrated with the stream pollution program of the
P.D. 34 143
Division. In many cases the samples from the sewage treatment plants, and in
some cases of sewage discharged without treatment, can be correlated with those
from receiving streams. In the past few years this work has been supplemented
by determinations of the rates of deaeration and aeration of the streams. In many
cases there have been simultaneous examinations of industrial wastes, and this
has required many times special determinations of metals, of paints, of oils and
greases, of detergents, and of other materials which make the sewage of today
a very complex mixture. It was often necessary to devise new methods, or to
adapt old ones to make these determinations.
As usual, the Station has made many analyses of sand and stone and other filter
materials intended for use in new or enlarged municipal treatment plants. Special
analyses usually for the determination of nitrogen and organic matter have been
made from practically every treatment plant using slow sand filters, including
many State institutions, to assist the engineers in regard to cleaning, or additions
or replacements, but a much greater number of analyses, particularly of sand
and soil, has been in connection with sewage disposal in rural areas and other
regions of the State which are, because of the rapid growth of many cities and
towns, not served by municipal sewers. In addition to the usual analyses on these
samples, it was often necessary to set up percolation experiments.
At the old Station a group of septic tanks and several subsurface disposal areas
had been in operation for many years. From these experiments there have been
gathered much valuable data in regard to tank dimensions, detention time, signifi-
cant methods of analysis, sludge accumulation, and especially the degree of treat-
ment by septic tank most suited for disposal in a given soil. It was shown for
instance that in relatively very fine soil, the inorganic suspended solid content of
the effluent has a very important effect on the adequacy and permanence of a
receiving field.
The Station also for many years had the opportunity of measuring and observing
the operation of several large disposal fields nearby. As a result of all of these
studies, the Station was able to make significant contributions to the bulletin on
rural sewage disposal prepared by the Division.
In the last year of the old Station the study of trickling filters, which had gone
on without interruption since 1890, was continued until the end of 1953. During
most of those years a group of a dozen filters was operated with relatively heavy
liquid rates and high B.O.D. loadings; most of the filters were operated in sets
to show effect of such factors as depth and type of stone, sedimentation, and
recirculation, as well as secondary or two-stage treatment. Several conclusions
have been reported from year to year from this work. Single-pass trickling filters
receiving enormous loadings up to 20,000 pounds per acre-foot per day still showed
a degree of purification; although the removal of B.O.D. and of suspended solids
might be as low as 20% of the loadings applied, nevertheless the filter did effect a
real change in the sewage applied. Filters on which the effluent was recirculated one
or more times gave materially greater reductions in B.O.D. than similar filters re-
ceiving the same load but with no recirculation. This improvement was relatively
slight with raw B.O.D. loadings of 1,000 pounds or less per acre-foot, but the rela-
tive efficiency increased rapidly with loadings increasing from 1,500 to 7,000 pounds.
Increasing the number of passages through the filter from one time to three or four
materially improves the efficiency of the filter; further increases give very little
if any added improvement. Both single-pass and recirculated filters showed fairly
sharp decreases in percentage B.O.D. removal up to about 7,000 pounds loading,
and with loads further increased the efficiency expressed in per cent dropped very
slowly. In Figure 8 the average per cent of B.O.D. removal and the average
pounds removed per acre-foot per day is plotted against all the loading for both
single-pass and recirculated filters operated from 1941 to 1955. The curves of
percentage of removal are similar in that they show a deflection at about 7,000
pounds loading. The improvement in efficiency effected by recirculation is plainly
shown. The curves for removal in pounds per acre-foot are quite different; that
for the recirculated filters is practically a straight line up to a loading of 12,000
144
P.D. 34
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pounds, but the curve for the single-pass filters shows a fairly sharp deflection
at about 4,000 pounds loading, and from this point the ratio of removal to the
applied is much less.
For any given B.O.D. loading from 1,000 to 10,000 pounds per acre-foot per day
a filter with or without recirculation with six feet of stone gives much greater B.O.D.
efficiency than filters with only three feet or four feet, and the differentiation
increases in proportion to increasing load. Removal of suspended solids is also
better, but the difference in loadings up to about 2,000 pounds is very small.
The efficiency in pounds removed per acre-foot of systems, including two trickling
filters in series, was generally less than that of a single filter with the same net
loading, but if the order of receiving the sewage was alternated once a week, the
overall efficiency of the combined system was much increased.
The period of detention in intermediate settling tanks in recirculating filters
had an important effect on the normal efficiency. Longer detention gave improved
settling but decrease in dissolved oxygen, with the net result that within reasonable
limits efficiency was improved by reducing the detention time as the load increased.
Aeration of intermediate tanks was not successful except with very heavy loadings.
It is interesting to note that in later experiments with highly organic waste a very
definite improvement in trickling filter efficiency was effected by intermediate
aeration.
Secondary filtration of settled trickling filter effluents on four-foot beds of sands
showed that highly satisfactory effluents could be obtained with continuous loadings
up to 250 pounds of B.O.D. per acre, as against a normally accepted loading of
100 pounds; and that for short periods loadings could be increased to 350 pounds
per acre without serious injury for the filter or undue deterioration of the effluent.
In the new Station a continuous uniform supply of settled domestic sewage
is available throughout the research area. The system of sumps, pumps, tanks
and distribution pipe was fully described in the 1955 report of the Division. There
are now in operation 11 experimental trickling filters. Of these eight are arranged
in four pairs, each pair being operated in exactly the same way as far as possible.
Frequent analyses over a period of one and one-half years indicate that it is possible
to operate such filters so as to obtain results which are statistically alike, and
thus to indicate that results reported from the operation of a single filter have
a reasonable degree of reliability. The group of filters have also contributed
further data confirming our results on the effect of B.O.D. loading.
Industrial Wastes
In the past seven years in addition to the examination of over 1,000 samples
of industrial wastes in connection with stream pollution, the Station has investi-
gated wastes from 27 types of industries located in 35 cities and towns. In every
case more or less research work was necessary; in many cases field assistance was
given and in several, extensive investigations, generally including operation of
biological units, oftentimes with chemical or other pretreatment methods were
conducted. In many cases the wastes were of types formerly considered difficult
or indeed impossible to treat biologically because of their toxicity or other inhibitory
characteristics.
For over 60 years this Station has been interested in the treatment of wastes
from the textile industry. Although a great many of the larger woolen plants have
left Massachusetts, there are still large quantities of textile wastes discharged in
many parts of the State ; and because of changes in processing and especially because
of the growing use of man-made fibers there are still many problems in the disposal
of textile wastes. The most important waste formerly was that from the scouring
of wool and this is still a serious problem, although the amount of wool now scoured
in all of Massachusetts is probably less than that once processed in greater Lawrence
alone. This waste is particularly important because of its heavy concentration
of alkalinity, grease and B.O.D., of which each 100 pounds of wool scoured may
contribute as much as nine pounds.
146
P.D. 34
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P.D. 34 147
In 1947, a process was developed at the Station which used carbon dioxide to
reduce the alkalinity of the wool scourings and calcium chloride to break the fatty
emulsions. Very satisfactory reductions of waste constituents were obtained
in the laboratory and also in several scouring plants which adopted the process
(Figure 9). Meanwhile further work at the Station showed that, when the calcium
chloride was added to the wastes at temperatures near the boiling point, the reaction
was accelerated so that classification of the wastes was complete in five to ten
minutes instead of two hours in the first of the work process, but the resulting sludge
was compact and could be quite readily processed for the recovery of grease and
80 per cent of the B.O.D. of the original wastes could be removed. It was also
found possible to use with a fair degree of success common salt in place of calcium
chloride at the higher temperature. One of the local mills adopted this process
and found that the clarified liquor could be returned to the scouring bowls at a
very considerable saving in chemicals. With this recycling process it was found
that the net discharge of B.O.D. and of grease decreased over 60 per cent and the
reduction in suspended solids was over 80 per cent from the figures before the
process was in use. It was also found that the recovery of usable grease increased
almost 100 per cent.
Changes in dyeing, particularly those involving the use of high pressures in the
process, also made material differences in both the character and concentration
of dyeing wastes. Extensive studies at the Station resulted in a satisfactory
evaluation of the new wastes, and extensive experiments showed that with proper
adjustment of pH and additions of nitrogen and phosphorus very satisfactory treat-
ment could be accomplished on biological units. Another new development in
dyeing resulted from the use of copper as a mordant in the dyeing of artificial fibers.
Investigation showed that sufficient amounts of copper were discharged so that
the wastes when carried to a municipal treatment plant could cause considerable
interference in sludge digestion. The Station has cooperated with the Lowell
Technological Institute on these and other problems regarding textile wastes.
Other extensive investigations were concerned with the manufacture of artificial
fibers. It was found that in almost every case such wastes were bactericidal in
nature and normally would not have been regarded as amenable to biological
treatment. In several series of experiments, which included the use of the Warburg
apparatus and extensive use of shaking equipment and particularly of a good deal
of patience, it was found possible to develop bacterial flora either in trickling filters
or aeration equipment which gave very satisfactory reductions in B.O.D.
Another waste in which extensive studies were made was that of processing flax
in the manufacture of cigarette papers. With the cooperation of one of the in-
dustries engaged in this manufacture the waste was studied for almost a year. The
character of the inhibiting substances was examined and found to consist of reducing
sugars and various sulphur compounds, and nevertheless by the development of
several cultures it was found possible to treat these wastes biologically. A series
of three reports on this subject was prepared by the Department.
Work of quite a similar nature included investigation of polymerizing wastes, and
other intermediates from the manufacture of plastics and wastes containing phenols
and cresols. These latter substances are particularly important because in con-
centrations of only a few parts per billion they impart a very undesirable taste
to water. All of these wastes likewise were found to be amenable to biological
treatment.
Another chemical waste upon which the Station has worked periodically for
many years includes formaldehyde and methyl alcohol among the inhibiting sub-
stances. The industry producing this waste has built a large treatment plant with
the cooperation of the Station in its original design and maintenance and it is
interesting to note that formaldehyde in concentrations up to 1200 parts, or that
found in material advertised as disinfectant, has been satisfactorily reduced by
biological means to five to ten parts per million.
Other inhibiting wastes, including those containing prussic acid and its derivatives
from plating, high acid and high iron wastes from steel manufacture and rouge
148 P.D. 34
wastes from the manufacture and processing of glass were shown to be satisfactorily
treated by the same calcium chloride process which had been used for the wool
scouring wastes.
Organic wastes which were subjected to experimental research included those
from the manufacture and processing of fish meal, waste from the manufacture of
gelatin and ice cream, several wastes from the meat packing industry, wastes from
the cranberry industry on the Cape, wastes very high in fiber content from a fulling
mill and a continuation of the work on laundry wastes. Two of the most unusual
wastes were those from processing of sea moss and the manufacture of pickles and
other condiments.
Training Activities
Practically all the colleges nearby regularly send one or more classes each year
to visit the Station, and often members of these groups make individual visits later.
Several hospitals also include visits to the Station as part of their training programs,
and school children, Scout groups, and other youth organizations now make annual
visits.
As previously indicated, representatives of many of the water and sewage treat-
ment plants have spent more or less time at the Station for training, and this practice
is growing. In addition, the orientation and indoctrination courses of the Depart-
ment always include some time at the Station.
Since the new building was put into use, there have been several formal courses,
lasting three or four days, given on water bacteriology, the membrane filter, and
limnology. In addition there have been 18 foreign students, brought to the United
States by Federal agencies, who have spent from two weeks to six months in training
at the Station.
Radiological Studies
Since 1951 instruments for the measurement of radioactive emanations have
been in use at the Station. The first work was on measurement of the natural
activity, or background, of the water supplies of the State, all of which have been
examined once or several times since. A little later the same levels were found
for many of the streams in the State, especially those used for water supply, or
those covered by our pollution studies. Almost from the beginning measurements
have also been made of all the precipitation; this has been frequently in cooperation
with various Federal agencies. These measurements became important during the
several series of experiments conducted by the Armed Forces. The results obtained
here and elsewhere have served to establish the patterns of passage of atmospheric
contamination.
From time to time new equipment has been received for measurement of air
volumes and for more accurate and more differential determination of various types
of emanations for use by Civil Defense authorities and by Federal agencies.
The Station made studies of the effect of normal water filtration processes on
radioactive fallout, which have been published in connection with other studies
at Harvard University under the auspices of the AEC. These indicated that,
although considerable removal took place, normal filtration was by no means
sufficient to remove dangerous concentrations.
In another series of experiments the Station cooperated with the AEC and Har-
vard University in the measurement of isotopes deposited in Cochichewick Brook
in North Andover, and measured for several days thereafter. The results of this
study have also been published by the AEC.
Plumbing Laboratory
To help in obtaining a better understanding of the public health problems which
result from faulty plumbing, the Department provided space on three floors of the
new Lawrence Experiment Station for a Plumbing Laboratory. Special facilities
have been designed and installed for the three-fold purpose of training, testing
P.D. 34 149
and research. Classes have been held for plumbers, public health workers and
others to explain and demonstrate the public health hazards in plumbing systems.
Special facilities of the laboratory include double check valve assemblies to show
how potable water supplies must be protected against pollution when an auxiliary
water supply is used in the same building; a thirty-five foot hydraulic leg of clear
plastic pipe extending from the basement to the ceiling of the second floor shows
how high water oan be siphoned in a plumbing system and the danger that may
exist from back-siphonage of water from plumbing fixtures; a hot water tank and
heater is used to show water circulation, stratification, temperature and pressure
build up; emphasis is placed on the danger from explosion if hot water systems are
not properly installed and equipped with necessary safety devices; a high rate
vacuum pump with tank and accessories will make it possible to carry on special
demonstrations, tests and research over a range of controlled vacuum and pressure
conditions; there are classroom facilities for 25 students.
The program of training is aimed particularly at helping the apprentice plumber
have a better understanding of his importance and responsibilities in protecting
the public health. It includes a course or series of lectures and demonstrations on
the basic principles of hydraulics and public health for plumbers, plumbing inspec-
tors, sanitary engineers and others. The training has been and will be developed
with assistance of representatives of the plumbing trade, trade schools and the
apprentice training program.
Additional Information
Additional information is contained in Appendices A through J, which will be
furnished by the Division of Sanitary Engineering on request.
Appendix A: Acquisition of Land for Protection of Water Supplies.
Appendix B: Average Daily Consumption of Water in Various Cities and
Towns, 1950-1955, inclusive.
Appendix C : Summary of Water Treatment Plants.
Appendix D: Analyses of the Water of Public Water Supplies, for 1955:
Surface Water Sources.
Appendix E : Analyses of the Water of Pub he Water Supplies for 1955 : Ground
Water Sources.
Appendix F: Status of Fluoridation of Water Supplies.
Appendix G: Summary of Work Done in Institutions.
Appendix H : Legislative Reports.
Appendix I : Cities and Towns in Which Rules and Regulations Are Effective.
Appendix J: Sewage Treatment Plant Data.
150 P.D. 34
DIVISION OF FOOD AND DRUGS
Section 5, Chapter 111 of the General Laws states in part, as it pertains to food
and drugs, that the Department of Public Health shall take cognizance of the
interests of health and life among the citizens of the Commonwealth concerning
conditions and circumstances relative to the sale of drugs and food and adulteration
thereof. The law then proceeds to set forth, in Chapter 94, many definitions and
conditions affecting the sale of food and drugs. The Department has placed the
responsibility for the enforcement of Chapter 94 and related sections as the duty
of the Division of Food and Drugs.
The Division has carried on certain routine operations, as usual. However, in
writing this combined annual report, the author would be remiss in not stating the
pressing need for more personnel and funds to enforce the laws which place upon
the Division, on behalf of the Department, considerable urgent responsibilities.
In order that one may properly evaluate the tremendous responsibilities generated
by the food section of the industrial revolution which has come about following
World War II, one has merely to reflect upon the billions of dollars' worth of
chemicals now being sold to the food industry for incorporation into foodstuffs.
In some cases incorporation of chemicals is, in the opinion of this Division, in the
interest of the consumer; but in most cases it is not. Chemical industries expend
many millions of dollars in retaining high-priced experts to carry on their techno-
logical advances to develop new ways and means wherein their chemicals can be
incorporated into the greatest business of all — the food business. To cope with
these experts, the Commonwealth's Division of Food and Drugs operates in old,
outmoded laboratories, with insufficient personnel to deal with even routine prob-
lems, let alone complicated research programs.
Considerable time has been spent by the Director, working with Governor
Herter's Labor and Management Committee, studying all aspects of the fishing
industry and related activities of the present Fish Inspection Program of the
Commonwealth. Legislation which would transfer the present fish inspectors
from the Department of Natural Resources to the Department of Public Health
was discussed by the Committee. Also discussed was the recommendation that a
research program be carried on for one year by qualified food technologists, working
under the supervision of a highly qualified research consultant. This research team
would attempt to set up rapid tests for the grading of fish; investigate establish-
ments used for the preparing, cooking, freezing and distribution of fish ; investigate
the facilities available on fishing boats; and make recommendations for improve-
ment of the quality of fish brought into our port. The program would be financed
by the industry through a licensing program in which industry would participate.
A gradual change in divisional policy toward violators of the laws and regulations
entrusted to this Division for enforcement has evolved during the past six years
through closer cooperation with local health departments and an expansion in
inspectional and administrative services, to include not only an enforcement program
but also an educational program. Although this program has imposed an additional
burden upon the personnel of this Division, the results have been highly gratifying.
Much of the overlapping of State and local services has been eliminated, and closer
cooperation with the regulated industries has resulted. Local health agents,
inspectors and sanitarians have allowed us to coordinate their efforts to such a
degree that hardly a day passes that several of them do not see fit to call the Divi-
sion's offices for advice and assistance. The response of industry to the educational
program has resulted in the expenditure of hundreds of thousands of dollars in the
renovation of obsolete establishments, or in the erection of new plants when reno-
vation was inadvisable.
One of the major problems of this Division has been to see that the requirements
of the laws as they pertain to food have been conformed to. Since the industries
have realized that we are all working toward a common goal, that is, to see that the
consumer receives a safe, clean and nutritious article of food, and that those who
are ill receive full potency and standard drugs, a great stride has been taken to
reach this common goal. The Division's perspective being to forward the public
P.D. 34
151
health and the welfare of the purchasing public, and the industry's perspective to
produce better consumer-acceptance of their products, both stand on an equal
footing, with the consumer benefiting from the joint action. Under this progressive
policy, whenever a violation is discovered by the Division a hearing is held in one
of our office violators in the eastern part of the Commonwealth being serviced from
the Boston office, and those in the western part of the Commonwealth from our
Westfield office, so that a minimum of inconvenience in attending these hearings
is experienced by the violator. If it is the first violation, and upon investigation
evidence indicates a lack of understanding either of food technology processes or
of the requirements of the laws, the violator is shown the error of his ways and is
warned that any recurrence of the violation will be considered as willful and that
more severe action will be taken.
NUMBER OF CASES
Figure 1
Prosecutions and Hearings, 1942-1952
152 P.D. 34
Prosecutions in 1947-48 totaled 106; in 1949-50 there was a precipitous drop
to only 31 prosecutions (Figure 1). A leveling off at 33 prosecutions in 1950-51
indicated a large drop in the number of prosecutions entered by the Division in the
courts in comparison with a sharp increase in the number of hearings given, from
62 in 1946 to 319 in 1949-50. Since the adoption of our more progressive policy
in the handling of violations, the number of prosecutions, having leveled off, is
now about parallel with the drop in the number of hearings necessary. The Division
feels that the number of violators is being steadily reduced by correcting those
who were formerly flagrant violators and who may have been prosecuted several
times with no improvement in their actual plant facilities. An increase in the
number of prosecutions, to 41 in 1951-52, resulted from the extensive work done
by the Division on horse meat and sulphite violations, particularly in those in-
stances where there was a malicious intent and wilful violation of the law. Rein-
spections of establishments that had been renovated and modernized at our sug-
gestion have shown that they have been eliminated from the list of constant offenders.
We hope in the continuation of our program to strive toward a goal which will
eliminate obsolete and unsanitary plants from this Commonwealth so that the
principles of modern sanitation can be applied to the establishments designed for
their application. Of course there will always remain a certain number of malicious
and wilful offenders, who must be prosecuted to the fullest extent of the law. These,
however, represent a very small minority, and continued pressure will be brought
to bear until they conform with the law. The Division is gradually whittling down
the size of this group.
More modern food plant construction has resulted from the Division's attempt
to prove to the food industry that good sanitary practice is an inherent part of
good business. One large food manufacturer has gone so far as to construct a new
quarter-million dollar establishment when shown by hard facts that good sanitation
is good business. One large food chain spent almost one hundred thousand dollars
in renovating bakeries and improving food-handling equipment.
Most of our meat markets are using temperatures close to 32 degrees Fahrenheit
for their refrigerated cases instead of the previously used standard of 40 degrees,
due to an intensive campaign by the Division toward this goal. The selling point
of the program was the fact that meat products keep better and longer at the lower
temperature. Most of our storekeepers have instituted bi-weekly deliveries of
sausage meat, which was one of the items most involved in violations pertaining to
decomposed meat. Here again, the storekeeper was shown that it was not only
to his customers' advantage but also to his advantage to initiate such a system for
purchasing sausage products. In many cases, an increase in sausage sales has
resulted from this practice. During the hearings held on sausage meat violations,
it was pointed out to the storekeepers that sausage meat is the most perishable
meat commodity they handle and that even low temperatures of storage are not
always efficacious in maintaining the purity and freshness of this product.
Emergency Duties
The Division's action as an "emergency unit" was put to severe test during the
natural disasters created by Hurricanes Carol and Edna in 1954, and the floods
resulting from Hurricane Diane in 1955. During the early part of September, 1954,
emergencies caused by the hurricanes opened up a new phase of operation by the
Division; that is, the prevention of spoilage of large quantities of food, due to power
failure. Utilizing its technical knowledge, the Division's personnel, under orders
from the Governor's office, after the recommendation of Dr. Kirkwood, ordered
seizure of the dry ice stocks in the Commonwealth. A program of distribution of
this dry ice was set up, which saved many millions of pounds of perishable food from
spoilage. The potential of the Division as an agency prepared and organized to
handle emergency situations was vividly demonstrated. Not only was the spoilage
of many millions of pounds of food prevented but also there were removed from con-
sumer channels large quantities of spoiled or damaged foods. The Division co-
ordinated and facilitated the cleaning up of contaminated restaurants and food-
handling establishments so that the transmission of disease through the sale of
P.D. 34 153
contaminated food was prevented. Spoiled meats and other foods were immedi-
ately transferred to dumps in order that putrefaction could not become a public
health hazard. Immediate sterilization of the facilities of food-handling establish-
ments prevented their impregnation with contamination, and subsequent public
health dangers were thereby averted. Here, our lack of radio communication was
pointedly brought out, with telephone and other means of communication unavail-
able, due to power losses.
The emergency work connected with Hurricanes Carol and Edna, which also
included the salvaging or segregation of damaged food and drug products totaling
many millions of pounds, kept the Division fully occupied for almost two months.
Our already skeletonized program of food and drug supervision was further
hampered. This, of course, could not be avoided, due to the pressing demands
of the emergency work. Millions of dollars' worth of food which had become
contaminated as the result of the disasters were seized and destroyed by the
Division's inspectors.
Mopping-up operations were just about completed in October and we then had
the task of destroying large quantities of liquor stocks, in conjunction with agents
of the Alcohol Tax Unit of the Federal Government, said liquor having been
contaminated by flood waters. The total value of the food and liquor destroyed
by the Division as the result of contamination was approximately $10,000,000.
New Developments in the Food Industry
Frozen and Pre-Cooked Foods
One of the most radical changes in the presentation of foods to the consuming
public, by a highly competitive food distribution system, is the increasing use of
frozen foods and the advent of frozen pre-cooked foods. Catering to the ever
expanding philosophy of merchandising, that anything that will make the house-
wife's task easier is a good business venture, hundreds of frozen food processing
plants have sprung up in Massachusetts. Such items as frozen pre-cooked fish
sticks, pizzas, chicken dinners, etc. have become commonplace. This is a very
serious public health problem, since many persons have the concept that all one
has to do in the preparing of a frozen food is to process it, put it in a home freezer,
and sell it as a frozen food product. This, of course, is far removed from the truth.
Raw materials going into frozen foods must be of excellent quality before processing.
Great skill is needed in the sanitary preparation of these products, and quick-
freezing equipment is mandatory in order to maintain quality, wholesomeness and
nutritive value. The Division in its token supervision of this mushrooming enter-
prise has found extremely high coliform counts, filth and contamination as well as
decomposition in many of these products. This is not limited to small producers.
Contamination has been found in the products of large producers, who should have
been able to prevent such contamination in view of the large technical staffs
they employ to cope with these problems.
Preliminary investigations by the Division have indicated a large field of public
health interest and research in the deterioration of frozen foods from a nutritional
point of view. Unstable vitamins and other components are destroyed by improper
handling, shipping and keeping of these foods in their transmission between
manufacturer and consumer. Besides being a definite public health problem, in
that the ingestion of foods which have lost certain nutritive factors in part negates
the value thereof, there is the problem of violation of the adulteration laws since
they contain less than the professed standard therefor. Cold storage holdings,
which previously had been the overflow of seasonal purchasing procedures, have
been swelled by this far-reaching phase of the food industry.
Slaughtering
Slaughterhouses
Since the adoption of the Massachusetts laws pertaining to slaughtering, many
changes in the sanitary concepts of slaughtering have developed. Although our
laws and regulations have kept up with these developments, the physical establish-
154 P.D. 34
ments of our State-inspected slaughterhouses have not. As in all matters, a point
is finally reached wherein good public health practice cannot tolerate the main-
tenance of decrepit and obsolete construction not conducive to proper sanitation.
A program has been initiated to improve the conditions in this type of establish-
ment, which conditions have now become greatly intensified, due to the closing
of the slaughterhouses connected with the Brighton abattoir. Our program has
been hampered by the illness of one of our veterinary food inspectors.
Poultry Slaughtering
On a par with the expansion in the frozen food industry has been expansion in
the poultry slaughtering industry in Massachusetts. During the last decade,
poultry consumption in this Commonwealth has increased in the various categories
on the average of tenfold. Innovations in the marketing of poultry in the cut-up
form have provided an outlet for segments of diseased, deformed poultry. Certain
unscrupulous processors will dissect a carcass, remove tumorous growths, emaciated
members, diseased portions and the like and place in consumer channels those
portions of the carcass which outwardly appear wholesome. Here again, the
Division has not been able to extend adequate protection to the consumer from
this type of operation due to our lack of personnel. Seizures of poultry made
by the Division have been of such serious consequence that upon presentation of
evidence to lower court judges, the cases were directed to the Grand Jury for
indictment and action.
Poultry products have been involved in a majority of the food poisoning cases
investigated by the Division. This situation exists not only in Massachusetts but
poses a problem for the entire country and has caused to be introduced before the
Congress of the Uuited States legislation for Federal inspection of poultry. This,
however, will not solve the problem of inspection of the product within the confines
of our Commonwealth. A more progressive and comprehensive program of poultry
inspection is absolutely mandatory in the interest of the public health and welfare
of the consumer.
Registration of Food Processors
Although Massachusetts has long been a forerunner in progressive public health
legislation pertaining to food and drugs, one of the most glaring weaknesses of the
enforcement structure has been the lack of a general licensing program for food
processors. Prior to the passage of legislation requiring that all food processors
be registered, which became effective in 1956, any person who wished to process
food in a business other than the several specific food businesses already licensed
would set up certain processes, canning or freezing food without health authorities
being cognizant of his operations. The initial attempt by the Department to
license food processors met with severe opposition and we had to be content with a
registration program. It will require some time to develop this program of
registration, but it is hoped that with the cooperation of the local boards of health
great benefit will result in the interest of the consuming public.
Drug Abuses
Harmful Drugs
Chapter 577 of the Acts of 1954 defines "harmful drugs" as those upon the label
of which the Federal law requires the statement, "Caution. Federal law prohibits
dispensing without prescription." In 1955, this definition was amended to
specifically include any derivative, active principle, preparation, compound or
mixture of barbituric acid, amphetamine, ergot, or any hypnotic or somnifacient
drug.
Investigations by the Division have revealed that abuse of this category of drugs
far surpasses the abuse of narcotic drugs. Although the regulated use of these
drugs has proven to be one of the biggest boons to an ailing mankind, disastrous
consequences have resulted from their abuse. Since this is a summary report, the
reader is referred to a number of publications issued by the Department in detail on
the findings of our investigations. Two reprehensible facets in the improper use
of these drugs stand out :
P.D. 34 155
First, the fact that certain members of the medical profession have been prescrib-
ing harmful drugs, such as barbiturates and amphetamines, in large quantity.
Second, that the barbiturates and amphetamines have entered the channels of
narcotic drug traffic via the underworld.
In the evolvement of our present high-tension way of life, nervous disorders and
mental illnesses have taken a sharp upward trend. In order to meet the demand
by the medical profession for more effective medication to cope with this problem,
the chemical and drug industries have developed new and more potent sedative,
hypnotic, and somnifacient drugs. The introduction of these drugs has been
paralleled by the introduction of new stimulant drugs represented by the ampheta-
mine family.
With the advent of the somnifacient and stimulant drugs, abuses became evident.
After World War II, public health authorities and other control officials became
increasingly alarmed over these abuses. In 1948, the Massachusetts Department
of Public Health introduced a bill into the State Legislature which became the
Commonwealth's first harmful-drug law. Personnel, however, were not provided
for its enforcement. Inspectors had to be taken from already inadequately staffed
inspection programs and assigned to inspect specific complaints of abuses of the
harmful drugs. The first important investigation, conducted in cooperation with
the Division of Hospital Licensing, disclosed a glaring inadequacy of the law. It
restricted the retail sale of harmful drugs at drugstores but did not affect their
distribution at wholesale.
An inspector found 20,000 doses of barbiturates between blankets in a linen
closet at a nursing home. These had been obtained from a wholesale drug house.
Such incidents, together with information obtained through the special commission
study, made clear the need for revision of the harmful drug law.
Harmful Drug Law Revamped
In 1954, the law was revamped to prevent the recurrence of wholesale abuses
of these drugs. Specific definitions for oral and written prescription were set forth
for the first time in the history of law, and an inspector was assigned to enforce it.
A Federal Food and Drug Administration inspector, a Board of Pharmacy inspector,
and the Division cracked down on a large wholesaler-manufacturer of barbiturates
and amphetamines. Millions of capsules and tablets were confiscated and de-
stroyed, and the operator was prosecuted. A survey of the Massachusetts College
of Pharmacy revealed that huge amounts of these drugs were being legitimately
prescribed. An evaluation revealed that millions of pounds were being manu-
factured yearly in the United States. Common drugs were being compounded
with harmful ones and were being marketed in myriad combinations. While con-
trol officials were trying to evaluate the extent of the problem, our inspector, making
an investigation in cooperation with two Boston policemen, came upon the first
indication that barbiturates and amphetamines were being peddled by an organized
gang with a modus operandi similar to that of peddlers of narcotics. Two such
gangs were apprehended and prosecuted.
Again, technicalities were found in the law behind which the violator could take
refuge, but emergency action by our legislature resulted in a broadening of the
definition of a harmful drug and made its illegal possession a crime. The barbitu-
rates and amphetamines have a reaction of habituating prolonged users by a little
understood process, which is not technically addiction but does cause dependence
upon these drugs. Such a habitue will steal or commit any other crime to acquire
them. Evidence has shown prostitution, juvenile delinquency, and crime stemming
from the use of these drugs. In one case, a habitue forged several prescriptions for
barbiturates, but when apprehended he managed to escape a penalty for the forgery
because of a legal technicality. Again, the law was amended to make the forgery
of a prescription for a harmful drug a crime.
Law Enforcement
Our State, a pioneer in public health legislation, initiated the Massachusetts
Narcotic Law in 1885. This was an attempt to minimize the abuse of harmful
156 P.D. 34
drugs, an age-old problem which has addicted and enslaved those who have suc-
cumbed to it, resulting in many disrupted lives and all types of crime, including
murder. An analysis of the problem breaks it down to two parts: drugs which
emanate from the so-called legitimate channels, that is, drugs manufactured under
Federal supervision and sold through legitimate drug outlets; and drugs which
originate from illegitimate sources, that is, through smuggling and similar opera-
tions. For the most part, the drugs legitimately procured are used under proper
direction of a physician or dentist. A small part of these drugs falls into the hands
of abusers, through thefts or falsification of symptoms to physicians. Recent
investigations by the Division disclosed that several addicts had obtained narcotics
to supply their needs from three different physicians, who, of course, were not
aware of the duplicity. Our inspector also apprehended an addict with a suitcase
full of various drugs, including a quantity of narcotic drugs, acquired through
falsification and theft.
It is the responsibility of this Division, acting for the Department, and of police
officials, to enforce the narcotic laws. By mandate of the Legislature, the Depart-
ment is required to make analyses for various police agencies in connection with
narcotic law enforcement as well as to enforce the law and take cognizance of any
violation thereof. Due to our lack of personnel and the lack of coordination of
police agencies in this problem, very little has been done in the enforcement of
these laws outside of the Boston area.
In the Division's investigation of the harmful-drug law abuses, glaring violations
of the narcotic laws have been observed. We initiated the policy of attempting to
coordinate police efforts with ours for more stringent enforcement and have obtained
fine cooperation. Worthy of special note are the Attorney General, the Boston
police, the Massachusetts Police Chief's Association, the Department of Public
Safety, and the District Attorney of Suffolk County. It is hoped that when the
Division obtains sufficient personnel we shall be able to further carry on this work.
Chemicals in Food
Prior to World War II, the Food and Drug Division encountered relatively few
chemical additives to our vast food supply. Following World War II, our chemical
industries found themselves with many millions of dollars' worth of surplus chemicals
on hand and manufacturing facilities to produce thousands of tons of chemicals
annually. In looking for an outlet for these products they found a ready market
in the field of agricultural pesticides and insecticides. A genuine attempt was
made to regulate the use of chemicals on raw agricultural products on the farm by
the passage of the Miller amendment to the Federal Food and Drug Act. Since
then, interpretations of the original law have broadened the base decidedly. Where
the original intent was to allow for the addition of pesticides to crops in the field,
the law has been used to allow for the introduction of preservatives in processed
foods. This has posed a considerable problem for public health authorities since
so little is known about the long-range effects these chemicals may have on the
human organism, not only as each chemical is ingested individually, but in combi-
nation with the hundreds of other chemical additives. At the present time there
are approximately 350 applications pending on these additives for action by the
Federal Food and Drug Administration. Approximately the same number of
applications are anticipated this year. In the opinion of the Director of the
Division, this problem constitutes the number one health menace of our times.
Every day brings about new evidences as to the fallacy that we are able to prove
the safety of chemical additives to food.
Recently, in Massachusetts, one hundred young children were made ill when they
ingested novelty popcorn products colored with "Orange One Certified Food Color."
The Division brought this matter to the attention of the United States Food and
Drug Administration, who, by exhaustive tests through the years, had certified
this color as safe for use in food. It was later learned that the Administration had
evidence in its possession that this particular coloring and several of its chemical
brethren had carcinogenic properties. Three of these dyes have since been decerti-
P.D. 34 157
fied and three are in the process of being decertified. Another common household
chemical additive known as "coumarin," which is a synthetic vanilla, was also
found to possess carcinogenic properties.
The case in point from the evidence on hand is that although there are many
theories as to the methods of determining the safety of chemicals in food, no sure-fire,
fool-proof method has been developed. Industry attempts to interpret the United
States Food and Drug Administration's procedures under the Miller amendment
as being an approval program. From our inquiries and our study of the matter,
we find that this is not so. The United States Food and Drug Administration
merely carries out its legal requirements under the amendment, judging, from facts
presented by the private applicant, what would be considered a safe tolerance. This
is based on the applicant's research work. Recently it was found that the addition
of an organic phosphate to a food which contained another organic phosphate
reduced the tolerance for both compounds manyfold. The Administration now
requires cross checking of all four or five organic phosphates submitted. The
question this Division raises is: Why shouldn't all of the chemical additives be
cross checked; and who can say whether other chemical additives passing into the
human system, besides the organic phosphates, may or may not catalize a much
more toxic reaction, precipitating any one of a hundred organic failures? At best,
the ingestion of normal natural foods poses difficulty for digestion and assimilation
in many human beings.
Again, I reiterate that this is an extremely serious problem, and the most serious
that faces this generation from a public health point of view. The Department,
recognizing this, has passed a regulation forbidding the use of preservatives in food
to be sold in this Commonwealth without the Department's approval. The
addition of aureomycin and biphenyl to foods has been disapproved by the
Department at this date. The use of ammonia and sodium orthophenylphenate
to food has been approved. The approval of the orthophenylphenate compound
has been on the basis that the food for which it has been approved be thoroughly
washed so as to eliminate all but negligible traces of the compound.
R ':
70
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