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BOSTON UNIVERSITY
LIBRARIES
University Library
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Public Document
No. 34
C!)e Commontoealtl) of Qia$$aci)u$etts!
ANNUAL REPORT
Department oe Public Health
FOR THE
Year ending November 30, 1920
BOSTON
WRIGHT & POTTER PRINTING CO., STATE PRINTERS
32 DERNE STREET
Publication of this Document
approved by the
Supervisor of Administration.
CONTENTS.
Report of the Public Health Council
Report of the Commissioner of Public Health
Infant and Child Hygiene .....
Personnel Problems ......
The Plague Problems ......
Tuberculosis and Leprosy . .
Special Water Supply Investigation
Disease Prevalence ......
Venereal Disease .....••
Public Health Nursing ......
The Continuing Laboratory Problem of the Department
The Plumbing Report ......
Legislative Recommendations ....
Division of Administration .....
Division of Sanitary Engineering ....
Division of Water and Sewage Laboratories
Division of Communicable Diseases
Division of Tuberculosis .....
Division of Hygiene . . . . • •
Division of Biologic Laboratories ....
Wassermann Laboratory . . . . ■
Division of Food and Drugs .....
Appropriations and Expenditures for the Year ended Nov
Division of Administration ....
Division of Hygiene ......
Division of Communicable Diseases
Subdivision of Venereal Diseases
Division of Biologic Laboratories
Division of Food and Drugs ....
Manufacture and Distribution of Arsphenamine .
Division of Sanitary Engineering
Division of Water and Sewage Laboratories .
Division of Tuberculosis (Sanatoria)
State Examiners of Plumbers ....
Penikese Hospital ......
Recapitulation .....••
Expenditures of Tuberculosis Sanatoria for the Year en^
Special Appropriations — Tuberculosis Sanatoria .
Supplement ......-•
Report of Division of Sanitary Engineering
Private Wells .......
Water Supplies of Camps . . . . •
Difficulties of providing Water and Sewerage Facilities
Rainfall and Flow of Streams ....
Sanitary Protection of Public Water Supplies . ,
Examination of Water Supplies ....
Analyses of the Water of PubHc Water Supplies
30, 1920
ded Nov. 30
in Certain Districts
1920
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BOSTON UNIVERSITY LIBRARIES^
IV
CONTENTS.
Supplement — Continued.
Report of Division of Sanitary Engineering — Concluded.
Comparison of Water Supplies of the State by Chemical Analysis
Surface Water Sources
Ground Water Sources
Water Supply Statistics
Consumption of Water
Rainfall
Flow of Streams
Sudbury River
Nashua River
Merrimack River
Sudbury, Nashua and Merrimack Rivers
Sewerage and Sewage Disposal .
Examination of Rivers
Assabet River
. Blackstone River .
Charles River
Chicopee River
Concord and Sudbury Rivers .
Connecticut River .
Deerfield River
French River
Hoosick River
Housatonic River .
Merrimack River .
Millers River
Nashua River
Neponset River
North River in Peabody and Salem
Taunton River
Other Rivers ....
Report of Division of Water and Sewage Laboratories
Investigations in Regard to Corrosion of Pipes
Bacillus Coli and Bacillus Aerogenes
Studies of Shellfish ......
Purification of a Gas Company's Wastes
B. Coli in the Water of Swimming Pools
Operation of Trickling Filters ....
Intermittent Sand Filters in Operation Thirty-three Years
Removal of Color from Water
The Effect of Low Temperature upon Sterilization of Water by Means of
Liquid Chlorine or Bleach
Bacterial Measurement of the Degree of Pollution of Water
Report of Division of Food and Drugs
Report of Division of Communicable Diseases
Report of the State District Health Officers .
Nursing Assistants .....
Educational Work ......
Diseases Dangerous to the Public Health .
District Changes ......
Health Districts and State District Health Officials
Work of the Engineering Division
Report of the Work of the Bacteriological Laboratory
Diphtheria .......
Typhoid Fever ......
Pneumococcus Type Determination .
CONTENTS.
Supplement — Continued.
Report of Division of Communicable Diseases — Concluded,
Report of the Subdivision of Venereal Diseases
Statistics
Clinics .
Social Service
Lapsed Cases
Arsphenamine
Advertising .
Educational .
Industrial
Meeting of Clinic Directors
Police Departments ....
Inspection of Jails and Houses of Correction
Sources of Infection . . . •
Courts .......
Keeping Fit Campaign ....
Penikese Hospital .....
Report of the Epidemiologist
Epidemiological Significance of Age Distribution in Certain Communicable
Diseases . . . . •
Sex Distribution of Communicable Diseases
Outbreaks of Communicable Diseases in 1920
Anterior Poliomyelitis
Influenza
Measles
Whooping Cough
Diphtheria
Scarlet Fever
Septic Sore Throat
Typhoid Fever .
Progress made in Past Five-year Period
Cases and Deaths from Diseases Dangerous to the Public Health, 1920
Cases and Deaths, with Case and Death Rates, per 100,000 Population for
All Reportable Diseases during the Year 1920
Incidence of Communicable Diseases by Months, 1920
Report of Division of Biologic Laboratories
Antitoxin and Vaccine Laboratory
Personnel
Production
Economics
Improvements
Educational .
Needs .
Wassermann Laboratory
Routine Tests
Complement Fixation Tests in Tuberculosis
Complement Fixation Tests in Gonococcal Infections
Costs .....
Report of Division of Hygiene
Changes in Personnel
Lines of Work ....
Investigations
Food and its Relationship to Health
Mouth Hygiene
Clinics for the Child in the Rural Community
Cancer Control .....
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VI
CONTENTS.
Supplement — Continued.
Report of Division of Hygiene — Concluded.
Lines of Work — Concluded,
Educational Work ....
Special Work ....
Report of Division of Tuberculosis (Sanatoria)
An Act to establish the Massachusetts Hospital for Consumptives
cular Patients .
Consultation Clinics .
Examination Clinics .
Observation Hospital
Subsidy .
Examination of Prisoners
Public Health Nurses
Consultants
Follow-up Work
North Reading State Sanatorium
Report of the Superintendent
Medical Report .
Clinics
Recommendations
Improvements
Medical Staff
Acknowledgments
Treasurer's Report
Valuation
Special Report
Statistical Tables .
Westfield State Sanatorium
Report of the Superintendent
Days of Treatment
Num*ber treated and Classification
Length of Residence
Support of Patients
Gain in Weight .
Dentistry .
Conditions of Discharge
Sanatorium School
Out-patient Department
Improvements
Additional Improvements requested
Acknowledgments
Treasurer's Report
Valuation
Special Report
Statistical Tables .
Lakeville State Sanatorium
Report of the Superintendent
Medical Report .
Work performed
Improvements
Farm
Recommendations
Changes in Personnel
Acknowledgments
Treasurer's Report
Valuation
and Tuber-
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CONTENTS.
Vll
Supplement — Concluded.
Report of Division of Tuberculosis (Sanatoria) — Concluded
Lakeville State Sanatorium — Concluded.
Special Report
Statistical Tables .
Rutland State Sanatorium .
Report of the Superintendent
Medical
Farm
Recommendations
Treasurer's Report
Valuation
Special Report
Statistical Tables .
Report of the State Examiners of Plumbers .....
Papers written in 1920 and Pamphlets issued .....
Papers written by Members of the State Department of Public Health during
the Year 1920
Pamphlets issued by the State Department of Public Health
Index .......•••
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C&e Commontoealtf) of a^a00ac|)U0ett0
Department op Public Health,
Boston, Jan. 19, 1921.
To the General Court of Massachusetts.
In accordance with the provisions of section 32 of chapter 30 of
the General Laws I have the honor to submit herewith the annual
report of the Department of Public Health for the year ending Nov.
30, 1920.
Respectfully,
EUGENE R. KELLEY,
Commissioner of Public Health.
SIXTH ANNUAL REPORT
Department of Public Health of Massachusetts.
For the fiscal year ending Nov. 30, 1920, the Department of Public
Health was constituted as follows: —
Commissioner of Public Health, .... Eugene R. Kelley, M.D.
Public Health Council.
Eugene R. Kelley, M.D., Chairman.
David L. Edsall, M.D., 1921. Sylvester E. Ryan, M.D., 1922.
J. E. Lamoureux, M.D., 1921. George C. Whipple, S.B., 1923.
Warren C. Jewett, 1922. Wm. T. Sedgwick, Ph.D., 1923.
During the j-ear 12 formal meetings of the Council were held, as
well as many meetings of the standing and special committees of
the Department. The standing committees of the Council for the
year were as follows: —
Sanitary Engineering (including Housing and Rural Hygiene).
Professors Whipple and Sedgwick, Dr. Kelley and Mr. Jewett.
Preventive Medicine and Hygiene.
Drs. Edsall, Kelley, Lamoureux and Ryan.
Food and Drugs. '
Professor Sedgwick, Drs. Lamoureux and Ryan and Mr. Jewett,
Finance, Law and Demography.
Professor Whipple, Dr. Ryan and Mr. Jewett.
In accordance with section 2 of chapter 792 of the Acts of 1914,
at a meeting of the Public Health Council held on Dec. 21, 1920,
the Commissioner of Public Health submitted to the Council a report
of the Department for the fiscal year 1920, and it was voted that
this report be approved and adopted as the report of the Depart-
ment of Public Health for the fiscal year 1920.
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
SIXTH ANNUAL REPORT OF THE COMMISSIONER OF PUBLIC
HEALTH.
To the Public Health Council.
Gentlemen: — In accordance with chapter 792 of the Acts of
1914, I have the honor to present herewith a report of the activities
of this Department for the past year, the sixth since the creation of
the present Department and the first under the reorganization of the
State government, with the change of title from State Department
of Health to State Department of Public Health, and with the im-
portant added function of administering five institutions, — the
four State tuberculosis sanatoria and the Penikese Leper Hospital.
Unlike nearly all other departments of the State government, the
general reorganization did not affect the form of organization, per-
sonnel, functions or fundamental statutes pertaining to the work
of the Department save in the matter of the transfer of these in-
stitutions.
The activities of the Department have followed the same general
lines as in previous years, but the impetus towards the newer fields
of health work has been greatly accentuated. Under the term "newer
fields of health work" I include such matters as nutrition, oral hy-
giene, personal hygiene, and public health nursing. In a sense these
subjects may be contrasted with the old-established factors in depart-
mental health work, such as sanitary engineering, pure food work,
and communicable disease control. These newer branches of sanitary
science are in many ways highly specialized, but have one thing in
common to a striking degree — they all center upon the individual
to a much greater extent than do the older branches of sanitary
science. To be effective they must reach the individual and evoke
a conscious response. To be most effective they must reach the
individual very early in life, by proxy through the parents up to
school age and thereafter by directly enlisting the child's active in-
terest and co-operation.
This does not mean that the adult has nothing to learn or to apply
for his own benefit from the teaching, for example, of modern nu-
tritional methods — he can learn much. It does mean that unless
an intelligent foundation is laid during childhood the resources of
preventive medicine must work against a tremendous and in many
respects a hopeless handicap when brought to bear upon the problem
of the adult. One who has suffered from faulty nutrition as an infant
and young child can never quite remove the resulting physical handi-
caps even by following the most judicious program of diet and phys-
ical training in later life.
No. 34.] ANNUAL REPORT. 5
Unfortunately the day has not yet arrived when the general public
or our agencies of government can get a true perspective upon the
relation of these newer phases to the whole subject of public health.
However, public enlightenment in these matters is rapidly becoming
more general, and it is daily becoming more difficult to find quali-
fied expert workers in these fields than it is to find opportunities for
them to follow their calling.
In the past decade the conviction has grown upon those who seek
to control the ravages of communicable disease that in many instances
a sound nutritional and physical developmental foundation in early
life is necessarv for success in combating infection in later life.
Infant and Child Hygiene.
For several years this Department has called attention in every
possible way to the problem of infant and child hygiene. It has
encouraged the extension and multiplication of such activities by
both public and private agencies. It was responsible for a State-
wide survey of infant and child hygiene needs early in the period
of the war, made possible by the far-sighted generosity of the Metro-
politan Chapter of the Red Cross. Since then it has consistently
urged cities and towns to supply the workers needed in each com-
munity as shown by the survey.
The Department has gradually increased its own staft' of investi-
gators in this field and has conducted educational programs and
demonstration clinics to point out to communities their needs in
these matters. This last method has been used during the past year,
particularly in the western portion of the Commonwealth, and the
local response has been most surprising. Every community, large
or small, which our workers have visited has been astonished at
the amount of malnutrition and correctable defects among its infants
and children as revealed by these examination clinics, and many
have set in motion some machinery for the perpetuation of such
work and for providing facilities to correct the defects uncovered
in clinic examinations.
The most far-reaching and ambitious proposals in this direction,
however, are those embodied in the various so-called "Maternity
Benefit" measures introduced in the Legislature during the past
session. The Great and General Court, finding itself unable to arrive
at a definite conclusion upon this important subject, referred all
such proposed legislation to a special recess commission for study,
and provided a sum of money sufficient to carry out fundamental
field investigations for the purpose of collecting accurate data upon
6 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
the subject for this State. This commission consisted of the Com-
missioner of Public Health and the Commissioner of Public Welfare,
ex officio, and three members appointed by the Governor. The per-
sonnel of the commission was as follows: Dr. Alfred Worcester, chair-
man, Dr. Eugene R. Kelley, Mr. Robert W. Kelso, Mr. Edward E.
Whiting and Mrs. Helen A. MacDonald. For months the commis-
sion met regularly each week under the able leadership of its chair-
man, Dr. Alfred Worcester of Waltham, who devoted a great deal
of time to the investigation. A first-hand study was made of the
causes of maternal and infant deaths in this State in the months
just preceding the appointment of the commission, together with
statistical studies for more remote periods. All data bearing on
this problem in other parts of the country and abroad were sought
and considered.
As a result of its deliberations the commission reached the con-
clusion that a system of State-wide extension of public health nursing
service offered the most promising results with the least expenditure
of public funds, and legislation designed to extend rapidly such serv-
ice was submitted with a unanimous recommendation from the com-
mission for its adoption.
It is felt that the present loss of maternal and infant life is obviously
so much greater than need be, and the life-saving results of such
nursing service have been so promptly and uniformly realized where-
ever they have hitherto been given fair trial, that the people of the
Commonwealth through their representatives will authorize this
Department to enter upon this phase of public health service on a
broad scale in co-operation with the private nursing agencies already
in the field.
Mouth hygiene and nutrition problems are closely allied with child
hygiene, although these subjects have vast and important applica-
tions to later age periods as well. The activities of the Department
in these fields have been the subject cf most careful thought on my
part during the entire year. I wish emphatically to express my con-
viction that we are falling far short of what we should do in these
subjects, but for several years past recommendations looking towards
expansion in these fields to an extent more nearly approximating what
the Department should be doing have been greatly revised down-
wards by the authorities controlling finances. This experience has
been the more striking because these same authorities have been
sympathetic with nearly all other phases of our work. They have
said that they could not perceive any widespread popular demand
for expansion in these fields, and, while willing to continue the slender
staff already employed, have declined to appropriate funds for an
No. 34.] ANNUAL REPORT. 7
extension of the force. Personally I feel that these subjects are so
vital to the well-being of the present and future citizens of the State
that an immediate expansion at least threefold is imperatively needed,
with every regard for public economy, and I do not see that any one
can set limits as to the possible future extension that may be indi-
cated. But, until public opinion on this point is aroused, no one can
justly criticize either the executive or legislative branches of the
State government for declining to approve this Department's recom-
mendations in this respect. The first and most obvious duty of the
Department is to better inform the public of the facts. Once this
is done public opinion will shape itself on these subjects, and I know
of no subject upon which public opinion is more universally of one
mind when once informed. In the summary of the Division of Hygiene
the present small activities of the Department in nutrition and mouth
hygiene are very briefly sketched.
Peksonnel Problems.
I wish to refer briefly here to one handicap under which all of
our divisions have labored to an even greater extent than last year.
I refer to the constant losses among our professional and skilled per-
sonnel on account of better remuneration available outside the State
service.
A substantial salary increase, averaging from 15 to 20 per cent,
was granted to nearly all our staff by action of the legislative and
executive departments during the year just closed. This all too
long delayed and in many instances still inadequate recognition of
faithful service alone saved the work of the Department from utter
demoralization and breakdown. Doubtless the same condition held
true in many other State departments, but the Department of Public
Health is peculiarly a department of technically trained executives
and employees, and here is felt and will continue to be felt to an
unusual degree the pressure of outside competition. Five professions
make up the bulk of our technical staff, — medicine, chemistry, en-
gineering, bacteriology and nursing. The outside pressure of economic
competition for trained service in these professions has been so great
that I marvel that the Department has been able to retain any of
its staffs. I do not think that the facts in this matter are at all known
or understood, but if salaries alone had been the determining factor
the Department would have lost practically 100 per cent of its staff
of physicians, chemists, engineers, bacteriologists and nurses during
the past year. As it was, the percentage of turnover was very great,
ranging from 33 to 50 per cent in all divisions. Practically all the
8 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
members of the staff who have resigned did so to take new positions
paying at least 50 per cent more and in several instances the new
salary has been double that received in the Department. I refer to
this critical situation in some detail because I am not at all satisfied
that it is all a matter of the past.
It is true that we have entered upon a period of industrial depres-
sion and the demand for unskilled and certain technical services is
much slackened. On the other hand, the cost of living and the pur-
chasing power of the dollar generallj^ have not yet materially changed.
Furthermore, because of a combination of lessened output of graduates
from the technical schools during the war, or, as in the case of phy-
sicians, for a long period before the war, and the great increase in the
opportunities for such graduates in industry and other outside public
service there exists to-day a partial vacuum, so to speak, in regard to
these professions. This manifests itself in a constant economic pressure
operating in the form of a higher wage opportunity to draw these
classes of trained specialists out of State and municipal service.
The Plague Problems.
The plague has been a scourge of mankind from remotest ages.
Originally the term was used in a loose sense to designate any severe
epidemic, but for several centuries now it has been confined in a
medical sense to the bubonic plague. This disease has had a curious
and as yet unexplained tendency to sweep over all the world where
commercial intercommunication exists at irregular periods, generally
some centuries apart. In the intervals plague persists in certain fairly
well-defined spots in Asia and from time to time breaks forth from
these foci in epidemics of great severity.
In the fourteenth century a terrible outbreak of plague occurred
in Europe for over the period of a generation and according to the
estimates resulted in the death of at least one-quarter of the popula-
tion. Minor epidemics followed this great outburst. The best known
of these, though really representing a diminishing phase of the out-
break, was the great plague of London, immortalized by Defoe in
his noted work. From this time on plague tended to recede from
Europe of its own accord. It never was a factor in the Western
Hemisphere until the present pandemic. Commencing in one of
the well-known permanent homes of the disease in China near the
borders of Thibet in 1894, plague again began a world-wide sweep.
That the disease under conditions favorable to it has lost none of
its ancient malignancy may be judged from the fact that for over
No. 34.] ANNUAL REPORT. 9
ten years, consecutively from 1904 to 1914, deaths from plague in
India alone averaged nearly a million each year.
Meanwhile modern sanitar}^ science has discovered the method
of transmission and has found that plague is essentially a disease
of rats and only spreads to man where man lives in close association
with rats. Moreover, it has been demonstrated that it is possible
by definite measures directed against the rat to minimize the prob-
ability of the spread of infection and to eradicate it if found in sea-
ports before it becomes sufficiently extensive in rats to be a serious
human menace.
Plague first manifested itself in this country in San Francisco nearly
twenty years ago. After a period extending over several years in
which the local commercial interests, medical authorities, political
agencies and press all joined in a remarkable campaign of denial,
cases of this disease, following the great disaster of 1906, assumed
a degree of frequency and deadliness where evasion or denial were
no longer possible. Then, by a remarkable campaign conducted by
Federal, State and city health authorities, with all the civic bodies
of State and city actively co-operating, the disease was completely
eradicated from San Francisco within three years.
In 1914 the port of New Orleans became infected. After an appar-
ently successful campaign of eradication plague again appeared in
that city in November, 1919. This resulted in a much more thorough
rat eradication program being put into force with apparently prompt
success. But this summer numerous human cases appeared suddenly
in three other seaports, — Galveston and Beaumont, Texas, and
Pensacola, Fla. Systematic rat catching and laboratory examination
of rat corpses revealed extensive rat plague in all these cities. The
control methods promptly put into effect have resulted in apparent
control of the situation in each city.
At the same time alarming though obscure reports have come of
plague being present and more or less concealed in many places in
Europe.
As a result, it seems only the part of common prudence to make
a careful investigation into the condition of the rat population of
all the seaports of this State. This is already being done on a more
or less thorough scale in practically all ports south of and including
New York City. New England has not so large a total tonnage as
other sections of the country, but in the aggregate number of ports,
any one of which may serve as a point of infection, this section has
an astonishingly large percentage of the ports of the entire country,
and Massachusetts itself has by far the largest number of ports in
10 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
New England. The city of Boston has already taken steps to examine
into the condition of its rat population.
The port of Boston is a complex affair. Ten or more separate
cities and towns border upon it. Several other ports are in close
proximity to Boston. In all of these places a careful survey should
be made of water-front conditions and of the rat population. For
instance, if a smaller city bordering or near-by Boston becomes in-
fected, the efforts of the Boston authorities will be largely neutralized.
For this reason and because of the obvious saving in "overhead"
in having a scientific inquiry of this sort done in one or two labora-
tories rather than expecting each small municipality to do its own
investigation independently, I have considered it the plain duty of
the Department, as a protection both to the public health and our
commercial interests, to recommend to the General Court to appro-
priate during the special session a sum of money sufficient for the De-
partment to take the lead, and, supplemented by the efforts of the
municipalities and towns directly threatened with the possibility of
the invasion of plague, to carry through a general rat survey and
rodent laboratory examination in all seaports carrying on interstate
and foreign commerce. The organization that can best give the
definite direction and concentration of laboratory material required
for this work and at the same time guarantee an adequate type of
laboratory work is the Department of Public Health. A unified
State-wide effort, applied to all ports, regardless of size, presents the
only effective method of attacking this question.
Tuberculosis and Leprosy.
The activities of the new Division of Tuberculosis are summarized
later in this report, and the detailed account of the entire work of
the Division, including that of the sanatoria, is printed in the general
report of the Department.
The subject is so important that I wish to refer briefly to it here
largely by way of emphasis.
Last year I touched upon the proposed new organization. This
■ has been attained by the transfer to the Division of Tuberculosis of
all tuberculosis activities formerly carried as a part of the work of
the Division of Communicable Diseases.
The year has been signalized by a veritable new access of enthusiasm
and interest in the tuberculosis problem. I feel it is no reflection upon
the splendid work of the voluntary tuberculosis societies in the past
to state that never have the relations between such bodies and this
Department and local boards and departments of health been as
No. 34.] ANNUAL REPORT. 11
mutually helpful as during the past year. All that I predicted in
my last report has been realized and more. The establishment of
consultation clinics for large cities and special examination clinics for
the smaller cities and towns is in my judgment the most promising
development in years in pointing the way towards the long-held ideal
of having in the sanatoria only early and favorable cases of the dis-
ease. There should be collected enough men, women and children
in the early stage of tuberculosis to keep the four State sanatoria
filled and still furnish a large group of this type for the county and
municipal institutions.
To properly develop the consultation plan will probably require
a considerable enlargement of the sanatoria medical staff. I do not
recommend such an enlargement this year because the experiment
is still in its incipiency. But if the response of the medical profession,
local health departments, school and tuberculosis workers to the
generous offer of the sanatoria staffs to take the time, in spite of
the already crowded routine, to examine suspicious cases in their
own localities in consultation with patients' own physicians continues
as it has begun, some addition to the staffs of the sanatoria will be-
come a necessity. And if the extension of such consultation service
brings about only a 10 to 15 per cent increase in the number of per-
sons showing truly "incipient" or "favorable early" types of con-
sumption seeking admission to our sanatoria, the resulting economic
saving in the reduction of average period of treatment will be suffi-
ciently large to many times outweigh the additional expense of an
increased medical staff.
The management of the sanatoria during the past year has been
extremely difficult because of labor scarcity, failure in deliveries of
coal and other necessities, and particularly because of the inability
of the sanatoria to compete with industrial establishments and with
other institutions having a more elastic wage scale. So paralyzing
has been the effect of this labor shortage that it has been necessary
on occasions for a superintendent of a sanatorium to "fill in" in all
sorts of domestic service positions, even to waiting on table. That
such a situation has meant straining the mechanism of the institu-
tions to the point of absolute breakdown is self-evident. That, on
the whole, a high grade of medical and nursing care and dietary and
domestic service have been maintained throughout the year speaks
volumes for the loyalty and patience of the superintendents and the
group of loyal officers and employees who refused to leave their posts
under the constant pressure of offers of higher pay from outside
sources.
These institutional conditions all hold true to even a greater degree
12 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
in the problem of the administration of the leper hospital at Penikese.
Seldom has a State received the benefit of unselfish devotion to duty
under such peculiarly trying circumstances as these which have char-
acterized the services rendered by the Superintendent of this insti-
tution and his wife over a long period of years and particularly during
the hard year just passed.
Isolated on a small barren island, cut off from professional and
social associations alike, ministering to the needs of those most to
be pitied of mankind, for years he has given the benefit of a highly
trained scientific mind and real human sympathy to his charges.
It is only fitting that as a climax he should have succeeded in pro-
ducing the first practical arrests in the United States of the formerly
hopeless disease of leprosy.
Five years ago the Federal government passed legislation providing
for a national hospital for lepers and relieving States, counties and
cities of further burdens in the care of such cases. During the period
of the war it seemed to be impossible to settle the question of a site
and suitable buildings. At present the United States Public Health
Service has consummated a bargain with the State of Louisiana
whereby the State has turned over to the Federal government its
leper hospital. Certain enlargements and alterations are planned and
in the near future the entire problem of provision for the care of the
relatively few lepers in Massachusetts will be assumed by the Federal
authorities.
Special Water Supply Investigation.
In accordance with the direction of the Legislature this Depart-
ment and the Metropolitan District Commission have maintained
a considerable engineering force in the field, carried out extensive
office compilations and studies, and extensive geological and meteoro-
logical field studies. A certain amount of laboratory experimental
work has been done bearing upon the pressing problem of the ex-
tension in the near future of the water supplies of Massachusetts,
particularly in the eastern part of the State.
The continuance of the period of excess rainfall now running over
nearly a decade has been most fortunate for Massachusetts. It is
this circumstance alone that has prevented an actual failure of the
water supplies of many of our cities and towns.
The always great difficulties of conducting an engineering investi-
gation of such magnitude have been greatly increased by the un-
precedented weather conditions of the past winter, which put a
complete stop to all engineering work in the field for months, and
No. 34.] ANNUAL REPORT. 13
because of the universal shortage of technical services. Nevertheless,
the investigation is making satisfactory progress, and by the end of
another year, if not sooner, the Joint Board will complete its studies
and submit to the Legislature plans for the solution of this problem,
which though at present little appreciated by the general public is
one of the most serious questions of public concern that this genera-
tion of Massachusetts citizens must solve.
Disease Prevalence.
In the matter of disease prevalence the past year has been note-
worthy in two respects: (1) a recurrence of influenza in epidemic
form and (2) a very considerable epidemic of infantile paralysis.
Fortunately, both of these were much less severe than the last pre-
ceding epidemics of these diseases.
Influenza began to exhibit epidemic proportions in January and
continued until late in March, when it subsided rather rapidly to
normal proportions. The epidemic was mild only in a relative sense.
If the terrific influenza fatality of 1918 had never occurred, this epi-
demic would have been considered by health officers and the general
public alike as an almost unprecedented disaster. In all, 1,660 deaths
and about 35,000 cases were reported.
Poliomyelitis began to be reported to an unusual degree in July,
became most serious about October 1, and then steadily declined
until it practically reached normal frequency about December 1.
In contradistinction to the great outbreak of 1916 this outbreak was
quite sharply localized. At that time practically all sections of the
State were affected, while this year nearly all the cases were in the
eastern half of the State, the great majority being in the immediate
vicinity of Boston with the exception of a distinct additional zone of
relatively heavy infection extending down the Merrimack River
valley. Although this was one of the heaviest visitations of the
disease on record, there being almost exactly one-third as many cases
and deaths as during the great epidemic of the disease in 1916 (689
in 1920, 1,920 in 1916), and although this Department gave out the
facts of prevalence as cases were reported day by day, the outbreak
produced no public alarm whatever.
It is difficult to state just why such a complete reversal of senti-
ment occurred. The war and the influenza epidemic have perhaps
accustomed our people to death in the mass to such an extent that
the public poise is not shaken by occurrences that a few years ago
would have produced almost a public hysteria.
Aside from poliomyelitis and influenza the Commonwealth has
14 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
again been free from serious epidemics. Scarlet fever has been more
prevalent than has been the case for several years, but the relative
mortality has been low and the total of deaths, though more than
the yearly record of the three immediate preceding years of remark-
ably low mortality, is not above the average for the past ten years
and is far below the average of a generation ago.
Diphtheria shows about the same mortality as for the past two
years. There have been no extensive outbreaks of this disease, but
its non-epidemic occurrence has been above the average. The means
for the prevention and cure of diphtheria are now so well-known that
I feel very keenly the continuance of this unnecessary mortality in
children, and I believe the Department must make an extraordinary
effort during the next few years to reduce the residual diphtheria
mortality to negligible proportions.
In my last report I dwelt in some detail upon the steadily declining
typhoid rate. This fortunate condition has continued and our record
for this year is a little better than ever before. For the first time in
the history of the Commonwealth, at least since dependable statistics
have been available, the total typhoid deaths for the year are less than
100, and this with a steadily increasing population. This sustained
record of less deaths practically every year for the past eight con-
secutive years, culminating in a new low death rate record for typhoid,
is something to which every citizen of the State can point with pride.
This achievement represents the fruits of the intelligent application
on a wide scale of the accumulated public health science and expe-
rience of the past fifty years, and points the way to the possibilities for
a more complete control of other communicable diseases.
Even more impressive and satisfactory to every health worker is
the continuance of the decline in mortality from tuberculosis. The
surprising drop in mortality for this disease which I commented on
in 1919 has continued throughout the present year. In all, approx-
imately 500 less deaths have been recorded during 1920 than during
1919. This establishes a new low death rate for tuberculosis for this
Commonwealth, — the rate being approximately 100 deaths per 100,-
000 population, — last year's rate being 105.8, and both years being
substantially below the previous low record of 1913, which was 113
deaths per 100,000. These figures are particularly remarkable when
it is considered that Massachusetts has one of the most difficult
types of population with which to show satisfactory results in tuber-
culosis work that could well be imagined.
As I observed last year, there is no justification for assuming that
anti-tuberculosis activities, State, county or city, public or private,
No. 34.] ANNUAL REPORT. 15
are responsible for all or even the greatest portion of this showing.
Experience teaches that fluctuations must be expected in the mor-
tality from this disease in the future. Nevertheless, I can see no logic
in the captious criticisms of a pessimistic school of writers who have
come to the front of recent years, and, often approaching the subject
from a background of theory with little or no first-hand knowledge
of the disease, have charged that all declines in tuberculosis mortality
have been purely accidental and especially that institutional treat-
ment of the disease has produced no results.
Massachusetts has put into effect one of the finest and most com-
plete institutional programs for consumption in existence. This
State is also developing better facilities for early diagnosis and ex-
tending the machinery for better informing and convincing the public
of the wisdom of early examination in suspected cases of tuberculosis
and early treatment. All of these things are being done and coin-
cidentally we are obtaining some of the best results in tuberculosis
work that can be found the world over. As long as such results can
be shown I believe it is the wisest as well as the most humane policy
to continue steadily along the present lines while constantly on the
alert to discover and adopt other better means of combating this dread
disease, but not to be stampeded under any circumstances into aban-
doning any of the methods that have been thoroughly tried out for
tuberculosis control and which have stood the test by the only stand-
ard for proving values — results.
Venereal Disease.
The present program against venereal disease has now had nearly
three years of trial. It has been supported by a combination of State
and Federal funds. Federal funds have been voted for the last three
years by Congress for the furtherance of such work and these funds
have been allotted equitably to all States whose individual appro-
priations for venereal disease work equalled or exceeded the Federal
allotment. In turn, States have generally passed on funds to indi-
vidual communities to assist them in the establishing of clinics for
the treatment of these diseases and in other ways. This Common-
wealth led the way for venereal disease control measures by pre-
paring and distributing freely to qualified institutions and physicians
arsphenamine, so essential in the treatment of syphilis. Twenty such
clinics have been assisted, and in all but five instances these clinics
have been originated directly as a result of this program.
Like all new movements it is only fair to say that our venereal
16 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
disease program has had its ups and downs. We have tried out
thoroughly and carefully proposals for better education of the public
along these lines.
The policy of the Department has always been distinctly conserva-
tive on the educational side of this question and therefore has received
criticism from certain sources representing the impatient radical
element in venereal disease and social hygiene work who of late years
have been urging a universal campaign of publicity without stint
to reach the entire population in the mass. This Department
has steadily disapproved lectures on these subjects to mixed age
groups, and cleverly exploited moving-picture productions touching upon
subjects of sex and the dangers of venereal infection. I believe time
has increasingly justified this conservative stand. Experience has
shown that a large element of morbid curiosity enters into the draw-
ing power of the public lecture on sex topics, that a hope of viewing
the salacious rather than of absorbing useful hygienic and moral
lessons fills the "movie" when the sex motif is presented on the screen,
and that some of the points so forcibly driven home by a sane lecturer
may have precisely the opposite of the intended result upon the im-
mature minds of their auditors. But within what the Department
considers suitable channels an educational campaign in these matters,
which cannot fail to be productive of good results, has been quietly
and persistently carried on.
Our handling of the subject as a public health problem has proved
thoroughly sound and practical in its development. A co-operative
project carried out with the State Probation Commission, perhaps
unique in this country, has been the special work to thoroughly inform
court and probation officers of the applications of the venereal dis-
ease treatment and diagnosis facilities to their routine work.
Public Health Nursing.
It is a matter of deep personal regret that I cannot report better
progress in this most important field of public health activity. In
the Commonwealth, as a whole, public health nursing has progressed
during the past year in splendid fashion. But in our own organization
we have been forced to lose the services of many of our staff of public
health nurses because of the much more attractive and adequate
salaries offered on the outside from all manner of sources for their
services in work of most important public health nursing character.
I am thoroughly convinced that the Department must have a fully
organized division of public health nursing with adequate supervising
staff working under an efficient director before we can measure up to
No. 34.] ANNUAL REPORT. 17
our possibilities of leadership in this great field that is urgently de-
sired by every one in the State interested in or engaged in public health
nursing. Nor can the full possibilities of life saving and health pro-
moting by the adequate development of public health nursing service
be realized until the proper correlation of public health nursing activi-
ties throughout the Commonwealth, as such a division can best fur-
nish, is an accomplished fact.
The Public Health Council of the Department realizing the great
importance of this matter voted some months ago to establish such
a Division and to take advantage of the nation-wide co-operative
policy of the American Red Cross to make the Department's director
of the Division of Public Health Nursing, when established, also the
State supervisor of all nurses employed by the Red Cross. This
policy was decided upon in order to avoid any duplication or friction
between the public health nursing policies and personnel of the cities
and towns and those directly put into the field by the Red Cross.
Unfortunately under the present scheme of administrative organ-
ization of the State government, it is not possible to make a proposed
new division a reality until maintenance for it is provided in the
annual budget.
The budget authorities declined to approve the admission of such
a proposal until the question of maternity benefits shall have been
passed upon by the Legislature, and hence the problem of creating
a separate Division of Public Health Nursing must remain in a state
of suspended animation for the present, while the subdivision of pub-
lic health nursing of the Division of Hygiene has been reduced to
practically a paper organization for the reasons just explained.
The Continuing Laboratory Problem of the Department.
This subject was dealt with in last year's report and it was pointed
out then how serious this matter has become. An estimate for the
erection of a laboratory plant was submitted, but on account of
excessive construction costs, the State Supervisor of Administration
declined to recommend to the General Court that the erection of
such a new building be authorized. The Department has continued
to occupy on sufferance its old quarters for the Biologic Laboratories
at Forest Hills and for the Wassermann Laboratory in the Harvard
Medical School buildings and under protest from Harvard University,
which owns the property and desires its use for university purposes.
The Department has of necessity negotiated a short-term lease for a
small building well adapted for the purpose for the use of the labora-
tory unit manufacturing the remedy for syphilis, — arsphenamine.
18 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
The pressing question of laboratory facilities for this Department
is yet to be settled.
In this connection I wish to call to your particular attention the
summary submitted by the new director of the Division of Biologic
Laboratories in reviewing the work of the first nine months of his
administration. Never has the policy of obtaining full-time service
at the head of each important branch of the Department's activities
been more strikingly confirmed than by the public health and finan-
cial results of his short administration. Of even greater importance
for the future is the fact that this Division is beginning to bring its
true life-saving significance and possibilities adequately before the
medical profession, health authorities and institutional and school
authorities of the Commonwealth generally.
The Plumbing Report.
Last year the Legislature took cognizance of the practical and scientific
value of the report of the Special Plumbing Board, which had been ap-
pointed on the initiative of the Department to study the possibilities of
simplification of plumbing regulations and the resulting economies in
plumbing installations and better protection of the public against fraud or
incompetence by authorizing by special resolve the publication of the re-
port as a legislative document. The Legislature further directed the De-
partment to continue such studies and to submit legislation designed to
make plumbing procedure more uniform and less burdensome financially.
In spite of the fact that no funds were provided to carry on neces-
sary public hearings on this matter in different sections of the Com-
monwealth, as I recommended last year, the Board has continued
its work, has held four hearings at the State House, and has tried to
gain a comprehensive grasp of the problem as it affects the entire
State by correspondence and by conferences in Boston with repre-
sentatives of a number of organizations and official agencies interested
in the subject. As a result, the Board has drafted legislation, which
has been approved by the Public Health Council and which, I believe,
will, if enacted, operate greatly to the benefit of the public and help
in a minor way to solve the housing problem. Incidentally, by in-
creasing the volume of business it will, I believe, be of benefit to
persons connected with the plumbing business. I hope that the Gen-
eral Court will enact legislation which will make it possible to in-
corporate the fundamental principles embodied in the published report
of the Special Plumbing Board in a new plumbing code, which, while
providing minimum requirements State-wide in their application,
leaves their enforcement, as well as the adoption of regulations beyond
the minimum requirements, to the local authorities.
No. 34.] ANNUAL REPORT. 19
Legislative Recommendations.
The following recommendations for legislation have been submitted
to the General Court: —
1. A resolve authorizing the Department of Public Health to provide for the
prevention and control of bubonic plague. (Submitted to the special session
of the Legislature.)
2. An act authorizing the exchange or sale of surplus stock of biologic products
manufactured by the Division of Biologic Laboratories.
3. An act to provide for clean, sanitary and healthful food estabhshments.
4. An act exempting certain employees of the Department of Public Health
from civil service law and the rules and regulations made thereunder.
5. An act to regulate the manufacture of certain carbonated beverages and
soft drinks.
Division of Administration.
There have been but few changes in the Division of Administra-
tion during the past year. Li accordance with the terms of chapter
350 of the Acts of 1920 all purchases of office equipment, supplies
and furniture by individual departments must be made through the
Superintendent of Buildings. As might have been expected such a
radical change as this was the cause of some delay and dissatisfaction,
but a system has now been devised and is working smoothly between
this Department and the office of the Superintendent of Buildings.
The transfer of the four State sanatoria and their administration
unit to this Department has meant a slight increase in the work of
this Division. However, as all of the detail bookkeeping for each in-
stitution is handled by the institution itself this increased work is
materially less than would otherwise be the case.
All personnel matters are now handled through the office of the
Supervisor of Administration via the Division of Administration of
this Department. This is true in all cases except for certain classes
of employees at the State sanatoria, where the employment of a
certain quota of employees of various groups is allowed, and as long
as this quota is not exceeded individual requisitions upon the Super-
visor's office are not required.
"With the coming of the new year it is planned to transfer the
library and the librarian from this Division to the Division of Hy-
giene. The latter Division has charge of all publications and other
printed matter issued by the Department and therefore the Division
of Hygiene would seem a more logical place for the library than the
Division of Administration.
20 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Division of Sanitary Engineering.
The total number of formal applications received from municipali-
ties and others for advice wjth reference to water supply, drainage,
sewerage and other subjects presented for the consideration of this
Division during the year ending Nov. 30, 1920, was 141, or about the
same as in the year 1919.
The abnormally high prices of both material and labor, together
with unfavorable financial conditions which have especially marked
the larger part of the year 1920, have caused a further postponement
of much necessary municipal work, including the construction, exten-
sion or enlargement of many water supply and sewerage systems
already too long postponed on account of the recent World War.
The fact that this postponement of the construction of necessary
works has been followed as yet by no very serious consequences is
to be attributed to the high rainfall which has prevailed for a period
of several years. The flow of streams in the fall of 1919 was un-
usually large and the rainfall for the first six months of 1920 was
probably the greatest that has occurred in the State in that period
since 1870. This high rainfall, completely filling the reservoirs and
thoroughly saturating the ground, has resulted in the highest average
flow of rivers, judging from that of the Nashua River, in a period of
twenty-four years. While there was a considerable deficiency in rain-
fall in parts of the State during some of the months from July to
October, inclusive, the flow of streams, judging from the flow of the
Nashua River, was above the normal in all but two months through-
out the drier part of t|ie year. These conditions have contributed
considerably to the length of water supplies in many of the cities and
towns where the consumption of water has increased greatly, in some
cases nearly 50 per cent, since the last very dry year nine years ago,
and the use of water in some of the cities and towns is in excess of the
safe capacity of their sources of water supply. Furthermore, the
excessive rainfall and flow of streams has had a tendency to keep them
cleaner than usual, supplying an unusual amount of clean water for
the dilution of sewage and other objectionable matters which they
receive. There is no question that the use, or rather abuse, of the
rivers of the State if continued — using them for the removal of
quantities of foul matter in excess of their capacities for effective
dilution — will result when the next series of dry years occurs in
great nuisances in a number of streams. Relief from such nuisances
cannot be afforded promptly, two years or more often being required,
including the necessary preliminary steps, for the construction of
No. 34.] ANNUAL REPORT. 21
proper sanitary works, and the only practicable method of guarding
against the evil effects of such nuisances is to provide the necessary
works in sufficient season to make them available when required.
In addition to the regular work of the Division, certain special
duties were referred to it as the result of legislative proceedings during
1920. These are —
To make reasonable orders limiting and regulating the entrance or discharge
into the Charles River of polluting matter injurious to the public health. (Chap-
ter 541, Acts of 1920.)
Report relative to the sanitary condition of the Acushnet River and certain
streams tributary and adjacent thereto. (Chapter 32, Resolves of 1920.)
Much work has been done by this Division in the investigation of
special benefits accruing to land in the neighborhood of the Neponset
River, effected by improvement in the channel of that stream, in
order to facilitate a decision of the questions involved by the com-
mittee of the Department having this matter in charge. While this
work has not been very extensive, it has required considerable thought
and much planning.
The special investigation of the water supply needs and resources
of the Commonwealth, authorized by the Legislature of 1919, by the
Joint Board consisting of the Public Health Council and the Metro-
politan District Commission has been prosecuted as rapidly as prac-
ticable during the year.
One of the notable accomplishments of the year, made possible by
the return of men called away by the war and the consequent increase
in the office force, has been the compilation and classification of the
data which this Division collects regularly from year to year as a part
of its routine work as required by law. This work, which for the
past few years has been necessarily postponed to as great an extent
as possible, is now being brought up to date. These activities are
fundamental and essential as a basis of sound conclusions and ade-
quate advice concerning the major problems of water supply, sewerage
and sanitation submitted for the advice of the Department.
Division of Water and Sewage Laboratories.
The Division of Water and Sewage Laboratories has been engaged
during 1920 in carrying out its usual activities. These are divided
between analytical work and research. During the year 6,343 chemi-
cal, 1,887 bacterial and 1,920 microscopical examinations were made.
These analyses were made to ascertain the condition during the year
of the rivers, wells, public water supplies and ice supplies of the State;
22 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
of the efficiency of sewage filtration areas; for determining the char-
acter of trade wastes and for the furtherance of studies regarding
their disposal; and for determining the condition as regards bacterial
pollution of shellfish from different sources. Besides this a large
amount of analytical work has been done for the new Commission
upon Water Supply Needs and Resources of the State. Research
has been carried on in regard to the corrosion of pipes in many cities
and towns of the State and at the experiment station; many studies
have been made upon methods for the disposal of trade wastes; upon
important modifications of the activated sludge tank process of sewage
disposal; upon seasonal and other variations in the bacterial quality
of shellfish from different areas of the State; of the relative signifi-
cance of B. coli and B. aerogenes in bacterial water examinations and
methods for the differentiation of these two species; in regard to the
efficiency in water treatment of liquid chlorine at low temperatures;
and of the effect of certain wastes upon municipal filtration areas.
Many experimental water and sewage filters, septic tanks, etc., are
in operation at the various stations for various purposes.
One of the interesting and exceedingly important and promising
lines of research carried on there during the past three years has been
in regard to the removal of color from water by the precipitation of
the usual color removing chemicals in the sand of filters instead of
by the direct application of such chemicals to the water undergoing
filtration as is universal in the so-called mechanical filtration of water.
By this method of color removal the chemicals are used over and
over again, thus reducing the cost of such water treatment very
materially. In fact, the longer such filters continue in operation
the smaller grows the cost per million gallons of water treated owing
to the continual reuse of the chemicals. Among other advantages
of the method are the absence of carbonic acid in the filter effluents,
thus lessening the danger of corrosion common with mechanical filter
effluents and the absolute prevention of acid effluents due to the
passage through the filters of undecomposed aluminum sulphate.
Division of Communicable Diseases.
With the exception of an outbreak of influenza in January, February
and March and of anterior poliomyelitis during the late summer
months there have been no outbreaks of any great magnitude.
During the influenza outbreak from January 1 to March 31 there
were 35,633 cases and 1,660 deaths, giving an apparent fatality rate
of 4.65 per cent. There have been roughly 1,000 additional cases
for the remainder of this year, with 9 deaths.
No. 34.]
ANNUAL REPORT.
23
The total number of cases of all reportable diseases for the year
was 135,242.
The diseases showing a noticeable increase over 1919 are chicken
pox, measles, lobar pneumonia, scarlet fever and whooping cough.
These five diseases give an excess of approximately 31,000 reported
cases with reports of measles markedly predominating.
Anterior poliomyelitis showed an undue incidence about the 1st
of July. This continued to increase up to about the week ending
October 2 when the peak was reached, and since that date the casea
have decreased. That the preparalytic diagnosis of anterior polio-
myelitis through, lumbar puncture and immediate determination of
cellular content of the spinal fluids might be available to the phy-
sicians of the State, the Department, co-operating with the Harvard
Infantile Paralysis Commission, appointed two physicians especially
trained in this work. Fifty-seven cases were visited and classified
by them as follows: —
Late paralytic,
Early paralytic,
Preparalytic, .
Not poliomyelitis.
Not diagnosed.
Puncture.
8
10
&
2
The number of cases is of course too limited to draw conclusions.
However, of the 10 cases diagnosed by this method before paralysis
was apparent, 7 have been reported on and 3 were found to have
subsequently developed paralysis.
Typhoid fever has closely followed in cases and deaths the low
figure obtained in 1919. In but six communities has there appeared
an undue incidence: —
Period.
Chelsea,
Ipswich,
Fall River, .
Taunton,
Northampton,
New Bedford,
Total, .
July.
September and Octo-
ber.
September.
July and August.
January and Febru-
ary.
January to November.
24 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
The necessity of revaccinating inmates of institutions against typhoid
fever is shown by the fact that in Taunton, Northampton and Fox-
borough State hospitals cases of typhoid fever have occurred during
the year.
Intensive work in diphtheria has been carried on throughout the
year, emphasizing the necessity of taking school and neighborhood
cultures of contacts of clinical cases. In one community — West-
field — we have demonstrated that endemic diphtheria can be con-
trolled by proper culturing and immunizing.
One institution, the Lyman School for Boys, has been completely
Schicked and immunized with toxin-antitoxin mixture. Similar work
in other State and municipal institutions which care for children will
be done during the ensuing year.
Ten outbreak notices have been sent to communities showing an
undue incidence of diphtheria. In nearly every instance this inci-
dence has been due to the missed case and to direct contact. In
Williamstown two outbreaks were investigated and the source of
infection found to be an infected finger of a milker. It is interesting
to note in connection with this outbreak that one cow developed a
sore on the udder from which virulent organisms of diphtheria were
obtained.
An outbreak of septic sore throat in Winchester, involving 43 cases,
was traced to one milk route. It was found by culturing all per-
sons handling the milk supply that a milker had a hemolytic strepto-
coccus in his throat, and was evidently the source of infection in these
cases.
Scarlet fever has had an unusual prevalence during the year. It
is believed that because of the mild type of the infection many cases
were not reported, no physician being called in attendance. The
number of deaths reported will exceed that of the past few years.
There were but eight outbreak notices sent out, these outbreaks being
mainly due to school or community contact with the unrecognized case.
An undue incidence of measles during the year has occurred, most
cases being of an extremely mild type with a low fatality rate. It
is believed that the apparent increase in the total number of cases
of communicable disease reported represent to a considerable degree
better reporting by physicians generally rather than an actual increase
in the amount of disease in the State. Early in the year arrange-
ments were made with the Board of Registration in Medicine for
closer co-operation with this Department in obtaining reports from
physicians who have been persistently remiss in this respect. We
have had but one instance in which it became necessary to ask their
assistance during the past year.
No. 34.] ANNUAL REPORT. 25
From Dec. 1, 1919, to Nov. 30, 1920, the Diagnostic Laboratory
has examined 28,637 specimens, an increase of 2,783 over the corre-
sponding period last year. The total cost will approximate S9,000.
The cost per examination is about 31 cents, which has been the average
for the past five years. The increase in amount of work each year
offsets the increased cost.
There has been an increase in all lines of work except the Widal
test for typhoid fever and smears for gonococci. The slight decrease
in Widal tests is probably due to the fact that there is less typhoid
fever reported in the State. The typhoid culture work, however,
has increased 65 per cent over the previous year, giving a total of
approximately 900 examinations. Three typhoid carriers have been
discovered.
To November 30, 545 specimens of sputum were examined for
pneumococcus type. This is an increase of 50 over last year's total.
The subdivision of venereal diseases has continued its campaign
for the prevention and control of venereal diseases along the same
lines as in former years. A notable achievement has been the work
with the courts and probation officers. Every court in the Com-
monwealth has been visited, our campaign outlined and the co-oper-
ation of the judge and probation officers secured.
The incidence of venereal diseases from our reports shoM^s a de-
crease. We have visited several communities, interviewing the phy-
sicians, and they are unanimous in the report that they are treating
fewer cases of venereal disease than in previous years.
The study groups formed last year for the discussion of venereal
disease problems have been continued and much interest has been
displayed. During the year 62 meetings were held with 18 groups.
More and more does it become evident that the clinic treatment
is the keystone of all venereal disease control, and attendance at
nearly all of the clinics is increasing. During the year three new
clinics have been established. All large centers of the State are now
adequately cared for by this clinic service.
All jails have been visited during the year and have been found to
be complying with the law requiring the physical examination of all
inmates committed for thirty days or more.
The conferences held quarterly for clinic chiefs have continued to
be a marked success. The programs arranged by the subdivision have
been of real merit and the attendance of the clinic chiefs has been
constant.
The reorganization act of 1919 placed the Penikese Hospital for
lepers under the charge of this Department. There has been little
or no change in the administration of this work from that of pre-
26 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
ceding years. There are at present fifteen patients at the hospital,
two of whom are soldiers cared for by the War Risk Insurance Bureau.
The labor situation has been acute all the year and only by per-
sistent effort on the part of the superintendent has there been suffi-
cient personnel to keep the institution up to its standards. The per
capita cost is unavoidably high owing to the location of the hospital.
Nothing may be purchased without a substantial addition to the
first cost, due to transportation charges.
The care given by the superintendent to these unfortunate people
is of the best and is reflected in an air of satisfaction and content-
ment in the institution.
The personnel of the Division has undergone many changes. Owing
to our inability to secure properly qualified persons for District Health
Officers it has appeared wise to redistrict the State into seven districts
rather than eight as formerly. It is yet too soon to form an opinion,
as to whether or not this plan may be worked out advantageously
and without too great a burden upon the District Health Officers
affected by the change.
That the tuberculosis work formerly done by this Division might
be more completely co-ordinated with the work done by the sanatoria
it was recommended that all tuberculosis work be transferred to the
Division of Tuberculosis. This has been done and will, I believe,
in the very near future give evidence of the wisdom of such a move-
ment.
The attention of this Division was called early in July to the intro-
duction of plague in new foci in the Southern ports. Representatives
of the Department were sent to these ports to study plague preventive
measures and a definite plan for rodent surveys has been outlined
by which it is hoped the introduction of plague into the Common-
wealth will be prevented. The surgeon general of the United States
Public Health Service has detailed to this Department as well as to
the health departments of the other New England States an officer
who shall act in an advisory capacity on plague control methods.
Preliminary surveys of all seaport cities and towns of Massachusetts
have been made, together with a definite plan for a rodent survey
for each, and ordinances prepared for each community to adopt.
All that is needed is the necessary appropriation to put these plans
into effect.
The Public Health Service early in the year delegated to this De-
partment an epidemiological aide who has been instrumental in carry-
ing out several mosquito surveys and who has also done special work
on diphtheria in the Connecticut valley.
This Division has also lent its aid and assistance in formulating a
No. 34.] ANNUAL REPORT. 27
plan for lectures to nurses in hospital training schools. This com-
prises a course of nine lectures on the fundamental principles of public
health, with the object of interesting this group of people in public
health matters.
The multiplicity of detail which the District Health Officer handles
in his district is increasing each year. During the past twelve months
his assistance has been solicited in special investigations, such as the
maternity investigation, in lecturing to nurses and other groups of
people interested in public health, with considerable time expended
in co-operative effort with the Massachusetts Tuberculosis League.
Much of the success of the consultation service for the diagnosis of
tuberculosis must be credited to the efforts of the field force.
With the assistance of the United States Public Health Service,
an attempt has been made to establish in Barnstable County a com-
munity health organization with a full-time executive officer, trained
in public health, and the necessary assistance. Great interest has
been aroused and it is hoped that the local communities will appro-
priate, at their coming town meetings, sufficient money to make such
a combination possible.
One of the difficult features of public health administration is the
evaluation of the results of the efforts of those engaged in this par-
ticular endeavor.
We see, however, that here and there appears an additional public
health nurse, a new nutritional or child welfare clinic, a full-time
health officer replacing perhaps an untrained agent of the board,
more efficient school inspection, the local board placing special em-
phasis upon the control of an outbreak, a survey as to the tuber-
culosis situation in a community, or increased consultations with the
physicians in obscure cases or in helping to establish a differential
diagnosis. These achievements give answer to the query so often
heard, "W'hat does the District Health Officer accomplish?" — for
these are the tangible results of the persistent effort of the conscien-
tious public health worker.
Side by side goes the nursing assistant advocating and teaching
public health to the community itself. The year's work is replete
with evidence of her devotion to her work. No new activity for
increasing the community's public health is without her honest effort
and participation. More than ever is it apparent that with these
field workers must rest the task of educating the local community to
its full responsibility.
28 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Division of Tubekculosis.
The Division of Tuberculosis was organized Jan. 1, 1920, pursuant
to chapter 350 of the General Acts of 1919. This act, which is known
as the consolidation of departments act, abolished the Board of Trus-
tees of Hospitals for Consumptives and transferred to the Department
of Public Health all the rights, powers, duties and obligations of said
board. By this act the Commissioner of Public Health was directed
to establish within the Department of Public Health a Division of
Sanatoria which shall include the institutions formerly under the
Board of Trustees of Hospitals for Consumptives.
Previous to the passage of this act the tuberculosis work of the
Department of Public Health was confined to the Division of Com-
municable Diseases. An important step taken by this Division was
the compilation of all known cases of tuberculosis from Jan. 1, 1915,
to Jan. 1, 1920. This work has been transferred to the Division of
Tuberculosis. So the Division of Tuberculosis has the administrative
supervision of the four State sanatoria, the compilation of all known
cases of tuberculosis in the State, and the general supervision of all
tuberculosis activity in the Commonwealth.
The policy of the former trustees was to admit to the State sana-
toria only cases of pulmonary tuberculosis. Of this class only in-
cipient cases were admitted to Rutland; advanced types of pulmonary
tuberculosis were admitted to the other State sanatoria. Admission
to the sanatoria was limited to persons over fifteen years of age, ex-
cept at Westfield, where children between the ages of five and fifteen
were admitted.
When it is remembered that formerly the State sanatoria were
the only hospitals in the Commonwealth where consumptives were
admitted, the wisdom of this policy is apparent.
The county hospital act, which provided that all cities of 50,000
population or over should maintain a tuberculosis hospital, and that
cities under 50,000 should combine and maintain a county tubercu-
losis hospital, has given increased facilities for hospital care for tuber-
culous patients.
And so the Division of Tuberculosis has had under advisement
the proposition of placing the four State sanatoria on an even basis.
This plan proposes to admit to the sanatoria only cases favorable
for arrest. It also proposes to limit the residence of patients at the
sanatoria. The presence of patients at the sanatoria for five years
or more is entirely incompatible with the theory of sanatorium treat-
ment of tuberculosis. It is believed by the best minds in tuberculosis
work that intensive sanatorium treatment of early, favorable cases
No. 34.] ANNUAL REPORT. 29
of pulmonary tuberculosis will arrest the disease inside of one year
and turn the patient back to society capable of self-support. The
old policies of restricting admission to the sanatoria to cases of pul-
monary tuberculosis and of admitting children between the ages of
five and fifteen years to the Westfield State Sanatorium seem sound
and worthy of continuation.
For the year ending Nov. 30, 1920, there were admitted to the
sanatoria 1,472 patients; discharged, 1,363; died, 251.
An important piece of work done during the past year was the
examination of inmates of the prisons in the State with reference to
the presence of tuberculosis. This examination was made by the
staffs of the sanatoria. The following is the result of this examina-
tion: number of prisoners examined, 1,500; active cases, 7; should
be under observation, 43.
The tuberculosis associations of the State are very active in securing
physical examination of all contacts. At various times they have
sought the aid of this Division in securing the services of the sana-
toria staff for this purpose. The demands became so frequent that
it was found necessary to adopt a definite policy in regard to this
work, and so a series of examination clinics was inaugurated. These
clinics are held in cities and towns which are not provided with a
tuberculosis dispensary, in accordance with chapter 537 of the Acts
of 1911. The patients for these clinics are furnished by the tubercu-
losis societies, and the examination is done by the sanatoria staff.
The need of assistance to physicians throughout the State in the
early diagnosis of pulmonary tuberculosis has long been apparent.
In order that these physicians might keep their patients as private
patients and still avail themselves of consultation service, in cases
where patients were unable to meet a consultant's fee, consultation
clinics were inaugurated in September of this year. These clinics are
held in sixteen cities. The results of three months' experience are as
follows: number of cases, 170; positive diagnosis, 85; negative diag-
nosis, 85.
The co-operation of the public health nurse of local boards of health
has been stimulated by the formation of associations of public health
nurses. In every health district such an association has been formed
and semi-annual meetings are held at the various State sanatoria,
where tuberculosis problems are discussed.
The payment of subsidy for non-bacillary types of pulmonary
tuberculosis which are receiving hospital care will materially increase
the appropriation formerly made for subsidy purposes.
30 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Division of Hygiene.
The major activities of the Division of Hygiene during the past
year have been these: study of the maternity benefit problem; ex-
tension of efforts along the line of improving the nutrition of the
child and of awakening in the public an appreciation of the need of
mouth hygiene; extension of rural clinics; and, lastly, the prose-
cution of two investigations, namely, of the midwife situation and of
the open-air school.
The beginning of the legislative year saw the introduction of various
bills providing for better care of maternity and infancy. The Divi-
sion of Hygiene studied these bills carefully and made estimates for
the information of the Legislature as to the cost of administration of
one form or another, were such a law to be enacted. Many requests
came in from women's clubs and others for a critical estimate of the
value of such legislation.
The facts upon which suggested legislation was predicated are un-
deniable. The loss of over 700 mothers annually from causes related
to childbirth, many of these from causes clearly preventable, the loss
of nearly 4,000 infants under one month of age, and the loss of 2,500
babies stillborn; these, and the additional facts of maternal and
infant ill-health and disability are sufficient to render it imperative
to attempt some remedy.
The creation by the Legislature of a recess commission to study
the problems involved in maternity benefits gave an additional oppor-
tunity to the Director and staff of the Division of Hygiene to study
this subject so bound up with the most vital part of the Division's
work. This study, begun under the auspices of the Maternity Benefit
Commission, ought to be carried on by the Division of Hygiene
through a series of years, regardless of the passage of specific legis-
lation regarding maternity protection. This would have been done
previously but for the lack of an adequate force and funds. Profiting
by the experiences gained during the summer, such an investigation
could be carried along with much greater ease than would heretofore
have been the case.
An investigation into the midwife situation in this State has re-
<?ently been made. Massachusetts has been criticized because of its
illogical method of handling the midwife. Obliged by law to report
births, the midwife is liable to prosecution for practicing medicine
illegally if she does report them. Attempts have been made to abolish
the midwife but without avail, as figures will show.
The investigation undertaken this year by the Division of Hygiene
furnished information upon which could be based some estimate as
No. 34.] ANNUAL REPORT. 31
to the number of midwives practicing and as to the type of work
done by them. A series of nine representative cities and towns was
chosen for careful study. In these towns two keen investigators
found 117 midwives practicing and obtained information which would
point to still others. Certain of these midwives are graduates of
training schools abroad; others have had little or no training of any
kind. Some apparently have a fair idea as to cleanliness and an
appreciation of their limitations; others have neither the one nor
the other. There is reason to believe that repressive measures have
done more to discourage the practice of the better grade midwives
than of the poorer ones who are willing to take a greater chance with
the law. A proper solution of the midwife problem is yet to be made
and this is a subject which must be considered very carefully again
during the coming year.
A further investigation of the open-air schools of the State has
been made this year in the course of which practically all the open-
air schools or classes in Massachusetts were visited. Answers to
questionnaires were obtained as to the practice in respect to such
schools in other States. It was hoped that possibly sufficient light
"would be thrown on this problem so that tentative uniform standards
might be suggested. However, it does not appear that this can
safely be done at present, and study and experience along these lines
in the near future seem to be indicated.
Several years have elapsed since educational effort directed towards
the practical application of the facts of nutrition to personal hygiene
and the public health was begun in the Division of Hygiene. With
printed material and lectures as a beginning, the work has developed
until vital contact is now had with practically all the agencies of the
State interested in this type of work. Contact with public groups
through the medium of illustrated lectures has reached the point
where one worker can no longer meet the demand. The great object
of the Division now is to be of assistance in the gradual process of
bringing the dietitian or nutritionist — the heir of the " cooking teacher"
— from a position of isolated specialist into the fellowship of public
health workers in general.
Hand in hand with the development of an interest in nutrition is
going interest in mouth hygiene. The latter field is newer in point
of time but bids fair to be tilled with equal rapidity owing to the
tremendous appeal which oral hygiene seems to be making at the
present time to the general public. As in the case of the nutrition
work, the first step in mouth hygiene activity in this Division was
through public lectures and the printed word. The work has grown
to the same point referred to under the head of nutritional activities.
32 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
One field worker is no longer sufficient to meet the demands. Re-
quests for advice on new problems involving the establishment of
new centers in municipalities for mouth hygiene work and the co-ordi-
nation of the newer with the older public health activities are becoming
more pressing every day. The exponent of mouth hygiene, like the
nutritionist, must be helped to find a secure and logical place within
the ranks of public health workers.
The newest activity of the Division of Hygiene bids fair to be one
of great importance. Starting in a modest way a year ago at the
agricultural fairs, the rural clinic service has developed into a whole-
time piece of work which has won for itself a definite place in the
Division's activities. The aim of the rural clinics is to demonstrate
by the examination of children the need of greater attention being
paid to their normal development. The ultimate aim of this work
is to so demonstrate the need for such preventive and corrective
facilities for children that communities will institute and provide such
facilities as a permanent thing.
Division of Biologic Laboratories.
Certain changes have been made in the organization of this Divi-
sion during the past year, the principal one being the appointment
of a full-time director, an arrangement which has proved most suc-
cessful. The volume of work of both branches of the Division of
Biologic Laboratories — the Antitoxin and Vaccine Laboratory and
the Wassermann Laboratory — show a noteworthy increase over the
previous year. During the coming year it will be absolutely necessary
to somewhat increase the present small force in order to properly
handle the increased work; as has been stated previously the present
quarters afford altogether too little space for the number of workers
and the amount of work being done. The problem of providing for
the expansion of the laboratories and their permanent housing is still
to be settled.
A considerable saving has been effected by purchasing supplies on
bids and in quantity, and by standardizing the various apparatus and
supplies used.
The accompanying table shows the production, distribution and
stock on hand of all products of the Antitoxin and Vaccine Laboratory
for the past two years and is a very interesting exhibit of the work
of the Laboratory for this period (see next page). With reference
to production it is interesting to note that the amount of blood taken
from immune horses at each semimonthly bleeding has been increased
by approximately 30 per cent. The horses have borne the increased
bleedings with no ill effects and production has been increased by the
No. 34.]
ANNUAL REPORT.
33
above figures. The methods formerly used in the vaccination of
calves for the production of smallpox vaccine have been changed,
with the result that the yield of vaccine from each calf has been
increased approximately 75 per cent.
On Feb. 1, 1920, the average potency of diphtheria antitoxin pro-
duced was 230, whereas the serum will average approximately 450
units at the present time. The 100 per cent increase in the average
potency of all diphtheria antitoxin produced during the year has been
made possible by the stronger toxin available and by the change in
the method of immunizing diphtheria horses.
Product.
1 . Diphtheria antitoxin :
Produced
Distributed, ....
On hand, ....
2. Diphtheria plasma:
Produced, . . .
Used in concentration,
On hand, ....
3. Concentrated diphtheria antitoxin:
Produced, ....
Distributed, ....
On hand, ....
1919.
Liters.
602.26
646.067
72.3
165.95
109.05
60.
Total
1,000 Unit
Doses.
143,101
16,028
Units
per c.c.
221
147
Liters.
769.1
482.0
232.4
1,126.6
725.
369.1
158.6
100.73
55.2
1920.
Total
1,000 Unit
Doses.
Units
per c.c.
179,756
38,471
60,720
372
381
1,100
Product.
1919.
1920.
Liters.
Total Doses.
Liters.
Total Doses.
4. Antimeningococcic serum:
Produced,
Distributed,
On hand,
5. Antipneumococcic serum, Type I:
Produced
Distributed
On hand,
6. Smallpox vaccine:
Produced
Distributed,
On hand,
7. Typhoid paratyphoid vaccine:
Produced
Distributed
On hand
86.5
67.365
31.
23.800
42.200
36.925
2.349
3.247
112.3
74.123
5,766
4,565
238
422
369.25
140,940
194,807
112,300
74,123
317.665
48.310
47.2
147.700
44.4
100.700
4.844
3.151
1.624
73.5
49.191
16.6
21,177
3,585
1,477
444
1,007
290,610
189,064
97,440
73,500
49,191
16,600
Outfits.
Total Doses.
Outfits.
Total Doses.
8. Schick outfits:
Produced
Distributed,
On hand,
96.
96.
9,600
9,600
91.
63.
30.
9,100
6,300
3,000
34
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
1919.
1920.
Product.
Liters.
Total Doses.
Liters.
Total Doses.
9. Diphtheria toxin-antitoxin:
Produced,
Distributed
. On hand,
1.108
1,108
6.443
3.614
2.829
6,443
3,614
2,829
Liters.
Potency.
Liters.
Potency.
10. Diphtheria toxin:
Produced,
Used,
On hand,
533.
583.
20.
.006
.006
.006
539.
456.
83.
.0025
.0025
.0025
Wassermann Laboratory.
During the past year the activities of the Wassermann Laboratory
have been confined to the execution of tests established during previous
years. Its personnel has not changed in number but the volume of
its work shows a noteworthy increase over that of 1919 as indicated
in the following table: —
1919.
1920.
Increase
(Per Cent).
Wassermann tests,
Gonococcus fixation tests
Diagnostic examinations for Department of Animal Industry:
(o) Complement fixation test for glanders,
(b) Examination for rabies,
(c) Pathologic and bacteriological examinations,
Totals
31,485
222
122
84
79
31,S92
37,277
1,758
237
161
65
39,498
18
609
94
23.5
1 Decrease.
In addition to these activities, investigations carried on by this
laboratory on the utility of complement fixation as a clinical aid in
the diagnosis of tuberculosis have shown that the test at present is
not sufficiently dependable for the purpose.
Division of Food and Drugs.
During the year just passed, 10,847 samples were examined and
311 cases were prosecuted. This figure represents a slight increase
in prosecutions over last year's figures, but a decrease in the number
of samples collected, due largely to weather conditions in the early
part of the year when transportation was practically stopped.
No. 34.] ANNUAL REPORT. 35
There has been rather more special co-operative work with local
boards of health than heretofore. Analyses have been furnished to
the milk inspectors or health officers of Barnstable, Lawrence, Newton,
North Adams, Fitchburg, Weymouth, Arlington, New Bedford and
Woburn, and the milk inspectors or agents of the boards of health of
Springfield, Fitchburg, Fall River, Newton and Somerville have fur-
nished this Department information resulting in the collection of
evidence relative to violations of the law.
The liquor samples are nearly as numerous as those submitted last
year, but all the samples submitted were intended for prosecution in
the Massachusetts courts, a marked contrast to the large numbers
submitted and examined last year for prosecution in the United States
courts. Fifty cities and towns submitted samples during the year.
The character of the samples 'submitted has changed materially from
those submitted in former years. Most of the samples formerly sub-
mitted consisted of beer, cider and wine. More than half the samples
now submitted consist of distilled liquors.
Special investigations outside of the usual work upon milk and
eggs have been made of sausages, dried fruits, salad dressing, sugar,
clams and soft drinks. It was found that many of the soft drink
manufacturers were using saccharine. Most of these persons ceased
this practice after being given a hearing. Those who did not were
prosecuted, and in all cases convictions have been obtained.
The usual investigations of the cold-storage warehouses and cold-
storage food have been made during the year as well as the usual
investigations of slaughtering under Massachusetts inspection. Rela-
tive to the latter, a number of violations were found in Berkshire
County, such as selling unwholesome meat and selling meat obtained
from diseased animals. Convictions were secured in these instances.
In general, however, the local slaughtering inspection is carried out
in a satisfactory manner.
During the year a new bakery law has been enacted, to be enforced
jointly by this Department and local health authorities. Regulations
have been adopted after a series of conferences with local boards of
health and certain bakeries. One inspector has been assigned to work
under this law. The bakeries of certain cities have already been in-
spected, and it is proposed to inspect all the bakeries in the State in
this manner during the coming year.
In connection with the co-operative purchasing plan of the State
institutions, a number of analyses have been made for the Depart-
ment of Public Welfare, these analyses being confined to soap chips,
soap bars and milk powders. The soap chips are being purchased
upon specifications and each barrel is examined to see whether or
36 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
not the chips conform with the specifications. It was intended to
purchase coal in this manner, and the apparatus has been purchased,
but owing to the fact that no competitive bids could be obtained,
no analyses of coal have been made as yet.
Since January 1 the arsphenamine production has been suffi-
cient to supply all the needs of the Department. A new method for
the recovery of toxic batches has been developed by the staff of the
department of pharmacology of the Harvard Medical School, the
head of which department. Dr. Reid Hunt, has served as pharma-
cologist to test the toxicity of arsphenamine ever since this Depart-
ment commenced its manufacture. This method has been applied
to several toxic batches and the resulting purified product has been
used successfully in the clinics. The process seems to produce a
purer product than the process usually employed, and steps are now
being taken to manufacture all our arsphenamine by this process.
Appropkiations and Expenditures for the Year ended Nov. 30,
1920.
Division of Administration.
Appropriation for personal services, . . . . . . . $21,100 00
Expended for personal services, 20,343 62
Balance, $756 38
Appropriation for expenses, $11,500 00
Brought forward from 1919 to cover sundry charges, ... 66 50
Credit by refund, 12^00
$11,578 50
Traveling, $503 13
Express, 145 12
Printing and binding, 5,288 15
Books and subscriptions, 377 25
Advertising, 15 28
Stationery, maps and blue prints, 811 26
Postage and postal orders, 1,673 82
Telephone and telegraph messages, 966 84
Typewriter supplies and repairs, 144 39
Sundry office supplies, 101 35
Messenger, 274 90
Miscellaneous, "0 S2
Total, S10,3S1 31
Unexpended balance, 1>197 19
$11,578 50
No. 34.] ANNUAL REPORT. 37
Division of Hygiene.
Appropriation for personal services, 118,645 00
Expended for personal services, 16,690 26
Balance, $1,954 74
Appropriation for expenses, S20,500 00
Brought forward from 1919 on account of cancer investigation, . 1,801 54
Transfers from Administration appropriation, 292 39
S22,593 93
Traveling, $5,029 22
Express, . 268 05
Printing and binding, 6,977 57
Books and subscriptions, 53 36
Advertising and educational work, 2,159 20
Stationery, maps and blue prints, 412 25
Postage, 849 94
Telephone and telegraph, 99 20
Typewriting supplies and repairs, 136 73
Mo\ing-picture expenses, 92 58
Automobile truck expenses, 1,101 95
Office supplies, 328 62
Laboratory supplies, 31 69
Special investigations, 3,173 62
Miscellaneous, 76 12
Total, $20,790 10
Unexpended balance, 1,803 83
$22,593 93
Division of Communicable Diseases.
Appropriation for personal services, . $55,500 00
Expended for personal services, 54,969 03
Balance, $530 97
Appropriation for expenses, $22,500 00
Brought forward from 1919, 168 60
Credit account of cash returned to treasury, 4 50
$22,673 10
38 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Traveling, $11,933 26
Express, 37 19
Printing and binding, 1,223 90
Books and maps, 164 85
Postage, 1,500 85
Typewriter supplies, 35 50
Extra services (field), 274 33
Telephone and telegraph, 889 13
Office supplies and stationery, 946 00
Laboratory and experimental work, 3,069 46
Furniture, "53 08
Animals, 174 25
Food for animals, 19 29
Labor, 62 05
Office rent and Hght, 1,187 13
Miscellaneous, 55 80
■ Total, $22,326 07
Unexpended balance, 347 03
$22,673 10
Subdivision of Venereal Diseases.
Appropriation for personal services, ^ $5,200 00
Expended for personal services, 8,949 83
Balance withdrawn from Federal fund, ..... $3,749 83
Appropriation for expenses, ^$11,342 50
Travehng, $2,269 99
Printing and binding, 151 95
Reprints, books and maps (educational), 1,641 33
Typewriter supplies, 4 00
Extra services (field), 50 00
Telephone and telegraph, 28 65
Office suppUes and stationery, 98 19
Clinics, 9,458 34
Furniture, 9 00
Miscellaneous, 1 75
Total, $13,713 20
Balance withdrawn from Federal fund, ...... 2,370 70
$11,342 50
1 An equal amount received from the United States government for venereal disease control activities
in accordance with the provisions of the Chamberlain- Kahn act does not appear as State appropriation.
No. 34.] ANNUAL REPORT. 39
Division of Biologic Laboratories.
Appropriation for personal services, 1 $29 740 00
Expended for personal services, 29 120 94
Balance, $619 06
Appropriation for expenses, 1 $26 500 00
Credit account of refunds to treasury, 438 15
126,938 15
Apparatus, chemicals and laboratory supplies, $8,489 23
Traveling, 222 94
Express, 136 18
Books, stationery, office supplies and furniture, 961 50
Printing, 618 84
Purchase of animals, 3,057 75
Shipping, 1^135 19
Services of veterinary surgeon and saddlery, 9 30
Food for animals, 7,601 20
Rental of telephone, messages and postage, . . . . . 515 17
Rent, 2,058 32
Water, gas, electric lighting and heating, 1,251 96
Labor and materials, 1,215 17
Ice, 647 20
Miscellaneous, 656 02
Total, $28,575 97
Balance withdra^vn from Federal fund, 1,637 82
$26,938 15
Division of Food and Drugs.
Appropriation for personal services, $28,750 00
Expended for personal services, 28,359 65
Balance, $390 35
Appropriation for expenses, $11,000 00
Brought forward from 1919, 7 80
$11,007 80
Apparatus and chemicals, $1,688 46
Traveling, 6,524 98
Purchase of samples, 516 04
Express, 20 75
> An additional amount equal to one-half of expenditures of Wassermann Laboratory received from
the United State? government for venereal disease control activities in accordance with the provisions
of the Chamberlain-Kahn act does not appear as State appropriation (approximately S5,000).
40 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Printing, $498 69
Books, maps and stationery, 441 64
Telephone, telegraph messages and postage, 186 15
Sundry laboratory supplies, 499 27
Typewriter supplies and repairs, 115 78
Branding outfits, 78 74
Labor, . 10 80
Professional services, 225 00
Miscellaneous, 3 04
• ,1.
Total, $10,809 34
Unexpended balance, 198 46
$11,007 80
Manufacture and Distribution of Arsphenamine.
Appropriation for personal services, ^ $5,250 00
Expended for personal services, 8,156 77
Balance withdrawn from Federal fund, $2,906 77
Appropriation for expenses, ^ $3,775 00
Brought forward from 1919, 5 77
Credit account of refund, 25 00
$3,805 77
Apparatus, chemicals and laboratory supplies, $2,512 68
Professional services, i 733 33
Animals, 510 40
Travel, 115 20
Express, 81 18
Rent, 900 00
Labor, 69 96
Purchase of arsphenamine, 1,660 96
Heat and light, 414 57
Ice, 45 63
Telephone, 35 04
Water, . 21 00
Shipping, 1,158 23
Printing and binding, 19 40
Miscellaneous, 78 84
Total, $8,356 42
Balance withdrawn from Federal fund, 4,550 65
$3,805 77
' An equal amount received from the United States government for venereal disease control activities
in accordance with the provisions of the Chamberlain-Kahn act does not appear as State appropriation.
No. 34.1 ANNUAL REPORT. 41
Division of Sanitary Engineering.
Appropriation for personal services, S33,500 00
Expended for personal services, 28,882 14
Balance, $4,617 86
Appropriation for expenses, $11,200 00
Brought forward from 1919, 7 15
$11,207 15
Apparatus and materials, $1,650 53
Traveling, ' 4,096 08
Express, 1 96
Printing and binding, 239 71
Maps, blue prints and books, 259 25
Stationery, drawing materials and office supplies, .... 1,077 06
Telephone, telegraph messages and postage, 235 14
Services, collecting samples and reading gauges, . . . . 351 95
Furniture and equipment, 1,132 44
Miscellaneous, 74 94
Total, $9,119 06
Unexpended balance, 2,088 09
$11,207 15
Division of Water and Sewage Laboratories.
Appropriation for personal services, $28,500 00
Expended for personal services, 26,470 27
Balance, $2,029 73
Appropriation for expenses, $5,000 00
Credit by refunds to treasury, 148 43
$5,148 43
Apparatus and materials, $2,878 03
Traveling, 386 97
Express, 1,275 67
Printing and binding, 158 40
Maps, blue prints and books, 17 75
42 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Stationery, drawing materials and office supplies, .... S130 67
Telephone, telegraph messages and postage, 53 82
Labor, 40 80
Rent, 150 00
Miscellaneous, 32 30
Total, S5,124 41
Unexpended balance, 24 02
$5,148 43
Division of Tubekculosis (Sanatoria).
Appropriation for personal services, $12,170 00
Expended for personal services, 11,850 83
Balance, S319 17
Appropriation for expenses, $2,700 00
Credit by cash returned to treasury, 48 89
$2,748 89
Traveling, $1,343 46
Printing, 491 34
Telephone and telegraph, 66 10
Books and subscriptions, 60 19
Stationery, 219 94
Postage, 230 10
Office equipment, 13 00
Miscellaneous, 79 50
Total, S2,503 63
Unexpended balance, 245 26
$2,748 89
Appropriation to cover payment of subsidies to which certain
cities and towns are entitled under the provisions of chap-
ter 597, Acts of 1911, as amended by chapter 290, General
Acts of 1917, $173,596 12
State Examiners of Plumbers.
Appropriation for the year ended Nov. 30, 1920, .... $4,620 00
Brought forward from 1919, 219 86
$4,839 86
No. 34.] ANNUAL REPORT. 43
Salaries and examiners' wages, $3,478 06
Traveling, 510 94
Express, 34 97
Printing, 349 56
Postage, 79 44
Books and stationery, 42 32
Plumbers' materials, 30 25
Extra services, 105 15
Cleaning, 17 00
Office supplies, 19 77
Telephone and lighting, 106 16
Miscellaneous, 8 25
Total, $4,781 87
Unexpended balance, 57 99
$4,839 86
Penikese Hospital.
Appropriation for the year ended Nov. 30, 1920, .... $34,820 00
Salaries, $13,742 12
Traveling, transportation and office expenses, 1,887 88
Food, 6,173 32
Clothing and materials, 723 12
Furnishings and household supplies, 1,354 84
Medical and general care, 2,076 44
Heat, hght and power, 4,358 47
Farm and stable, 3,857 21
Grounds, 54 52
Repairs, ordinary, 1,464 75
Total, $35,692 67
Deficit, 872 67
44
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Recapitulation.
Appro-
priation plus
Credits.
Total Appro-
priation.
Expended.
For the Division of Administration,
For the Division of Hygiene,
i
For the Division of Communicable Diseases, . . \
[
For the Subdivision of Venereal Diseases,
For the Division of Biologic Laboratories, . . . \
For the Division of Food and Drugs, .
. i
For the manufacture and distribution of arsphenamine, {
For the Division of Sanitary Engineering, .
For the Division of Water and Sewage Laboratories,
For the Division of Tuberculosis (Sanatoria),
For subsidies to cities and towns,
For the State Examiners of Plumbers,
For the maintenance of Penikese Hospital, .
Totals
. I
$32,600 00
78 50
39,145 00
2,593 S3
78,000 00
173 10
56,240 00
438 15
39,750 00
7 80
9,025 00
30 77
44,700 00 1
7 15 J
33,500 00 1
148 43 J
14,870 001
48 89 J
4,620 00
219 86
$32,678 50
41,738 93
78,173 10
16,542 50'
56,678 15-
39,757 80
9,055 77'
44,707 15
33,648 43
14,918 89
173,596 12
4,839 86
34,820 00
$30,724 93
37,480 36
77,295 10
22,663 03
57,696 91
39,168 99
16,513 19
38,001 20
31,594 68
14,354 46
173,596 12
4,781 87
35,692 67
$581,155 20
$579,663 51
1 An equal amount received from the United States government for venereal disease control activities.
2 Approximately $5,000 additional received from the United States government for venereal disease
control activities in accordance with thp provisions of the Chamberlain-Kahn act. These sums of money
do not appear as State appropriation.
No. 34.]
ANNUAL REPORT.
45
ExPE^^DITUKES OF Tuberculosis Sanatoria for the Year ended
Nov. 30, 1920.
Rutland.
Lakeville.
Westfield.
North
Reading.
Totals.
Appropriation for maintenance,
$304,280 00
$201,810 48
$196,503 00
$163,355 00
$865,948 48
Balance brought forward from pre-
3,722 33
-
-
789 48
4,511 81
$308,002 33
$201,810 48
$196,503 00
$164,144 48
$870,460 29
Personal services, ....
$115,107 90
$86,245 11
$82,998 08
$57,876 35
$342,227 44
Religious instruction,
1,800 00
1,131 44
1,189 60
1,600 00
5,721 04
Travel, transportation and office
3,184 34
1,947 37
1,841 38
2,036 06
9,009 15
Food,
93,199 34
31,771 18
39,968 30
56,699 78
221,638 60
Clothing and materials, .
239 64
14 95
979 89
936 63
2,171 11
Furnishings and household supplies,
10,455 68
5,946 08
10,034 44
6,285 84
32,722 04
Medical and general care.
8,787 89
3,866 35
3,365 87
3,308 26
19,328 37
Heat, light and power, .
30,734 22
12,827 04
14,859 63
12,514 78
70,935 67
Farm,
20,419 85
39,236 88
16,889 89
8,400 25
84,946 87
Garage, stable and grounds, .
7.181 58
7,867 16
5,082 98
2,724 75
22,856 47
Repairs, ordinary, ....
9,129 09
7,233 25
9,950 06
3,412 98
29,725 38
Repairs and renewals.
1,090 48
654 06
9,325 54
3,735 72
14,805 80
Total expenditures, .
$301,330 01
$198,740 87
$196,485 66
$159,531 40
$856,087 94
Unexpended balance,
$6,672 32
$3,069 61
$17 34
$4,613 08
$14,372 35
Average number of inmates, .
345
231
265
188
1,029
Weekly per capita cost, .
$16 78
$16 50
$14 24
$16 29
$16 00
Receipts for board of inmates.
$48,712 23
$34,574 10
$42,187 19
$29,322 30
$154,795 82
Receipts from sales,
830 87
1,070 16
1,541 96
796 13
4,239 12
Total receipts
$49,543 10
$35,644 26
$43,729 15
$30,118 43
$159,034 94
46
DEPARTMENT OF PUBLIC HEALTH. [P. D. No. 34.
Special Appropriations — Tuberculosis Sanatoria.
Rutland.
Appropriation fob —
Act or Resolve.
Amount.
Total ex-
pended to
Nov. 30,
1920.
Balance
carried to
Next Year.
Kitchen, service and storehouse buildings, .
Chap. 55, 1918
$55,000 00
353,905 74
$1,094 26
Lakeville.
Shelter for young stock, ....
Chap. 629, 1920
$2,500 00
$1,696 52
$803 48
Generator unit
Chap. 629, 1920
9,005 00
153 30
8,851 70
Purchase of land,
Chap. 153, 1919
2,500 00
-
2,500 00
$14,005 00
$1,849 82
$12,155 18
Westfield.
Purchase of land,
1920
$1,890 00
-
$1,890 00
Remodeling barn,
1920
5,700 00
$5,662 76
37 24
Remodeling farmhouse and dormitory,
1920
10,000 00
9,988 23
11 77
Installing engine and generator, .
1920
6,500 00
1,311 90
5,188 10
$24,090 00
$16,962 89
$7,127 11
North Reading.
Nurses' hall and chapel.
Cottage for engineer and steward.
Chap. 211, 1919
Chap. 629, 1920
Chap. 225, 1920
$48,150 00
16,500 00
$64,650 00
$48,144 42
9,611 29
$57,755 71
$5 58'
6,888 71
$6,894 29
1 Reverting to treasury of Commonwealth.
(
SUPPLEMENT
[471
Division of Sanitaey Engineering
X. H. GooDNOUGH, Director
149]
I
EEPORT OF DIVISION OF SANITARY ENGINEERING.
During 1920, as in the years which immediately preceded, the
conditions brought about by the war — scarcity and excessive prices
of labor and material — have continued to prevent the construction
of necessary public works, especially water supplies and sewerage
systems. Furthermore, the remarkably high rainfall — the greatest
in thirty years — following the high rainfall of preceding years has
furnished an abundant supply of water from nearly all sources of
water supply in use in the State, including many which are noAv being
used in excess of their safe capacity. At the same time, the high
rainfall has maintained a high flow in the streams, and thus has caused
a greater dilution of polluting substances than has been the case in
any previous year for more than a quarter of a century.
The Department received during the year 141 applications in
relation to water supply, drainage, sewerage, the pollution of streams
and similar matters, the number being about the same as for several
years. Of these, 40 were in relation to public water supplies, 55 in
relation to wells and springs used mainly as sources of water supply
for factories, camps and summer colonies, 7 to sources of ice supply,
17 to sewerage, drainage and sewage disposal, 5 to pollution of streams,
and 17 to miscellaneous matters. One new water supply was introduced
during the year, the works being constructed by a water company for
the supply of the town of Auburn, and a very few additions were made
to existing water supplies.
The total population of the State by the Census of 1920 was
3,852,356, of which 3,702,549 were included in cities and towns
having public water supplies in the whole or in part of their territory.
The towns not yet provided with water supplies number 138, the
aggregate population of which in 1920 was 149,807. There still
remain 13 towns, having in 1920 a population in excess of 2,500, which
are not provided with public water supplies. These towns are the
following: —
52
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Town.
Population.
Town.
Population.
Tewksbury,
Templeton
Somerset,
Warren,
Westport,
Seekonk,
4,450
4,019
3,520
3,467
3,115
2,898
2,780
Wilmington,
Sutton, ......
Hanover
Dighton
Harvard
Bourne,
2,581
2,578
2,575
2,574
2,546
2,530
Wilbraham,
39,633
In most of these towns and in many others of smaller size, public
water supplies are very badly needed, not only for public comfort
and convenience and for protection from fire, but principally for the
protection of health, since the well waters, which are the main
sources of supply in most of the villages of the State not yet pro^'ided
with public works, are usually more or less polluted and in many
cases wholly unfit for use. In many of these long-settled communities
sewage has been disposed of by discharging it into vaults and cess-
pools for many years, and seepage from these sources of contamination,
which tends to flow to a lower level, pollutes the ground water and
commonly finds its way to the nearest w^ell or perhaps to several wells
where the ground water is lowered on account of the draft for domestic
use. The results of the continuous discharge of sewage into the ground
about the dwelling houses in villages are to a considerable extent
cumulative, and the w^ater of wells in such communities usually grows
worse from year to year.
Private Wells.
In consequence of the pollution of wells in the thickly populated
villages not yet provided with public water supplies and of the
general spread of the knowledge of the fact that a pure water supply
is the most valuable agent in the maintenance of health, the Depart-
ment is receiving an increased number of applications for the examina-
tion of private or semi-public sources of water supply, that is, supplies
used for farms and village dwellings often used by two or more
families. The results of the tests of a limited number of these sources
which have been examined during the past year have showm that the
majority of the wells brought to the attention of the Department
were very badly polluted and unsafe for domestic use. The amount
of this work is constantly growing, and properly attended to is no
doubt a great aid in the protection of the public health from the
dangers following the use of impure water. This work requires
No. 34.] DIVISION OF SANITARY ENGINEERING. 53
expert care to avoid the condemnation of sources which may safely
be used and subjecting the owner or occupant of such premises to a
serious expense for a new well or other source of water supply, and
to avoid at the same time the approval of sources which may be the
cause of great injury to health. The danger from the use of polluted
wells needs no emphasis, and is now becoming so well understood
that the requests for examinations of such sources are increasing, and
further provision for this work will have to be made if it is to be
continued and properly carried out.
Water Supplies of Camps.
A most notable increase in the work of this Division has been
brought about by the multiplication of the number of camps for
associations of all sorts since the close of the war. Most of these
camps are located along the banks of the rivers or near the shores of
lakes or ponds usually remote from any source of public water supply.
A supply of drinking water is obtained in these cases usually from
some neighboring spring or well, or by sinking a well at the most con-
venient point on the premises. The danger to the public health of the
use of an improper or infected water supply in such places is obvious,
and this Division has sought to meet the demands for sanitary exam-
inations of such communities as promptly and effectively as possible, a
work that has been difficult under the existing circumstances and one
which if it is to be continued will require a larger organization.
Difficulties of providing Water and Sewerage Facilities in
Certain Districts.
Attention has been called to the problem in water supply and
sewerage brought about by the development of lands for occupation
by summer cottages and camps, which have been increasing very
rapidly not only on the seashore but also along the banks of rivers
and the shores of lakes and ponds. A similar important problem is
that of water supply and sewerage in connection with real estate
developments adjacent to or in the neighborhood of cities and larger
towns. In some places lands are built upon which are so located or
are of such a character that it is impracticable to provide them with
a public water supply or an effective system of sewerage or drainage
unless at excessive cost.
The attention of the Department has been called to a number of
such districts where houses, sometimes in large numbers, have been
54 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
constructed on rocky hills, mostly in outlying territory, where the
ledge has little or no earth covering and where it is impracticable or
exceedingly difficult and expensive to construct water and sewer
mains and service pipes. The purchaser of lands in such cases often
fails to realize or gives little heed to the difficulties he is likely to
meet in maintaining satisfactory sanitary conditions in and about
his premises, and the municipality hesitates to extend proper water sup-
ply and sewerage service to such a district. In other cases, areas of low,
wet land have been built upon where proper drainage is impracticable
except at an expense which may be far in excess of the value of the
property involved. Such conditions have been overcome and made
satisfactory in a few municipalities by taking advantage of the laws
providing for a board of survey, or a planning board if the powers
and duties of the board of survey are placed in its hands. The
board of survey, under existing laws, is empowered to examine, hold
hearings, and pass upon all schemes for new development of real
estate at the outset and before any construction work is undertaken.
The public is thus given an opportunity to learn the dangers of
building in a locality deemed objectionable by the board of survey.
Such publicity, if placed in the hands of properly trained officials,
would not only secure better development of the new districts in
cities and towns but would aid greatly in preventing the development
of undesirable areas for residential purposes, and prevent the danger
to the public health which such settlements entail.
Many of the difficulties arising from objectionable real estate de-
velopments could be prevented if cities and towns generally would
accept and put in force the board of survey laws already provided by
the Legislature.
Rainfall and Flow of Streams.
The rainfall for the year 1920 was greatly in excess of the normal,
and during the first six months of the year was probably the greatest
that has occurred in a period of fifty years. On the Wachusett
watershed near the middle of the State the excess of rainfall over
the normal amounted to 10.34 inches and an excess occurred in every
month of the year, with the exception of January, August and October.
The flow of the Nashua River during 1920, as measured by the
Metropolitan Water Board at Clinton, exceeded that of any year
since the observations of the flow of that stream were established
twenty-four years ago. The flow of the stream was much less than
the normal in the months of January and February, a condition due
largely to an exceptionally cold winter, since the precipitation in
No. 34.] DIVISION OF SANITARY ENGINEERING. 55
those months was chiefly in the form of snow. Slight deficiencies also
occurred in August and October, but in the other months the flow
was in excess of the normal, that of March being the greatest that
has occurred in that month in any year since measurements of the
flow of this river were begun.
Sanitary Protection of Public Water Supplies.
The importance of efficient sanitary protection of public water
supplies has been emphasized again by the occurrence of a great
epidemic of typhoid fever in a middle western State. In this case
the water supply of a town of 10,305 inhabitants became contaminated,
a condition which was followed by the occurrence of about 882 cases
of typhoid fever and 25 deaths, a rate of about 24 per 100,000 of
population. This epidemic calls attention once more to the calamitous
results which may follow the pollution of a public water supply, and
emphasizes again the need of giving to public water supplies all the
protection possible against danger of infection from whatever cause.
The death rate from typhoid fever in Massachusetts in 1887, the first
year after the establishment of supervision of the water supplies by
the State, was 45 per 100,000 of population, while in the year 1920
the death rate was 2.5 per 100,000, in all probability the lowest of any
State in the Union. In a large degree this decrease is a measure of
the improvement in water supplies and in the efficiency of their protec-
tion during that period.
Examination of Water Supplies.
The usual examinations of water supplies have been carried on
during the year and many of the sources have been inspected by the
engineers of this Division. The waters of the various sources have
been analyzed chemically and microscopically, the latter in the case
of surface w^aters, and bacterial tests have been made where such
tests appeared to be necessary or desirable. In very few cases have
emergency water supplies been found necessary, the high rainfall
insuring an adequate supply in practically all cases from existing
works.
Following are average results of chemical analyses of the sources of
public water supply examined in 1920.
56
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Analyses of the Watek of Public Water Supplies.
Averages of Chemical Analyses of Surface-water Sources for the Year
1920.
[Parts in 100,000.]
Source.
o
a
a
>
a
o
S fi
Ammoni.v.
0
1
0
6
ALBUMINOID.
City or Town.
■3
a
1
02
i
a
Metropolitan Water
District.
Wachusett Reservoir, upper end,
Wachusett Reservoir, lower end.
.27
.15
3.78
3.52
.0026
.0020
.0157
.0120
.0023
.0019
.25
.27
1.1
1.1
Sudbury Reservoir, .
.17
4.12
.0028
.0135
.0024
.31
1.4
Framingham Reservoir No
3, .
.19
4.08
.0034
.0161
.0029
.31
1.5
Hopkinton Reservoir,
.60
4.28
.0041
.0188
.0033
.32
1.1
Ashland Reservoir,
.59
4.32
.0027
.0180
.0028
.29
1.3
Framingham Reservoir No
2,
.79
6.40
.C067
.0230
.0037
.62
1.6
Lake Cochituate,
.22
6.12
.0027
.0204
.0044
.64
2.6
Chestnut Hill Reservoir,
.18
4.07
.0026
.0119
.0020
.33
1.5
Weston Reservoir,
.17
4.04
.0027
.0134
.0018
.35
1.5
Spot Pond, .
.10
4.00
.0014
.0130
.0024
.33
1.4
Tap in State House, .
.18
4.18
.0013
.0112
.0015
.33
1.5
Tap in Revere, .
.08
3.91
.0010
.0113
.0014
.34
1.5
Tap in Quincy, .
.15
4.02
.0006
.0104
.0012
.33
1.6
Abington,
Big Sandy Pond,
.10
4.47
.0028
.0127
.0018
.68
1.4
Adams (Fire Dis-
trict).
Dry Brook,
Bassett Brook, .
.18
.00
6.47
3.92
.0011
.0010
.0072
.0041
.0002
.0003
.14
.11
4.7
2.5
Amherst,
Amethyst Brook large reservoir,
.41
3.31
.0008
.0132
.0011
.14
0.8
Amethyst Brook small reservoir.
.16
3.10
.0007
.0090
.0016
.13
0.8
Andover,
Haggett'a Pond, ....
.15
4.53
.0018
.0148
.0023
.40
1.9
Ashburnham,
Upper Naukeag Lake,
.08
2.39
.0009
.0092
.0005
.15
0.5
Ashfield,
Bear Swamp Brook, .
.26
5.10
.0009
.0124
.0012
.09
2.8
Athol, .
Phillipston Reservoir,
.75
5.10
.0046
.0196
.0033
.18
1.2
Buckman Brook Reservoir
.28
3.67
.0072
.0215
.0069
.16
1.0
Inlet of filter.
.30
3.93
.0035
.0178
.0041
.13
1.0
Outlet of filter, .
.49
3.81
.0026
.0171
-
.15
1.1
Barre,
Reservoir, .
.13
4.25
.0016
.0206
.0046
.33
1.4
Blandford (Fire Dis-
trict).
Brockton,
Freeland Brook, .
.05
4.05
.0008
.0040
.0005
.28
1.4
Silver Lake,
.16
3.80
.0013
.0119
.0014
.55
0.7
Cambridge, .
Lower Hobbs Brook Reservoir,
.27
6.04
.0042
.0213
.0026
.45
2.5
Upper Hobbs Brook Reservoir,
.51
6.74
.0069
.0233
.0034
.47
2.7
Stony Brook Reservoir,
.36
6.25
.0047
.0203
.0025
.52
2.7
No. 34.] DIVISION OF SANITARY ENGINEERING.
5/
Averages of Chemical Analyses of Surface-water Sotirces, etc. — Continued.
[Parts in 100,000.]
a
0)
>
§ .
l-s
§2
Ammonia.
6
e
1
O
Source.
<u
1
ALBUMINOID.
CiTT OR Town.
"3
...»
o
H
c
c
■d
Cambridge— Con.
Fresh Fond
.27
7.25
.0056
.0230
.0054
.61
3.1
Cheshire,
Thunder Brook, .
.02
8.22
.0019
.0049
.0003
.11
5.3
Kitchen Brook, .
.01
6.93
.0010
.0049
.0005
.09
4.9
Chester (Fire Dis-
trict).
Austin Brook Reservoir,
Horn Pond,
.08
.10
4.45
3.75
.0006
.0010
.0092
.0148
.0022
.0008
.12
.12
1.6
1.6
Chicopee,
Morton Brook, .
.06
4.27
.0024
.0056
.0012
.22
1 0
Cooley Brook,
.60
4.33
.0060
.0120
.0022
.20
1.3
Clinton, .
Tap in town,
.11
3.90
.0005
.0105
.0025
.20
1.2
Colrain (Griswold-
ville).
Concord,
McClellan Reservoir, .
Nagog Pond,
.01
.05
7.38
3.09
.0008
.0013
.0048
.0105
.0009
.0015
.17
.35
5.1
1.0
Dalton (Fire Dis-
trict).
Egypt Brook Reservoir,
Windsor Reservoir,
.19
.35
4.85
4.97
.0006
.0055
.0087
.0168
.0013
.0027
.12
.13
2.3
2.5
Cady Brook,
.20
4.17
.0013
.0091
.0012
.16
1.9
Danvers,
Middleton Pond,
.53
4.48
.0053
.0196
.0036
.38
1.7
Swan Pond,
.23
5.22
.0018
.0176
.0031
.33
2.0
Deerfield (South
Deerfield Water
Supply District).
Egremont (South),
Roaring Brook, .
Goodale Brook, .
.03
.00
6.97
4.00
.0002
.0006
.0053
.0024
.0002
.0001
.15
.11
4.1
2.4
Fall River, .
North Watuppa Lake,
.18
4.08
.0022
.0162
.0034
.50
1.3
Falmouth,
Long Pond,
.06
3.98
.0008
.0090
.0010
1.01
0.7
Fitchburg, .
Meetinghouse Pond, .
.07
3.12
.0034
.0154
.0015
.18
0.8
Scott Reservoir, .
.12
2.99
.0081
.0120
.0025
.25
0.9
Wachusett Lake,
.09
2.96
.0025
.0117
.0021
.18
0.7
Falulah Brook, .
.15
3.04
.0031
.0123
.0021
.18
0.7
Ashby Reservoir,
.34
3.31
.0069
.0186
.0027
.18
0.6
Gardner,
Crystal Lake,
.07
5.04
.0018
.0149
.0015
.34
2.1
Gloucester, .
Dike's Brook Reservoir,
.28
3.88
.0040
.0106
.0017
.68
0.5
Wallace Reservoir,
.57
4.57
.0037
.0147
.0022
.79
0.4
Haskell Brook Reservoir, .
.19
3.75
.0025
.0087
.0012
.65
0.5
Great Barrington
(Fire District).
East Mountain Reservoir, .
Green River,
.10
.00
5.52
9.30
.0075
.0011
.0101
.0045
.0017
.0002
.11
.10
3.0
6.6
Great Barrington
(Housatonic ) .
Greenfield (Fire
District No. 1).
Long Pond,
Glen Brook Upper Reservo
Glen Brook Lower Reservo
ir, .
r, .
.04
.03
.02
7.05
6.52
5.77
.0019
.0040
.0023
.0169
.0068
.0089
.0013
.0011
.0015
.20
.23
.17
5.9
2.6
3.6
58
DEPARTIMENT OF PUBLIC HEALTH. [Pub. Doc.
Averages of Chemical Analyses of Surface-water Sources, etc. — Continued.
[Parts in 100,000.]
i
o
O
1
>
§
Jo
Pi
Ammonia.
.1
u
O
Source.
6
albuminoid.
City or Town.
t
o
B
§
%
Hadley (Water Sup-
ply District).
Hatfield,
Hart's Brook Reservoir,
Running Gutter Brook Reservoir
.04
.06
5.37
5.60
.0024
.0017
.0133
.0057
.0026
.0008
.23
.23
2.5
2.5
Haverhill, .
Johnson's Pond, ....
.21
5.46
.0022
.0169
.0018
.44
2.5
Crystal Lake,
.17
3.87
.0012
.0146
.0016
.33
1.4
Kenoza Lake,
.20
5.00
.0017
.0155
.0019
.42
2.4
Lake Saltonstall,
.07
6.81
.0028
.0168
.0028
.62
2.7
Pentucket Lake,
.15
4.38
.0011
.0148
.0024
.38
2.1
Millvale Reservoir,
.61
5.45
.0034
.0178
.0019
.35
2.0
Hingham,
Accord Pond,
.19
3.22
.0022
.0122
.0013
.45
0.6
Fulling Mill Pond,
.67
5.71
.0091
.0275
.0094
.69
1.5
Hinsdale (Fire Dis-
trict).
HOLYOKE,
Reservoir, .
Whiting Street Reservoir,
.15
.08
2.95
5.01
.0007
.0033
.0093
.0115
.0014
.0014
.12
.21
0.4
2.9
Fomer Reservoir,
.35
4.19
.0017
.0118
.0019
.16
1.4
Wright and Ashley Pond,
.08
5.36
.0045
.0149
.0025
.18
3.0
High Service Reservoir,
.08
4.27
.0038
.0146
.0024
.19
2.0
White Reservoir,
.26
3.67
.0052
.0184
.0062
.17
1.4
Hudson, .
Gates Pond,
.07
3.59
.0034
.0180
.0035
.24
1.6
Huntington (Fire
District).
Ipswich, .
Cold Brook Reservoir,
Dew's Brook Reservoir,
.13
.32
3.22
5.04
.0012
.0048
.0061
.0159
.0008
.0020
.14
.63
1.3
1.8
Lawrence, .
Merrimack River, filtered.
.40
6.24
.0062
.0081
-
.47
1.2
Lee,
Codding Brook Upper Reservoir,
.10
4.32
.0027
.0090
.0015
.12
2.3
Codding Brook Lower Reservoir,
.09
4.31
.0022
.0070
.0007
.13
2.1
Basin Pond Brook,
.59
4.55
.0030
.0170
.0014
.12
1.6
Lenox,
Reservoir, .
.04
7.70
.0003
.0068
.0014
.09
6.1
Laurel Lake,
.10
13.40
.0033
.0140
.0032
.18
13.2
Leominster, .
Morse Reservoir,
.16
2.65
.0017
.0119
.0019
.17
0.5
Haynes Reservoir,
.20
2.52
.0050
.0205
.0040
.17
0.4
Fall Brook Reservoir,
.11
2.65
.0027
.0117
.0016
.20
0.5
Lincoln, .
Sandy Pond,
.09
3.72
.0048
.0117
.0015
.36
1.4
Longmeadow,
Cooley Brook,
.05
5.22
.0050
.0083
.0015
.23
2.6
Lynn,
Birch Reservoir,
.16
4.76
.0056
.0176
.0045
.59
1.6
Breed's Reservoir,
.33
4.73
.0052
.0172
.0024
.56
1.6
Walden Reservoir,
.39
4.51
.0048
.0172
.0029
.50
1.5
No. 34.] DIVISION OF SANITARY ENGINEERING.
59
Averages of Chemical Analyses of Surface-water Sources,
etc.—
- Continuec
.
[Parts in 100,000.]
Source.
1
>
c
o .
2 c
Ammoni.a..
6
.albuminoid.
CiTT OR Town.
T3
i
3 o
a
c
o
:2-B
6
2
"3
o
1
1
-a
O
rt
fe
H
03
o
K
Lynn — Co«. .
Hawkes Reservoir,
.36
5.71
.0067
.0214
.0038
.59
2.2
Manchestei", .
Gravel Pond,
.13
4.39
.0020
.0129
.0026
.74
1.1
Marlborough,
Lake Williams, .
.18
5.72
.0056
.0191
.0026
.47
2.0
Milham Brook Reservoir, .
.35
4.99
.0049
.0170
.0024
.41
1.8
Maynard,
White Pond,
.08
3.14
.0018
.0128
.0022
.27
0.7
Milford, .
Charles River, filtered.
.18
6.93
.0015
.0071
-
.31
4.0
Montague, i
Lake Pleasant, .
.06
3.70
.0034
.0090
.0013
.17
0.9
Nantucket,
Wannacomet Pond,
.15
6.86
.0060
.0203
.0056
2.06
1.6
New Bedford,
Little Quittacas Pond,
.49
3.90
.0034
.0177
.0017
.49
0.8
Great Quittacas Pond,
.69
4.04
.0045
.0201
.0035
.47
0.9
Newburtport,
Artichoke River,
.36
7.51
.0155
.0303
.0052
.62
2.8
North Adams,
Notch Brook Reservoir,
.03
6.85
.0009
.0055
.0009
.09
5.1
Beaman Reservoir,
.02
6.68
.0019
.0081
.0012
.10
4.8
Northampton,
Middle Reservoir,
.22
4.18
.0026
.0115
.0021
.16
1.7
Mountain Street Reservoir,
.14
4.09
.0021
.0073
.0011
.13
1.8
North Andover,
Great Pond,
.11
4.77
.C041
.0139
.0017
.44
1.9
Northborough,
Lower Reservoir,
.58
4.44
.0041
.0178
.0022
.24
1.3
Upper Reservoir,
.69
4.40
.0034
.0185
.0027
.25
1.3
Northbridge, .
Cook Allen Reservoir,
.02
2.99
.0017
.0059
.0013
.21
0.8
North Brookfield, .
Doane Pond,
.40
3.58
.0052
.0219
.0044
.17
0.7
North Pond,
.41
3.67
.0042
.0249
.0059
.19
0.8
Northfield, .
Reservoir, .
.14
3.12
.0005
.0064
.0006
.16
1.0
Norwood,
Buckmaster Pond,
.16
4.30
.0074
.0162
.0032
.47
1.6
Outlet of filter, .
.08
3.57
.0012
.0082
.48
1.5
Orange, .
Reservoir, .
.07
3.92
.0006
.0045
.0007
.13
0.9
Palmer (Fire Dis-
Lower Reservoir,
.28
4.02
.0039
.0139
.0021
.25
1.4
trict No. 1).
Peabody,
Spring Pond, . .
.26
6.48
.0062
.0158
.0029
.68
2.0
Suntaug Lake, .
.07
5.49
.0049
.0192
.0057
.98
2.5
PiTTSFlELD,
Ashley Lake,
.16
4.50
.0036
.0142
.0025
.15
1.8
Ashley Brook,
.20
6.34
.0043
.0130
.0017
.14
3.8
Hathaway Brook,
.01
8.97
.0012
.0044
.0004
.13
7.7
> Supply for Turner's Falls Fire Bistrict, Millers Falls Water Supply District and Lake Pleasant Water
Supply District.
60
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Avermjes of Chemical Analyses of Surface-water Sources, etc. — Continued.
[Parts
in 100,000.]
Source.
6
i
t
W
a
o
a £3
S2
Ammonia .
6
O
^
albuminoid.
City or Town.
1
0)
C
CO
i
a
PiTTSFIELD— Con. .
Mill Brook
.29
4.17
.0022
.0112
.0011
.08
2.1
Sacket Brook,
.01
9.54
.0004
.0036
.0001
.12
7.8
Farnham Reservoir, .
.48
4.22
.0027
.0177
.0025
.09
1.6
Plymouth,
Little South Pond, .
.00
2.97
.0037
.0136
.0023
.59
0.5
Great South Pond, .
.00
2.78
.0028
.0132
.0022
.67
0.4
Randolph,
Great Pond,
.41
4.68
.0017
.0157
.0017
.51
1.3
Rockport,
Cape Pond,
.29
9.91
.0058
.0191
.0033
3.47
1.8
Russell, .
Black Brook,
.46
4.65
.0015
.0152
.0021
.11
1.5
Rutland,
Muschopauge Lake, .
.05
3.55
.0006
.0095
.0011
.32
1.2
Salem, .
Wen ham Lake, .
.27
6.98
.0088
.0195
.0043
.81
2.5
Longham Reservoir, .
1.24
9.35
.0184
.0361
.0076
1.12
2.5
Shelburne (S h e 1-
burne Falls Fire
District) .
Southbridge, .
Ipswich River at pumping sta-
tion.
Fox Brook,
Hatchet Brook Reservoir No. 3,
.56
.02
.16
11.29
6.02
3.37
.0135
.0002
.0029
.0243
.0038
.0143
.0068
.0001
.0018
.81
.15
.16
5.2
3.0
0.8
Hatchet Brook Reservoir No. 4,
.16
3.21
.0028
.0134
.0026
.16
0.9
South Hadley (Fire
District No. 1).
Leaping Well Reservoir,
Buttery Brook Reservoir, .
.07
.19
3.33
4.96
.0013
.0036
.0132
.0094
.0044
.0017
.20
.33
0.9
1.4
Spencer, .
Shaw Pond, ....
.05
2.54
.0013
.0115
.0012
.18
0.7
Springfield, .
Westfield Little River, filtered, .
.16
3.24
.0006
.0070
-
.16
1.4
Stockbridge, .
Lake Averie, ....
.09
6.86
.0014
.0128
.0014
.14
4.8
Stoughton,
Muddy Pond Brook, .
.17
3.67
.0007
.0081
.0016
.40
1.0
Taunton,
Assawompsett Pond, .
.39
3.80
.0032
.0162
.0023
.41
0.6
Elder's Pond, ....
.18
3.67
.0028
.0148
.0017
.46
0.8
Wakefield, .
Crystal Lake, ....
.17
6.06
.0072
.0194
.0036
.79
2.3
Wareham (Onset), .
Jonathan Pond
.05
2.67
.0011
.0095
.0013
.58
0.4
Wayland,
Snake Brook Reservoir,
.74
5.36
.0092
.0244
.0037
.37
1.6
Westfield, .
Montgomery Reservoir,
.33
3.49
.0018
.0117
.0023
.15
0.7
Tillotson Brook Reservoir,
.09
3.16
.0012
.0051
.0002
.14
0.8
West Springfield, .
Bear Hole Brook,
.13
7.73
.0044
.0092
.0011
.21
4.1
Bear Hole Brook, filtered, .
.02
7.18
.0008
.0051
-
.23
4.0
Weymouth, .
Great Pond, ....
1.01
5.10
.0073
.0224
.0018
.44
0.8
Williamsburg,
Reservoir,
.12
4.63
.0004
.0077
.0015
.15
2.3
No. 34.] DIVISION OF SANITARY ENGINEERING.
61
Averages of Chemical Anahjses of Surface-water Sources, etc. — Concluded.
(Parts in 100,000.]
a
1
W
a
o .
«o a
l-a
1^
Ammonia.
i
U
Source.
6
ALBUMINOID.
City or Town.
1
13
a
1
i
a
1
Williamstown,
Reservoirs
.03
7.75
.0008
.0048
.0005
.11
6.0
Winchester, .
North Reservoir,
.06
4.00
.0034
.0133
.0016
.37
1.7
South Reservoir,
.06
3.76
.0034
.0136
.0021
.36
1.6
Middle Reservoir,
.16
4.07
.0069
.0226
.0042
.35
1.7
Worcester, .
Bottomly Reservoir,
.23
3.52
.0025
.0146
.0012
.18
1.3
Kent Reservoir, .
.20
3.52
.0012
.0149
.0041
.17
1.4
Leicester Reservoir,
.34
3.40
.0032
.0157
.0029
.19
1.3
Mann Reservoir,
.22
3.67
.0023
.0153
.0028
.16
1.7
Upper Holden Reservoir,
.12
3.71
.0010
.0105
.0020
.21
1.0
Lower Holden Reservoir,
.10
3.31
.0017
.0108
.0019
.19
0.9
Kendall Reservoir,
.09
3.10
.0015
.0119
.0019
.19
1.1
Averages of Chemical Analyses of Ground-water Sources for the Year 1920.
[Parts in 100,000.]
Source.
6
c
'■♦J
II
Ammonia.
d
c
1
3
o
.65
.18
Nitrogen
as —
i
c
1
City or Town.
6
13
.1
SB
<
1
CO
'B
1
Acton (West and
South Water Sup-
ply District).
Adams (Fire Dis-
trict).
Amesbury,
Tubular wells, .
Tubular wells, .
.00
.00
8.15
13.65
.0004
.0003
.0024
.0014
.0940
.3320
.0000
.0000
3.5
10.6
•008
.006
Tubular wells, .
.36
14.68
.0047
.0039
.52
.0075
.0001
7.2
.295
Ashland, .
Tubular wells, old supply.
.01
6.65
.0002
.0019
.64
.0057
.0000
2.1
.022
Tubular wells, new supply.
.00
5.92
.0006
.0033
.39
.0054
.0001
2.1
.016
Attleboro, .
Large well.
.01
4.82
.0003
.0048
.48
.0105
.0000
2.1
.009
Avon,
Wells
.00
7.84
.0010
.0030
.55
.2420
.0001
2.9
.010
Ayer,
Large well.
.00
6.80
.0005
.0021
.60
.0580
.0001
3.0
.015
Tubular wells, ,
.00
6.43
.0011
.0043
.33
.0113
.0001
3.1
.020
Barnstable,
Tubular wells, .
.00
4.30
.0007
.0017
1.11
.0043
.0000
1.0
.023
Bedford, .
Large well.
.00
4.23
.0005
.0023
.31
.0060
.0000
2.1
.015
Billerica, .
Old wells
.07
11.48
.0014
.0060
.42
.0105
.0000
4.5
.176
62
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Averages of Chemical Analyses of Ground-water Sourcet, etc. — Continued.
[Parts in 100,000.]
Source.
c
Ammonia.
c
Nitrogen
AS —
i
City or Town.
■V
(»
6
1
o
i.S
1
O
.45
■4-0
c
•a
03
c
2
hi
Billerica — Co?j.
New wells.
.14
6.88
.0012
.0060
.0135
.0000
2.9
.040
Braintree,
Filter-gallery, .
.28
6.93
.0020
.0117
.74
.1233
.0000
2.5
.017
Bridgewater, .
Wells,
.00
4.72
.0003
.0018
.59
.0288
.0000
1.4
.015
Brookfield (East), .
Tubular wells, .
.00
2.80
.0000
.0018
.30
.0030
.0001
0.2
.005
Brookline,
Canton, .
Tubular wells and filter-
gallery, filtered.
Springdale well.
.11
.02
9.04
4.67
.0006
.0003
.0063
.0022
.76
.50
.02C6
.0230
.0000
.0001
3.9
1.9
.012
.010
Well near Henry's Spring,
.07
4.72
.0005
.0035
.50
,0252
.0000
1.8
.017
Chelmsford (North
C hebnsf ord Fire
District).
Chelmsford (Water
District).
Chicopee (Fairview).
Tubular wells, .
Tubular wells, .
Tubular wells, .
.06
.00
.02
6.35
8.00
5.49
.0088
.0003
.0007
.0064
.0014
.0024
.59
.65
.28
.1137
.1263
.0634
.0004
.0010
.0000
2.6
3.0
2.0
.016
.018
.038
Cohasset, . ■ .
Tubular wells, .
.09
12.99
.0008
.0072
1.81
.1386
.0000
5.2
.011
Filter-gallery, .
.33
11.00
.0017
.0149
1.34
.0520
.0000
3.9
.055
Dug well, filtered.
.11
8.14
.0026
.0074
1.08
.0069
.0001
2.9
.025
Dedham,
Deerfield (Fire Dis-
trict).
Douglas, .
T,arge well and tubular
wells.
Wells
Tubular wells, .
.07
.01
.02
10.43
4.45
6.30
.0021
.0004
.0005
.0045
.0039
.0022
1.08
.20
.41
.1483
.0100
.0505
.0002
.0000
.0000
4.2
2.0
2.0
.016
.012
.024
Dracut (Water Sup-
ply District).
Dracut (Collins-
ville).
Dudley, .
Tubular wells, .
Tubular wells, .
Tubular wells, .
.00
.00
.00
9.00
4.70
3.13
.0004
.0005
.0002
.0024
.0022
.0014
.70
.30
.23
.1200
.0050
.0093
.0001
.0000
.0000
3.8
1.6
1.4
.006
.027
.010
Duxbury (Fire and
Water District).
Easthampton, .
Tubular wells, .
Tubular wells, .
.00
.00
4.50
8.17
.0003
.0002
.0021
.0014
.71
.20
.0123
.0173
.0000
.0001
0.7
3.7
.020
.012
E a s t 0 n (North
Easton Village Dis-
trict).
Edgartown,
Well
Large well,
.00
.00
5.03
3.20
.0003
.0004
.0023
.0020
. 46
.98
.0469
.0045
.0000
.0000
2.1
0.7
.008
.010
Fair haven.
Tubular wells, .
.29
9.07
.0022
.0081
.86
.1320
.0005
2.8
.037
Foxborough (Water
Supply District).
Framingham, .
Tubular wells, .
Filter-gallery, .
.00
.00
5.15
12.53
.0008
.0154
.0029
.0069
.53
2.05
.0530
.0148
.0000
.0008
1.5
5.6
.018
.010
Franklin, .
Tubular wells, .
.00
5.30
.0006
.0028
.61
.0240
.0000
1.8
.010
Grafton, .
Filter-gallery, .
.04
11.82
.0004
.0050
1.41
.1750
.0001
4.5
.015
Granville,
Well
.05
4.18
.0002
.0019
.10
.0083
.0001
2.0
.069
Groton, .
Large well,
.01
6.43
.0004
.0026
.25
.0040
.0000
3.0
.013
Groton (West Groton
Water Supply Dis-
trict).
Hingham,
Tubular wells, .
.00
4.90
.0002
.0017
.17
.0077
.0000
2.8
.010
Wells
.10
5.25
.0026
.0051
.66
.0152
.0001
1.8
.020
i
No. 34.] DIVISION OF SANITARY ENGINEERING.
63
Averages of Chemical Analyses of Ground-water Sources, etc. — Continued.
[Parts in 100,000.]
c
o
Ammonia.
Nitrogen
AS —
City or Town.
Source.
5
S 2
1
-a
'3
<
1
o
.40
2
a
1
K
c
2
Holliston,
Large well.
.38
4.23
.0078
.0147
-
-
1.7
.031
Hopkinton,
Tubular wells, .
.00
10.75
.0004
.0025
.71
.1600
.0000
4.7
.022
Huntington (Fire
District).
Kingston,
Tubular wells, .
Tubular wells, .
.00
.00
5.75
s.'s
.0005
.0006
.0020
.0017
.24
.77
.0090
.0000
2.4
1.3
.010
.015
Leicester (Water Sup-
ply District).
Leicester (Cherry
• Valley and Roch-
dale Water Dis-
trict).
Littleton,
Wells
Wells
Tubular wells, .
.08
.19
.00
5.70
4.28
3.90
.0003
.0027
.0002
.0028
.0123
.0019
.30
.31
.24
.0807
.0103
.0000
.0000
2.0
2.0
1.8
.012
.013
.008
Lowell, .
Boulevard wells (tubular).
.43
6.87
.0447
.0064
.51
.0192
.0003
3.0
.356
Boulevard wells, filtered, .
.05
5.73
.0007
.0035
.50
.0351
.0000
2.6
.021
Manchester, .
Wells
.00
12.22
.0005
.0018
1.95
.1400
.0000
4.1
.025
Mansfield (W a t e r
Supply District).
Marblehead,
Large well.
Inlet of filter, .
.00
.31
4.87
16.03
.0003
.0146
.0014
.0105
.35
1.76
.1027
.0094
.0006
.0001
1.8
6.3
.007
.228
Outlet of filter, .
.13
13.58
.0004
.0066
1.61
.0107
.0000
6.1
.017
Wells
.14
15.33
.0014
.0064
2.13
.0117
.0001
6.0
.040
Marion, .
Tubular wells, .
.00
4.93
.0003
.0013
.65
.0287
.0001
1.5
.013
Marshfield,
Wells
.00
12.00
.0008
.0022
3.60
.0920
.0000
3.1
.010
Mattapoisett, .
Tubular wells, .
.00
5.63
.0002
.0017
.80
.0407
.0000
2.2
.0C9
Medfield,
Spring
.00
3.67
.0002
.0021
.32
.0083
.0000
1.5
.013
Medway, .
Wells
.00
6.79
.0008
.0020
.57
.0327
.0001
2.7
.007
Merrimac,
Tubular wells, .
.00
8.08
.0006
.0018
.51
.0150
.0001
3.3
.017
Methcen,
Tubular wells, .
.32
7.75
.0023
.0090
.50
.0148
.0000
3.1
.073
Middleborough (Fire
District).
Well
Filtered water, .
.28
.12
7.23
5.92
.0092
.0006
.0058
.0044
.58
.58
.0277
.0283
.0001
.0000
2.5
2.2
.335
.043
Millbury,
Well
.00
4.50
.0007
.0026
.33
.0147
.0000
1.9
.013
Millis,
Spring, ....
.00
10.50
.0003
.0018
.84
.2833
.0001
4.6
.011
Monson, .
Large well.
.05
3.43
.0003
.0023
.19
.0073
.0000
1.5
.011
Nantucket,
Welb in Wyers Valley,
.04
4.32
.0043
.0077
1.32
.0050
.0000
0.9
.050
Natick, .
Large well.
.00
10.08
.0006
.0032
.84
.0333
.0000
5.0
.010
Needham,
Welb
.01
6.10
.0007
.0022
.64
.0760
.0004
3.0
.024
.
Hicks Spring, .
.00
7.72
.0007
.0032
.83
.2667
.0000
2.7
.007
Newburyport,
Newton,
Wells and Artichoke River,
filtered.
Tubular wells and filter-
gallery.
.16
.04
6.84
6.61
.0010
.0011
.0091
.0047
.71
.44
.0207
.0268
.0000
.0001
2.9
2.6
.044
.016
64
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Averages of Chemical Analyses of Ground-water Sources, etc. — Continued.
[Parts in 100,000.]
o
a
Residue on
Evaporation.
Ammonia.
.s
2
o
.55
NiTBOGEN
AS —
c
1
City ob Town.
Sotirce.
1
"o
..s
<
GO
1
8
2
i
No. Attleborough, .
Wells,
.00
4.62
.0005
.0024
.0140
.0001
2.1
.013
Norton, .
Tubular wells, .
.00
4.73
.0005
.0021
.42
.0057
.0001
1.4
.015
Norwood,
Tubular wells, .
.15
8.52
.0021
.0064
.56
.0400
.0001
3.7
.161
Oak Bluffs,
Springs,
.00
4.30
.0005
.0022
1.01
.0060
.0001
0.7
.012
Oxford, .
Tubular wells, .
.00
5.23
.0001
.0021
.36
.0353
.0000
1.8
.010
Palmer (Bondsville),
Tubular wells, .
.00
5.70
.0006
.0015
.27
.0160
.0000
2.6
.012
Pepperell,
Tubular wells, .
.00
4.05
.0000
.0014
.20
.0040
.0000
1.5
.017
Provincetown,
Tubular wells, .
.01
16.42
.0005
.0017
7.42
.0048
.0000
4.4
.025
Reading, .
Filter-gallery, .
.54
9.25
.0147
.0149
1.35
.0100
.0000
2.2
.235
Filtered water,
.19
16.60
.0006
.0050
.99
.0072
.0003
7.1
.065
Salisbury,
Well, .
.19
9.48
.0008
.0034
.61
.0067
.0000
4.2
.059
Scituate, .
Tubular wells.
.00
14.32
.0001
.0014
2.99
.1660
.0001
4.9
.009
Sharon, .
Well, .
.00
13.77
.0003
.0020
2.11
.2633
.0001
! 6.0
.007
Tubular wells.
.03
5.00
.0004
.0015
.47
.0230
.0001
2.0
.020
Sheffield. .
Spring,
.00
4.23
.0000
.0010
.12
.0093
.0000
1 1.7
1
.005
Shirley (Shirley Vil-
lage VVater Dis-
Well, .
.00
4.27
.0001
.0012
.40
.0930
.0000
1.3
.012
trict).
Shrewsbury, .
Tubular wells.
.00
5.42
.0002
.0020
.49
.0310
.0000
1.9
.010
South Hadley (Fu-e
District No. 2).
Tisbury, .
Large well,
Well, .
.00
.00
5.50
3.90
.0004
.0000
.0014
.0016
.19
1.01
.0320
.0070
.0002
.0000
1.6
0.8
.005
.004
Uxbridge,
Tubular wells.
.00
5.20
.0001
.0020
.55
.0680
.0000
1.9
.007
Walpole, .
Tubular wells.
.00
4.80
.0003
.0014
.48
.0233
.0000
1.8
.018
Waltham,
Old well, .
.15
8.95
.0046
.0037
.78
.0154
.0000
4.2
.066
New well, .
.00
7.45
.0006
.0036
.57
.0142
.0000
i ^'^
.010
Ware,
Wells,
.00
7.57
.0002
.0015
.56
.1750
.0001
; 2.9
.016
Wareham (Fire Dis-
Tubular wells.
.00
3.55
.0002
.0008
.63
.0030
.0000
0.7
.007
trict).
Webster, .
Wells,
.00
4.03
.0003
.0018
.34
.0133
.0000
2.0
.014
Wellesley,
Tubular wells,
.00
10.38
.0020
.0023
1.15
.0883
.0000
4.3
.017
Well at Williams
Spr
ng, .
.22
17.70
.0015
.0029
1.37
.6900
.0001
6.0
.014
Filter-gallery,
.00
8.75
.0017
.0037
.99
.1007
.0000
4.3
.009
West borough, .
Filter basin,
.00
3.30
.0018
.0079
.29
-
-
0.9
.016
West Brookfield, .
Tubular wells.
.00
5.53
.0004
.0015
.29
.0713
.0000
1.2
.010
Westford,
Tubular wells.
.00
4.65
.0002
1
.0017
.19
.0075
.0000
2.3
.005
1
No. 34.] DIVISION OF SANITARY ENGINEERING.
65
Averages of Chemical Analyses of Ground-water Sources, etc. — Concluded.
[Parts in 100,000.]
Source.
o
a
o
Ammonia.
6
s
o
Nitrogen
AS —
o
c
City or Town.
8
■0
'o
..s
IB
1
CO
c
o
Weston, .
Well
.26
7.05
.0007
.0079
.52
.0120
.0000
2.7
.015
Winchendon, .
Old well
.11
4.20
.0017
.0024
.18
.0073
.0000
1.1
.118
New well,
.01
3.22
.0009
.0024
.16
.0065
.0000
1.1
.007
WOBTJRN,
Filter-gallery, .
.00
11.53
.0006
.0047
1.36
.0370
.0000
5.3
.008
Worthington (Fire
District) .
Wrentham,
Springs, ....
Tubular wells, .
.01
.00
2.77
4.25
.0004
.0001
.0033
.0014
.13
.32
.0080
.0210
.0000
.0000
1.5
1.4
.026
.007
Comparison of Water Supplies of the State by Chemical
Analysis.
A comparison of the different water supplies of the State by chemi-
cal analysis furnishes much information of interest and value as to the
general characteristics of the supplies now in use. In most places the
supplies are satisfactory, and those which are least desirable have not
yet become sufficiently unsatisfactory, at least from the consumer's
point of view, to lead to a change.
A comparison of the physical characteristics of the various sources
of water supply of the State shows wide differences in the character-
istics of w^aters which are in daily use often in adjacent communities.
All waters, whether from lakes, ponds and streams or from springs or
wells, have a common origin in the rainfall, yet there are such essential
differences in character between surface waters and ground waters that
in any attempt to compare the water supplies of the State it is im-
portant to consider these two classes separately. The waters of
running streams under normal conditions contain but little organic
life. Streams which drain swamps and areas of meadow lands, in
which much of the water is in contact for considerable periods with
decaying vegetation, grasses, leaves, soil and other organic matter, are
often highly colored and contain a great amount of organic matter,
commonly, however, carried for the most part in solution, so that
these waters, though highly colored, are often nearly or quite clear.
In the winter, and especially in the spring, the waters of the streams
are made up very largely of rain and melting snow, and the color and
66 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
organic matter are less than at other seasons. In hilly or mountain-
ous regions or in valleys where the soil is composed largely of sand
and gravel, surface waters are often clear and colorless and especially
in the drier part of the year contain but little organic matter and
differ but little from ground waters of which, in fact, they largely
consist. Ground waters, that is the waters of springs, wells and filter
galleries, are usually clear, colorless and free from odor and contain
little or no organic matter, though they may contain greater or less
amounts of mineral matter, depending upon the character of the soil
and rocks over which they pass. While most ground waters are clear,
colorless and practically free from organic or suspended matter, some
of them are affected by excessive quantities of iron or manganese, and,
though they may be clear and colorless when drawn from the ground,
quickly become turbid and colored, due to the oxidation of the mineral
matter they contain which accumulates in the form of a sediment.
The storage of water in ponds and reservoirs affords conditions favor-
able to the growth of vegetable and animal organisms which, in some
of the ponds and in reservoirs not properly prepared for the storage of
water, at times develop to such an extent as to give the water a de-
cided turbidity and an objectionable taste and odor. In some parts of
the State, chiefly in Berkshire County, the waters are affected by an
excessive amount of mineral matter due to limestone.
In the following tables are presented the analyses of all of the sur-
face and ground water supplies in use in the State, including possible
auxiliaries, which were examined during the five years from 1915 to
1919, inclusive. In the case of most of these waters the figures repre-
sent averages of from 30 to 60 analyses made at regular intervals of
one or two months. In a few cases the samples have been fewer and
represent longer intervals, but in all as often as once in three months,
and in a few other cases samples have been collected at intervals of
two weeks or even less. The use of some of these sources was begun
subsequent to 1915, and the examinations consequently cover a shorter
period than the five years mentioned, but these cases are indicated by
footnotes.
No. 34.] DIVISION OF SANITARY ENGINEERING.
6;
Surface Water Sources.
Averages of Chemical Analyses from 1915 to 1919, inclusive.
[Parts in 100,000.]
Source.
1
a
w
a
o
Ammonia.
ALBUMINOID.
City or Town.
05
g
§
2 a
.3 2
0) t.
1
i
o
a
o
0.
§
6
3
O
Metropolitan Water
District.
Wachusett Reservoir, upper end,
Wachusett Reservoir, lower end,
.30
.14
3.80
3.30
.0023
.0023
.0155
.0128
.0024
.0019
.29
.29
1.1
1.0
Sudbury Reservoir, .
.17
3.87
.0028
.0158
.0029
.33
1.3
Framingham Reservoir No. 3, .
.17
3.81
.0036
.0171
.0034
.34
1.3
Hopkinton Reservoir,
.63
4.37
.0031
.0223
.0026
.39
1.2
Ashland Reservoir, .
.64
4.57
.0032
.0248
.0029
.36
1.3
Framingham Reservoir No. 2, .
.79
5.30
.0055
.0275
.0035
.46
1.4
Lake Cochituate,
.20
6.44
.0045
.0249
.0058
.70
2.5
Chestnut Hill Reservoir, .
.17
3.79
.0023
.0149
.0027
.34
1.4
Weston Reservoir,
.16
3.87
.0026
.0155
.0027
.33
1.3
Spot Pond,
.08
3.78
.0021
.0160
.0027
.36
1.4
Tap in State House, .
.17
4.16
.0015
.0144
.0023
.35
1.4
Tap in Revere
.09
3.84
.0014
.0140
.0019
.35
1.4
Tap in Quincy
.15
3.89
.0010
.0121
.0015
.36
1.4
Abington,
Big Sandy Pond,
.09
3.74
.0032
.0149
.0021
.73
0.9
Adams (Fire Dis-
trict).
Bassett Brook, ....
Dry Brook, ....
.02
.22
4.01
6.80
.0016
.0021
.0048
.0109
.0007
.0016
.11
.13
2.4
4.9
Amherst ,
Amethyst Brook small reservoir,
.21
3.40
.0037
.0128
.0025
.18
0.7
Amethyst Brook large reservoir,
.49
3.72
.0026
.0152
.0029
.17
0.8
Andover,
Haggett's Pond
.15
4.25
.0031
.0180
.0026
.39
1.5
Ashburnham,
Upper Naukeag Lake,
.07
2.52
.0013
.0090
.0010
.16
0.5
Ashfield,
Bear Swamp Brook, .
.30
5.54
.0025
.0125
.0013
.14
2.7
Athol, .
Phillipston Reservoir,
.61
4.32
.0115
.0377
.0123
.20
1.0
Buckman Brook Reservoir,
.25
3.56
.0057
.0224
.0065
.15
0.8
Inlet of filter
.53
4.33
.0074
.0273
.0068
.16
1.1
Outlet of filter
.49
4.42
.0051
.0213
-
.17
1.2
Barre,
Reservoir, . . . .
.16
3.83
.0049
.0184
.0033
.22
1.3
Blandford (Fire Dis-
trict).
Brockton,
Freeland Brook
.07
3.56
.0005
.0047
.0005
.21
1.4
Silver Lake
.11
3.48
.0029
.0140
.0030
.64
0.8
Cambridge, .
Lower Hobbs Brook Reservoir, .
.16
6.39
.0054
.0252
.0037
.51
2.5
Stony Brook Reservoir,
.45
6.73
.0049
.0259
.0042
.59
2.5
68
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Averages of Chemical Analyses from 1915 to 1919, inclusive — Continued.
[Parts in 100,000.]
Source.
i
1
G
o
a) C
Ammonia.
6
a
1
o
ALBUMINOID.
City ob Town.
-a
<D
i
o
6
^1
CO d
6
"3
f2
s
■a
u
a
Cambridge — Core.
Fresh Pond, ....
.27
6.94
.0092
.0289
.0084
.65
2.9
Cheshire,
Thunder Brook, ....
.01
6.87
.0006
.0044
.0006
.12
5.8
Kitchen Brook, ....
.01
6.04
.0010
.0041
.0005
.11
4.7
Chester (Fire Dis-
trict).
Chicopee,
Austin Brook Reservoir, .
.11
3.78
.0023
.0141
.0034
.15
1.71
Cooley Brook, ....
.66
4.28
.0055
.0159
.0037
.17
1.3
Morton Brook, ....
.07
4.05
.0012
.0051
.0008
.17
1.0
Colrain (Griswold-
ville).
Concord,
McClellan Reservoir, .
.05
7.02
.0031
.0078
.0007
.14
4.3
Nagog Pond, ....
.06
2.79
.0021
.0137
.0015
.37
0.8
Dalton (Fire Dis-
trict).
Egypt Brook Reservoir,
.26
3.25
.0028
.0126
.0022
.12
1.5
Cady Brook
.30
4.73
.0014
.0134
.0012
.11
2.2
Danvers,
Middleton Pond,
.53
5.39
.0034
.0230
.0030
.44
1.8
Deerfield (South
Deerfield Water
Supply District).
Egremont (South),
Roaring Brook, ....
Goodale Brook
.10
.02
6.54
4.52
.0011
.0003
.0061
.0029
.0008
.0002
.17
.12
5.7
2.6
Fall Rivek, .
North Watuppa Lake,
.15
4.32
.0028
.0193
.0032
.63
1.0
Falmouth,
Long Pond, ....
.01
3.71
.0024
.0120
.0015
1.04
0.4
FiTCHBTJRG, .
Meetinghouse Pond, .
.09
3.11
.0050
.0165
.0023
.20
1.0
Scott Reservoir, ....
.14
3.17
.0075
.0182
.0046
.23
0.7
Wachusett Lake,
.10
2.88
.0051
.0163
.0025
.19
0.8
Falulah Brook, ....
.22
3.27
.0057
.0168
.0035
.21
0.6
Ashby Reservoir,
.65
3.84
.0165
.0304
.0062
.20
0.71
Gardner,
Crystal Lake, ....
.09
4.73
.0026
.0156
.0027
.31
1.9
Gloucester, .
Dike's Brook Reservoir,
.32
4.12
.0039
.0164
.0023
.84
0.4
Wallace Reservoir,
.52
4.69
.0039
.0216
.0049
.97
0.5
Haskell Brook Reservoir, .
.27
4.25
.0025
.0142
.0027
.86
0.5
Great Barrington
(Fire District).
East Mountain Rejervoir, .
Green River, ....
.12
.00
5.87
10.00
.0061
.0012
.0120
.0043
.0027
.0005
.13
.14
3.7
7.91
Great Barrington
(Housatonic).
Greenfield Fire Dis-
trict No. 1).
Hadley (Water Sup-
ply District).
Hatfield,
Long Pond, ....
.07
8.83
.0044
.0201
.0027
.14
6.2
Glen Brook Lower Reservoir, .
Hart's Brook Reservoir,
Running Gutter Brook Reservoir,
.03
.08
.10
5.52
4.30
4.79
.0024
.0015
.0029
.0078
.0058
.0071
.0016
.0010
.0010
.17
.19
.21
3.2
i.gi
2.3
Haverhill, .
Johnson's Pond
.16
5.27
.0025
.0192
.0020
.50
2.3
Crystal Lake
.19
4.06
.0026
.0208
.0033
.38
1.4
1 Average of foiu- years.
No. 34.] DIVISION OF SANITARY ENGINEERING.
69
Averages of Chemical Analyses from 1915 to 1919, inclusive — Continued.
[Parts in 100,000.]
a.
03
>
§
Ammonia.
6
1
O
Source.
£
albuminoid.
City or Town.
"3
a
3
c
-a
Haverhill— Core. .
Kenoza Lake, ....
.20
5.23
.0027
.0207
.0030
.46
2.2
Lake Saltonstall,
.10
6.59
.0048
.0193
0029
.65
3.0
Pentucket Lake,
.17
5.26
.0029
.0205
.0035
.49
2.2
Millvale Reservoir,
.59
6.21
.0042
.0246
.0044
.40
2.3
Hingham,
Accord Pond,
.23
3.93
.0024
.0162
.0024
.66
0.7
Hinsdale (Fire Dis-
trict).
HOLTOKE,
Reservoir, .
Whiting Street Reservoir,
.22
.09
2.70
5.02
.0040
.0048
.0136
.0161
.0023
.0025
.10
.22
0.7
2.6
Fomer Reservoir,
.33
4.19
.0031
.0145
.0024
.16
1.4
Wright and Ashley Pond,
.12
5.33
.0048
.0173
.0031
.18
2.6
High Service Reservoir,
.12
4.26
.0055
.0193
.0032
.19
1.7
White Reservoir,
.26
3.90
.0085
.0203
.0047
.15
1.5
Hudson,
Gates Pond,
.08
3.63
.00.34
.0178
.0030
.27
1.5
Huntington (Fire
District).
Ipswich, .
Cold Brook Reservoir,
.17
3.08
.0006
.0073
.0009
.15
1.31
Dow's Brook Reservoir,
.29
5.87
.0041
.0197
.0031
.80
2.0
Lawrence, .
Merrimack River, filtered.
.34
5.91
.0051
.0082
-
.45
1.4
Lee. . . .
Codding Brook Upper Reservoir,
.13
4.51
.0028
.0087
.0010
.12
2.0
Codding Brook Lower Reservoir,
.12
4.52
.0016
.0084
.0011
.12
2.6
Basin Pond Brook,
.59
4.54
.0028
.0187
.0028
.11
1.5
Lenox, .
Reservoir, .
.06
7.46
.0016
.0073
.0010
.11
5.7
Leomixster, .
Morse Reservoir,
.21
2.99
.0081
.0228
.0050
.19
0.4
Haynes Reservoir,
.29
3.12
.0228
.0403
.0141
.18
0.4
Fall Brook Reservoir,
.13
2.69
.0032
.0150
.0029
.21
0.6
Lincoln, .
Sandy Pond,
.09
4.21
.0049
.0166
.0033
.39
1.5
Longmeadow,
Cooley Brook,
.09
5.31
.0040
.0069
.0016
.25
2.4!
Lynn, .
Birch Reservoir,
.22
5.26
.0081
.0226
.0036
.73
1.9
Breed's Reservoir,
.37
5.95
.0095
.0269
.0046
.73
2.1
Walden Reservoir,
.47
6.45
.0076
.0240
.0036
.78
2.3
Hawkes Reservoir,
.58
6.95
.0088
.0302
.0050
.81
2.7
Manchester, .
Gravel Pond,
.13
4.65
.0050
.0158
.0022
.90
1.1
Marlborough,
Lake Williams, .
.13
5.19
.0035
.0193
.0023
.56
1.8
Milham Brook Reservoir,
.52
5.45
.0062
.0256
.0045
.44
1.6
Maynard,
White Pond,
.28
3.55
.0011
.0142
.0019
.29
1.0
1 Average of three years.
- Average of four years.
70
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Averages of Chemical Analyses from 1915 to 1919,
inclusive —
Continued
•
[Parts in 100,000.]
Source.
u
o
a
i
>
W
a
o
S c
Ammonia.
o
c
1
O
1
albuminoid.
City or Town.
"3
e2
•6
a
to
Milford, .
Charles River, filtered.
.22
5.86
.0011
.0074
-
.37
2.5
Montague, i .
Lake Pleasant, .
.05
2.88
.0019
.0111
.0028
.16
0.8
Nantucket, 2 .
Wannacomet Pond, .
.10
7.12
.0037
.0175
.0053
2.24
1.5
New Bedford,
Little Quittacas Pond,
.39
4.29
.0044
.0222
.0029
.58
1.0
Great Quittacas Pond,
.50
4.30
.0036
.0225
.0030
.57
0.9
North Adams,
Notch Brook Reservoir,
.06
7.22
.0021
.0060
.0010
.09
5.8
Beaman Reservoir,
.05
7.18
.0030
.0102
.0020
.10
4.9
Northampton,
Middle Reservoir,
.23
4.29
.0023
.0139
.0025
.17
1.7
Mountain Street Reservoir,
.09
4.05
.0017
.0089
.0016
.14
1.8
North Andover,
Great Pond,
.16
5.09
.0030
.0190
.0020
.48
1.9
Northborough,
Lower Reservoir,
.75
4.61
.0054
.0280
.0052
.32
1.2
LTpper Reservoir,
.86
5.35
.0067
.0293
.0060
.34
1 33
Northbridge, .
Cook Allen Reservoir,
.10
3.21
.0027
.0083
.0014
.23
0.7
North Brookfield, .
Doane Pond,
.43
3.69
.0078
.0331
.0082
.19
1.1
North Pond,
.48
3.56
.0060
.0365
.0120
.19
0.9
Northfield, .
Reservoir, .
.23
3.67
.0007
.0079
.0006
.14
1.2
Orange, .
Reservoir, .
.10
3.22
.0010
.0050
.0004
.13
1.0
Palmer (Fire Dis-
trict No. 1).
Peabody,
Lower Reservoir,
Spring Pond,
.25
.29
3.58
6.32
.0070
.0109
.0148
.0225
.0031
.0051
.19
.80
1.0
2.4
Suntaug Lake, .
.06
5.49
.0082
.0203
.0032
1.08
2.8<
Pittsfield, .
Ashley Brook,
.20
5.92
.0039
.0138
.0016
.11
3.8
Hathaway Brook,
.05
9.09
.0016
.0066
.0011
.13
7.3
Sacket Brook,
.13
6.73
.0017
.0069
.0007
.12
5.5
Farnham Reservoir, .
.58
4.81
.0040
.0213
.0030
.12
1.8
Plymouth,
Little South Pond,
.02
2.85
.0030
.0209
.0032
.68
0.3
/
Great South Pond,
.01
2.95
.0034
.0172
.0024
.69
0.2
Randolph,
Great Pond,
.41
4.81
.0023
.0179
.0021
.66
1.2
Rockport,
Cape Pond,
.38
11.88
.0100
.0299
.0084
4.47
2.2
Russell, .
Black Brook,
.20
3.87
.0008
.0095
.0012
.16
1.5
Rutland,
Muschopauge Lake, .
.06
2.86
.0017
.0131
.0026
.32
1.0
> Supply for Turner's Falls Fire District, Millers Falls Water Supply District and Lake Pleasant Water
Supply District.
2 Not including Siasconset supply. ' Average of tliree years.
< Average of four years.
No. 34.] DIVISION OF SANITARY ENGINEERING.
71
Averages of Chemical Analyses from 1915 to 1919, inclusive — Concluded.
[Parts in 100,000.]
o
6
a
>
c
o
i-B
Ammonia.
d
'u,
o
Source.
6
albuminoid.
City or Town.
e2
C
ft
a
a
1
Salem, .
Wenham Lake, ....
.36
7.45
.0115
.0263
.0061
.97
2.5
Longham Reservoir, .
1.31
7.84
.0190
.0452
.0114
.96
1.9
Shelburne (Shel-
burne Falls Fire
District).
Southbridge, .
Fox Brook
Hatchet Brook Reservoir No. 3,
.05
.22
5.50
3.27
.0004
.0039
.0048
.0178
.0005
.0032
.11
.20
3.2
0.8
Hatchet Brook Reservoir No. 4,
.24
3.07
.0053
.0205
.0038
.20
0.7
South Hadley (Fire
District No. 1).
Leaping Well Reservoir,
Buttery Brook Reservoir, .
.08
.12
3.37
4.47
.0063
.0070
.0192
.0106
.0079
.0023
.20
.33
0.9
1,1
Spencer, .
Shaw Pond, ....
.07
2.71
.0017
.0151
.0015
.21
1.0
Springfield, .
VVestfield Little River, filtered, .
.19
3.79
.0011
.0082
-
.15
1.3
Stockbridge, .
Lake Averic, ....
.12
7.52
.0020
.0176
.0031
.11
5.2
Stoughton,
Muddy Pond Brook, .
.19
3.90
.0007
.0089
.0018
.40
1.0
Taunton,
Assawompsett Pond, .
.30
4.15
.0040
.0197
.0029
.55
0.8
Elder's Pond
.13
3.81
.0043
.0188
.0026
.55
0.8
Wakefield,
Crystal Lake
.23
5.98
.0100
.0251
.0035
.84
2.0
Wareham (Onset), .
Jonathan Pond, ....
.02
2.59
.0011
.0096
.0013
.67
0.4
Wayland,
Snake Brook Reservoir,
.87
5.48
.0091
.0336
.0046
.38
1.6
VVestfield, .
Montgomery Reservoir,
.44
3.31
.0048
.0183
.0026
.15
0.6
Tillotson Brook Reservoir,
.14
3.23
.0023
.0082
.0012
.17
0.7
West Springfield, .
Bear Hole Brook, filtered, .
.06
7.96
.0018
.0055
-
.21
4.3
Weymouth,
Great Pond, ....
.79
4.15
.0044
.0204
.0025
.52
0.8
Williamsburg,
Reservoir, .
.14
4.44
.0013
.0090
.0014
.15
1.9
Williamstown,
Reservoirs, .
.04
8.08
.0012
.0108
.0050
.10
6.2
Winchester, .
North Reservoir,
.08
3.93
.0038
.0159
.0025
.44
1.5
South Reservoir,
.08
3.73
.0044
.0158
.0029
.41
1.5
Middle Reservoir,
.15
3.62
.0047
.0235
.0045
.42
1.3
Worcester, .
Bottomly Reservoir,
.27
4.64
.0048
.0194
.0026
.24
1.6
Kent Reservoir, .
.23
4.21
.0031
.0174
.0031
.27
1.5
Leicester Reservoir,
.18
3.92
.0052
.0172
.0022
.24
1.2
Mann Reservoir,
.18
4.33
.0031
.0163
.0022
.24
1.6
Upper Holden Reservoir, .
.15
3.24
.0021
.0114
.0018
.24
0.9
Lower Holden Reservoir, .
.13
3.13
.0030
.0131
.0017
.23
0.9
Kendall Reservoir,
.22
4.05
.0037
.0166
.0029
.26
1.2
72
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Gkound Water Sources.
Averages of Chemical Analyses from 1915 to 1919, inclusive.
[Parts in
100,000.]
Source.
o
6
o
o S
o 0.
Ammonia.
6
a
O
.69
.57
Nitrogen
AS —
a
City or Town.
6
Albu-
minoid.
01
o
'B
2
o
Acton (West and
South Water Sup-
ply District).
Amesbury,
Tubular wells, .
Tubular wells, .
.00
.23
9.13
16.48
.0005
.0027
.0020
.0044
.1500
.0001
3.6
9.0
.006
.194
Ashland, .
Tubular wells, old supply,
.00
4.51
.0006
.0020
.41
-
-
1.4
.007
Attlebobo, .
Large well.
.05
5.15
.0005
.0053
.58
.0163
.0000
1.9
.010
Avon,
Wells
.00
6.76
.0008
.0025
.56
.1984
.0000
2.3
.007
Ayer,
Large well.
.01
6.79
.0005
.0028
.64
.0542
.0000
2.7
.010
Tubular wells, .
.02
5.99
.0005
.0021
.28
.0090
.0001
2.5
.017
Barnstable,
Tubtilar wells, .
.00
4.41
.0007
.0020
1.16
-
-
0.7
.012
Bedford, .
Large well.
.05
4.44
.0007
.0034
.36
-
-
1.7
.021
Billerica, .
Old wells
.19
7.62
.0017
.0064
.47
-
-
2.7
.098
New wells
.13
7.80
.0013
.0050
.41
-
-
3.1
.0691
Braintree,
Filter-gallery, .
.27
9.02
.0018
.0139
1.13
.1564
.0000
2.7
.024
Bridgewater, .
Wells
.01
5.64
.0007
.0021
.67
.0309
.0002
1.7
.029
Brookfield (East), .
Tubular wells, .
.00
3.32
.0004
.0016
.23
-
-
0.7
.008
Brookline,
Canton, .
Tubular wells and filter-
gallery, filtered.
Springdale well.
.17
.03
9.25
4.56
.0007
.0004
.0079
.0034
.79
.46
.0294
.0115
.0000
.0000
4.3
1.4
.0141
.008 =
Well near Henry's Spring,
.10
5.17
.0005
.0042
.55
.0264
.0000
1.6
.008
Chelmsford (North
Chelmsford Fire
District).
Chelmsford (Water
District).
Chicopee (Fairview),
Tubular wells, .
Tubular wells, .
Tubular wells, .
.11
.00
.04
5.09
8.21
5.21
.0121
.0005
.0004
.0086
.0015
.0017
.48
.65
.23
.0427
.1275
.0562
.0001
.0002
.0002
1.9
2.9
1.5
.017
.008
.030
Cohasset,
Tubular wells, .
.10
14.19
.0007
.0076
1.96
.1422
.0001
5.4
.011
Dug well, filtered, .
.38
9.00
.0017
.0127
1.30
.0060
.0000
2.9
.035
Dedham,
Deerfield (Fire Dis-
Large well and tubular
wells.
Tubular wells, .
.06
.00
10.19
5.17
.0016
.0004
.0059
.0027
1.08
.15
.1178
.0001
4.2
2.6
.008
.0102
trict).
Douglas, .
Tubular wells, .
.01
4.88
.0005
.0017
.39
.0433
.0000
1.7
.063
Dracut (Water Sup-
Tubular wells, .
.00
8.29
.0004
.0016
.56
.0857
.0000
3.9
.011
ply District).
Dracut (Collins-
ville).
Dudley, .
Tubular wells, .
Tubular wells, .
.05
.00
6.41
3.58
.0005
.0003
.0053
.0020
.37
.25
.0225
.0000
2.5
1.1
.024
.005
Duxbiiry (Fire and
Water District).
Easthampton,
Tubular wells, .
Tubular wells, .
.00
.00
4.36
7.21
.0004
.0003
.0017
.0013
.86
.16
.0150
.0240
.0000
.0000
0.6
3.9
.006
.007
1 Average of three years.
- Average of four years.
No. 34.] DIVISION OF SANITARY ENGINEERING.
73
Averages of Chemical Analyses from 1915 to 1919, inclusive — Continued.
[Parts in 100,000.]
Source.
c
1%.
It
Ammonia.
d
c
'u
O
o
.60
.96
Nitrogen
AS —
i
o
a
-a
City or Town.
1
-d
.1
<
in
o
s
OQ
1
Easton (North
Easton Village Dis-
trict).
Edgarto-vvn,
Well,
Large well,
.00
.00
4.99
3.19
.0004
.0003
.0022
.0015
.0464
.0000
1.7
0.3
.008
.005
Fairhaven,
Tubular wells, .
.42
8.09
.0017
.0115
1.04
.0726
.0000
2.6
.014
Foxborough (Water
Supply District).
Framingham, .
Tubular wells, .
North filter-gallery, .
.00
.02
4.97
11.56
.0006
.0117
.0018
.0069
.50
1.74
.0408
.0152
.0000
.0003
1.7
5.3
.013
.0141
South filter-gallery, .
.02
12.36
.0310
.0077
2.00
.0228
.0006
5.3
.006'
Franklin,
Tubular wells, .
.00
5.26
.0005
.0020
.58
.0317
.0000
1.8
.008
Grafton, .
Filter-gallery, .
.06
12.61
.0009
.0044
1.68
.1802
.0000
4.8
.021
Granville,
Well
.02
4.15
.0004
.0028
.16
-
-
1.8
.013
Groton, .
Large well.
.00
6.41
.0004
.0028
.24
.0019
.0000
3.1
.011
Groton (West Groton
Water Supply Dis-
trict).
Hingham,
Tubular wells .
Wells
.00
.36
4.83
6.30
.0004
.0064
.0016
.0111
.19
.78
.0118
.02C4
.0000
.0002
2.8
1.8
.010
.019
HoUiston,
Large well,
.50
5.12
.0030
.0179
.41
.0056
.0000
1.4
.102
Hopkinton,
Tubular wells, .
.00
13.16
.0009
.0029
1.15
.2793
.0001
5.4
.018
Kingston,
Tubular wells, .
.00
4.72
.0005
.0018
.74
-
-
1.1
.010
Leicester (Water
Supply District).
Leicester (Cherry
Valley and Roch-
dale Water Dis-
trict).
Littleton,
Wells
Wells, .' .
Tubular wells, .
.14
.13
.00
6.41
5.17
4.39
.0015
.0054
.0003
.0062
.0082
.0016
.37
.31
.22
.0174
.0000
2.2
2.2
1.7
.031
.009
.006 =
Lowell, .
Boulevard wells (tubular),
.45
6.96
.0427
.0073
.43
.0222
.0001
2.8
.278
Boulevard welb, filtered, .
.08
6.55
.0007
.0052
.45
.0398
.0000
2.5
.0181
Manchester,
Wells
.00
12.15
.0003
.0016
2.01
.1523
.0000
4.0
.015
Mansfield (Water
Supply District).
Marion, .
Large well.
Tubular wells, .
.00
.00
4.41
4.52
.0006
.0003
.0019
.0017
.45
.73
.0550
.0286
.0000
.0000
1.6
1.2
.007
.007
Marshfield,
Wells
.00
29.42
.0004
.0023
10.51
.1030
.0001
6.4
.0242
Mattapoisett, .
Tubular wells, .
.00
6.53
.0005
.0020
.96
.0464
.0000
2.2
.007
Medfield,
Spring
.00
4.15
.0005
.0036
.37
.0088
.0000
1.4
.009
Medway. .
Wells
.01
7.28
.0005
.0022
.60
.0445
.0000
2.9
.009
Merrimac,
Tubular wells, .
.00
6.89
.0005
.0019
.54
.0152
.0000
2.8
.012
Methuen,
Tubular wells, .
.32
7.73
.0024
.0098
.48
.0160
.0000
3.0
.086
Middleborough (Fire
District).
Well
.39
7.42
.0066
.0083
.67
.0336
.0001
2.5
.360
1 Average of three years.
2 Average of four years.
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Averages of Chemical Analyses from 1915 to 1919, indvsive — Continued.
[Parts in 100,000.]
Ammonia.
Nitrogen
AS —
City or Town.
Source.
'o
o g
o
•6
'o
ii
o
a
'u
2
CO
o
1
..2
U
o
•5
03
o
o
tf
£
<
.67
z
z
ffi
A
Middleborough (Fire
Filtered water, .
.10
6.41
.0005
.0051
.0331
.0000
2.4
.028
District) — Con. .
Millbury,
Well, .
.02 4.53
.0009
.0040
.34
.0125
.0000
1.7
.019
Millis,
Spring,
.00 10.23
.0004
.0016
.80
.2285
.0000
4.2
.006
Monson, .
Large well.
.07
3.57
.0004
.0035
.20
-
-
0.9
.009
Natick, .
Large well.
.00
9.59
.0006
.0030
.82
.0274
.0000
4.6
.006
Needham,
Wells,
.01
6.98
.0004
.0026
.73
.1004
.0000
2.6
.0141
Hicks Spring,
.02
7.35
.0008
.0035
.79
.1610
.0000
2.3
.007
Newburyport,
Wells and Artichoke River,
filtered.
.19
7.30
.0036
.0133
.73
.0194
.0000
2.9
.044>
Newton,
Tubular wells and filter-
gallery.
Wells
.02
6.71
.0006
.0037
.53
.0433
.0001
2.7
.008
North Attleborough,
.01
6.22
.0008
.0025
.53
.0260
.0000
2.3
.010
Norton, .
Tubular wells.
.00
4.38
.0002
.0013
.49
-
-
1.3
.008
Norwood,
Tubular wells.
.14
9.73
.0018
.0061
.61
.0368
.0001
4.2
.051
Oak Bluffs,
Springs,
.00
4.47
.0008
.0023
1.02
.0155
.0000
0.8
.009
Oxford, .
Tubular wells.
.00
4.93
.0003
.0016
.35
.0463
.0000
1.8
.005
Palmer (Bondsville),
Tubular wells.
.00
5.63
.0006
.0020
.22
.0197
.0000
2.0
.013
Pepperell,
Tubular wells,
.00
3.48
.0002
.0017
.20
-
-
1.4
.006
Plainville,
Tubular wells.
.01
4.92
.0005
.0016
.37
-
-
' 2.2
.019
Provincetown,
Tubular wells,
.01
17.06
.0002
.0015
8.71
-
-
3.8
.019
Reading, .
Filter-gallery,
.68
12.95
.0231
.0164
2.12
.0093
.0002
3.3
.376
Filtered water.
.23
19.19
.0010
.0093
1.75
.0118
.0005
8.8
.038
Salisbury,
Well, .
.14
9.24
.0005
.0036
.60
-
-
4.2
.0272
Scituate, .
Tubular wells.
.00
16.19
.CC03
.0023
3.35
.1982
.0000
5.4
.007
Sharon, .
Well, .
.01
13.65
.0004
.0017
1.82
.2749
.0000
5.6
.007
Tubular wells,
.00
5.04
.0004
.0016
.49
.0326
.0000
1.9
.013
Sheffield,
Spring,
.00
3.70
.0017
.0023
.09
.0046
.0000
1.8
.006
Shirley (Shirley Vil-
WeU, .
.00
4.76
.0003
.0014
.49
.1282
.0000
1.4
.007
lage Water District) .
Shrewsbury, .
Tubular wells,
.00
4.98
.0003
.0021
.52
.0459
.0000
1.7
.0062
South Hadley (Fire
Large well.
.01
4.28
.0004
.0018
.17
.0331
.0000
1.5
.007
District No. 2).
Tisbury, .
Well, .
.00
4.44
.0002
.0019
.96
.0048
.0000
0.6
.008
Uxbridge,
Tubular wells.
.00
5.42
.0004
.0022
.55
.0542
.0000
1.8
.007
Walpole, .
Tubular wells.
.00
4.92
.0002
.0018
.46
.0341
.0000
1.8
.013
Waltham,
Old well, .
.15
8.94
.0044
.0042
.83
.0175
.0000
3.9
.074
Average of three years.
- Average of four years.
No. 34.] DIVISION OF SANITARY ENGINEERING.
75
Averages of Chemical Analyses from 1915 to 1919, incltLsive — Concluded.
[Parts in 100,000.]
Source.
6
c
0 o
Ammonia.
o
a
1
o
Nitrogen
AS —
c
-3
03
City or Town.
6
Albu-
minoid.
o
'S
1
Waltham — Con.
New well, ....
.00
7.96
.0013
.0041
.65
.0181
.0000
3.7
.007
Ware,
Wells
.00
7.04
.0002
.0017
.47
.1351
.0000
2.4
.007
Wareham (Fire Dis-
Tubular wells, .
.00
3.36
.0005
.0018
.59
_
-
0.6
.008
trict).
Webster, .
Wells
.02
4.08
.0009
.0044
.36
.0134
.0000
1.6
.015
Wellesley,
Tubular wells, .
.01
9.87
.0006
.0023
1.16
.0622
.0000
4.2
.012
Well at Williams Spring, .
.00
15.53
.0016
.0027
1.35
.5771
.0000
5.6
.008
Filter-gallery, .
.01
9.43
.0018
.0036
1.03
.0882
.0000
4.1
.006»
Westborough, .
Filter basin,
.03
3.27
.0020
.(3097
.29
-
-
1.1
.013
West Brookfield, .
Tubular wells, .
.00
4.72
.0003
.0016
.27
.0441
.0000
1.3
.007
Westford,
Tubular wells, .
.00
4.42
.0003
.0016
.19
-
-
1.7
.009
Weston, .
Well
.17
7.41
.0013
.0078
.61
.0346
.0000
3.1
.009
Winchendon, .
Old well, ....
.12
4.07
.0039
.0038
.16
-
-
1.3
.250
New well
.06
3.24
.0004
.0033 1
.15
-
-
0.8
.009
WOBURN,
Filter gallery, 2 .
.00
11.99
.0026
.0047
1.55
.0287
.0001
5.5
.005'
Worthington (Fire
District).
Wrentham,
Springs, ....
Tubular wells, .
.04
.00
3.02
4.23
.0005
.0004
.0038
.0017
.11
.40
.0463
.0000
1.4
1.4
.028
.014
1 Average of three
years. ^ Mixture of we
is an
d filte
r-galle
ry.
3 A^
rerage (
jf four
yean
3.
AVater Supply Statistics.
During the year 1920 but one new water works has been introduced
in the cities and towns in Massachusetts, this one being for the town
of Auburn. The reason that more works have not been installed has
been previously explained as being due, in part, to the high cost of
labor and materials, a condition which is gradually reverting back
to normal. New works in a great many places are urgently needed,
however.
Works for the public distribution of water in various cities and
towns in Massachusetts have been in use since the year 1799, and as
a means of reference as to when the works of the various cities and
towns were installed, the character of the w^orks, and the population
and valuation of the town in which the WT)rks are located, the follow-
ing table is submitted: —
76
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
CiTT OR Town.
Date
of In-
troduc-
tion.
Ownership.
Ground
or Surface
Supply.
Popu-
lation in
1920.
Municipal
Valua-
tion April 1,
1920.
Abington,
Acton,
Acushnet,
Adams, .
Agawam,
Alford, .
Amesbury,
Amherst,
Andover,
Arlington,
Ashburnham,
Ashby, .
Ashfield,
Ashland,
Athol, .
Attleboro,
Auburn, .
Avon,
Ayer,
Barnstable,
Barre,
Becket, .
Bedford,
Belchertown,
Bellingham,
Belmont,
Berkley, .
Berlin, .
Bernardston,
Beverly,
Billerica,
Blackstone,
Blandford,
Bolton, .
Boston, .
Bourne, .
Boxborough,
Boxford,
1887
1912
1916
1874
1877
1885
1880
1890
1872
1870
1904
1911
1875
1873
1920
1890
1887
1912
1895
1909
1887
1868
1898
1911
1909
1848
Town,
West and' South Water Supply
District.
Town (New Bedford Water Sup-
ply).
Adams Fire District, .
Town (Springfield Water Supply),
Town
Amherst Water Company,
Town
Town (Metropolitan Water Sup-
ply).
Town
Ashfield Water Company, .
Town,
Town
City
Auburn Water Company, .
Town
Town,
Barnstable Water Company,
Town
Town
Town (Metropolitan Water Sup-
ply).
City,
Town,
Town (Woonsocket, R. I., Water
Supply).
Blandford Fire District,
City (Metropolitan Water Sup-
ply).
Surface,
Ground,
Surface,
Surface and
ground.
Surface,
Ground,
Surface,
Surface,
Surface,
Surface,
Surface,
Ground,
Surface,
Ground,
Ground,
Ground,
Ground,
Ground,
Surface,
Ground,
Surface,
Surface,
Ground,
Surface,
Surface,
Surface,
5,787
2,162
3,075
12,967
5,023
248
10,036
5,550
8,268
18,665
2,012
834
869
2,287
9,792
19,731
3,891
2,176
3,052
4,836
3,357
674
1,362
2,058
2,102
10,749
935
868
769
22,561
3,646
4,299
479
708
748,060
2,530
298
588
$4,243,042
2,414,185
2,567,452
10,643,007
4,996,985
224,072
10,168,527
7,180,021
10,086,766
24,118,118
1,454,467
761,338
1,035,864
2,084,150
8,690,193
22,106,770
2,412,441
1,396,341
3,055,335
10,163,250
3,118,820
782,366
2,283,686
1,173,870
1,526,955
15,730,691
732,655
867,607
642,058
41,903,615
6,854,879
2,127,465
897,887
842,275
1,572,457,180
6,244,000
351,644
987,807
No. 34.] DIVISION OF SANITARY ENGINEERING.
77
City or Town.
Date
of In-
troduc-
tion.
Ownership.
Ground
or Surface
Supply.
Popu-
lation in
1920.
Municipal
Valua-
tion April 1,
1920.
Boylston,
Braintree,
Brewster,
Bridgewater,
Brim field,
Brockton,
Brookfield,
Brookline,
Buckland,
Burlington,
Cambridge,
Canton, .
Carlisle, .
Carver, .
Charlemont,
Charlton,
Chatham,
Chelmsford,
Chelsea,
Cheshire,
Chester, .
Chesterfield,
Chicopee,
Chilmark,
Clarksburg,
Clinton, .
Cohasset,
Colrain, .
Concord,
Conway,
Cummington
Dalton, .
Dana,
Dan vers,
Dartmouth,
Dedham,
1887
1888
1880
1889
1875
1856
1889
1907
1914
1867
1876
1893
1845
1882
1886
1901
1902
1873
1916
1884
1876
1915
1881
Town
Bridgewater Water Company,
City
Town,
Town
City
Town
North Chelmsford Fire District, ]
Chelmsford Water District, j
City (Metropolitan Water Sup-
ply).
Cheshire Water Company,
Chester Fire District,
City.
Town,
Cohasset Water Company,
Griswoldville Manufacturing ]
Company (Griswoldville). \
Colrain Fire District No. 1, J
Town,
Town, .
Dalton Fire District,
Town,
Town (New Bedford Water Sup-
ply).
Dedham Water Company,
-
794
Surface,
10,580
-
688
Ground,
8,438
-
778
Surface,
66,254
Surface and
ground.
Ground, .
2,216
37,748
-
1,433
-
885
Surface,
109,694
Ground, .
5,945
-
463
-
891
-
808
-
1,995
-
1,737
Ground,
5,682
Surface,
43,184
Surface,
1,476
Surface,
1,302
-
441
Surface and
ground.
36,214
240
-
1,136
Surface,
12,979
Ground, .
2,639
Surface,
1,607
Surface,
6,461
-
961
Ground, .
489
Surface,
3,752
-
599
Surface,
11,108
Surface,
6,493
Ground,
10,792
$649,306
11,092,239
1,113,360
4,751,311
946,250
60,628,361
1,768,596
103,636,400
2,341,876
1,424,102
141,704,972
6,866,045
582,686
2,120,815
765,657
1,639,920
2,795,650
6,421,540
41,364,400
941,612
1,016,673
436,702
42,718,050
455,524
505,669
11,774,907
6,647,539
1,167,220
7,331,008
982,491
390,010
4,716,879
537,104
8,671,925
7,383,875
16,311,565
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
City or Town.
Date
of In-
troduc-
tion.
Ownership.
Ground
or Surface
Supply.
Deerfield,
Dennis, .
Dighton,
Douglas,
Dover, .
Dracut, .
Dudley, .
Dunstable,
Duxbury,
East Bridgewater,
East ham,
Easthampton,
East Longmeadow,
Easton, .
Edgartovvn,
Egremont,
Enfield, .
Erving, .
Essex,
Everett,
Fairhaven,
Fall River,
Falmouth,
FlTCHBURQ,
Florida, .
Foxborough,
Framingham,
Franklin,
Freetown,
Gardner,
Gay Head,
Georgetown,
1903
1911
1910
1900
1906
1910
1918
1914
1888
1870
1913
1887
1915
1916
1906
1913
1896
1867
1894
1874
1899
1872
1891
1912
1885
1884
1882
South Deerfield Water Supply
District.
Deerfield Fire District,
Town,
American Woolen Company,
Collinsville.
Dracut Water Supply District,
Town
Town,
Duxbury Fire and Water Dis-
trict.
Town (Bridgewater Water Sup-
ply; Brockton Water Supply).
Town,
Town (Springfield Water Sup-
North Easton Village District,
South Easton and Eastondale
Fire and Water District
(Brockton Water Supply).
Unionville Fire and Water Dis-
trict.
Edgartown Water Company,
South Egremont Water Com-
pany.
Millers Falls Water Supply Dis-
trict.
City (Metropolitan Water Sup-
ply).
Fairhaven Water Company,
City,
Town
City
Foxborough Water Supply Dis- )
trict.
East Foxborough Water Supply
District.
Town
Town,
Town, .
Surface,
Ground,
Ground,
Ground,
Ground,
Ground,
Ground,
Ground and
surface.
Ground,
Surface,
Ground and
surface.
Ground,
Surface,
Surface,
Surface,
Ground,
Surface,
Surface,
Surface,
Ground,
Surface and
ground.
Ground,
Surface,
Popu-
lation in
1920.
Municipal
Valua-
tion April 1,
1920.
2,803
1,536
2,574
2,181
867
5,280
3,701
353
1,553
3,486
430
11,261
2,352
5,041
1,190
441
790
1,295
1,478
40,120
7,291
120,485
3,500
41,029
298
4,136
17,033
6,497
1,532
16,971
144
2,004
$4,287,051
1,517,435
2,973,227
1,656,730
2,797,267
3,311,301
3,146,800
434,890
4,231,456
3,614,481
591,299
12,489,697
1.986,590
4,476.6S-4
1,786,825
715,224
670,610
1,836,832
1.370,514
40,855,050
7,854,354
178,728,693
7,706,918
48,050,360
1,303,096
3,163,220
22,675,720
6,462,986
1,385,917
15,374,117
65,605
1,497,903
No. 34.] DIVISION OF SANITARY ENGINEERING.
79
City or Town.
Date
of In-
troduc-
tion.
Ownership.
Ground
or Surface
Supply.
Popu-
lation in
1920.
Municipal
Valua-
tion April 1,
1920.
GUI,
Gloucester,
Goshen, .
Gosnold,
Grafton, .
Granby, .
Granville,
Great Barrington,
Greenfield,
Greenwich,
Groton, .
Groveland,
Hadley, .
Halifax, .
Hamilton,
Hampden,
Hancock,
Hanover,
Hanson, .
Hardwick,
Harvard,
Harwich,
Hatfield,
Haverhill,
Hawley, .
Heath, .
Hingham,
Hinsdale,
Holbrook,
Holden, .
Holland,
Holliston,
HOLYOKE,
Hopedale,
Hopkinton,
Hubbardston,
1888
1885
1886
1910
1867
1888
1870
1897
1912
1915
1905
1887
1896
1802
Riverside Water Company,
City
Grafton Water Company,
Granville Center Water Com-
pany.
Great Barrington Fire District, '
Housatonic Water Works Com- |
pany, Housatonic. j
Greenfield Fire District No. 1, .
Groton Water Company, . 1
West Groton Water Supply Dis-
trict. J
Town (Haverhill Water Supply),
Hadley Water Supply District, .
George H. Gilbert Manufactur-
ing Company.
Town,
City,
1880
Hingham Water Company,
1889
Hinsdale Fire District,
1888
Town
1905
Town
1891
Holliston Water Company,
1873
City
1881
Milford Water Company, .
1884
Town
Ground,
Surface,
Ground,
Ground,
Surface,
Surface and
ground.
Ground,
Surface,
Surface,
Ground,
Surface,
Surface,
Surface and
ground.
Surface,
Surface,
Surface,
Ground,
Surface,
Surface and
ground.
Ground,
879
22,947
224
131
6,887
779
655
6,315
15,462
399
2,185
2,650
2,784
563
1,631
624
464
2,575
1,910
3,085
2,546
1,846
2,651
53,884
390
325
5,604
1,065
3,161
2,970
153
2,707
60,203
2,777
2,289
1,045
$712,611
29,692,552
305,598
1,002,223
3,792,103
888,824
597,010
8,170,305
17,242,462
391,095
3,190,650
1,610,246
2,977,390
941,155
4,250,789
487,078
399,434
2,335,728
2,085,278
3,316,752
2,053,333
2,186,898
2,432,825
64,125,571
295,134
325,928
8,917,067
810,568
2,132,630
2,536,319
168,476
2,577,881
89,527,690
3,397,653
2,093,587
885,751
80
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
City or Town.
Date
of In-
troduc-
tion.
Ownership.
Ground
or Surface
Supply.
Popu-
lation in
1920.
Municipal
A'alua-
tion April 1,
1920.
Hudson,
1884
Hull, .
1882
Huntington, .
1899
Ipswich, .
1894
Kingston,
1886
Lakeville,
-
Lancaster,
1885
Lanesborough,
-
Lawrence, .
1875
Lee,
1881
Leicester,
1891
1911
Lenox, .
1875
Leominster, .
1873
Leverett,
-
Lexington,
1884
Leyden, .
-
Lincoln, .
1874
Littleton,
1912
Longmeadow,
1895
Lowell,
1872
Ludlow, .
1873
Lunenburg, .
-
Ltnn,
1871
Lynnfield,
-
Malden,
1870
Manchester, .
1892
Mansfield,
1888
Marblehead, .
1885
Marion, .
1908
Marlborough,
1883
Marshfield,
1890
1900
Mashpee,
-
Mattapoisett, .
1913
Maynard,
1889
Medfield,
1889
Town
Hingham Water Company,
Huntington Fire District, .
Town
Town
Town (Clinton Water Supply), .
City
Berkshire Water Company,
Leicester Water Supply District, 1
Cherry Valley and Rochdale [
Water District. J
Lenox Water Company,
City
Town (Metropolitan Water Sup-
ply).
Town :
Town
Town
City
Ludlow Manufacturing Com-
pany (Springfield Water Sup-
ply).
City
City (Metropolitan Water Sup-
ply).
Town,
Mansfield Water Supply District,
Town
Town,
City
Brant Rock Water Company,
Humarock Water Company,
Town
Town ;
Medfield Water Company,
Surface,
Surface and
ground.
Surface and
ground.
Surface,
Ground,
Surface,
Surface,
Surface,
Ground,
Surface,
Surface,
Surface,
Surface,
Ground,
Surface,
Ground,
Surface,
Surface,
Surface,
Surface and
ground.
Ground,
Surface and
ground.
Ground,
Surface,
Ground,
Ground, .
Surface,
Ground,
7,607
1,771
1,425
6,201
2,505
1,419
2,461
1,054
94,270
4,085
3,635
2,691
19,744
695
6,350
330
1,042
1,277
2,618
112,759
7,470
1,634
99,148
1,165
49,103
2,466
6,255
7,324
1,288
15,028
1,379
242
1,277
7,086
3,595
S5,827,389
13,178,150
1,040,095
6,052,526
1,844,360
1,284,210
2,531,339
931,196
104,659,330
3,662,596
2,822,116
7,378,422
17,484,515
447,114
9,945,296
282,843
1,969,111
1,630,355
4,967,612
123,803,827
8,427,628
1,864,655
101,544,572
1,976,018
44,542,777
11,539,928
6,345,655
11,878,027
3,326,240
13,293,501
3,021,935
501,445
2,143,276
5,184,220
2,209,389
No. 34.] DIVISION OF SANITARY ENGINEERING.
81
City or Town.
Date
of In-
troduc-
tion.
Ownership.
Ground
or Surface
Supply.
Popu-
lation in
1920.
Municipal .
Valua-
tion April I,
1920.
Medford,
Medway,
Melrose,
Men don,
Merrimac,
Methtten,
Middleborough,
Middlefield,
Middleton,
Milford, .
MUlbury,
MUlis, .
MillviUe,
Milton, .
Monroe, .
Monson, .
Montague,
Monterey,
Montgomery, .
Mount Washington
Nahant, .
Nantucket,
Natick, .
Need ham.
New Ashford,
New Bedford,
New Braintree,
Newbury,
Newbuktport,
New Marlborough
New Salem, .
Newton,
Norfolk, .
North Adams,
1870
1911
1870
1904
1875
1885
1876
1881
1895
1891
1885
1895
1887
1886
1909
1917
1885
1878
1913
1874
1890
1869
1881
1876
1861
City (Metropolitan Water Sup-
ply).
Town,
City (Metropolitan Water Sup-
ply).
Town
City, ..;...
Middleborough Fire District,
Town (Danvers Water Supply),
Milford Water Company, .
Millbury Water Company,
Town
Town (Metropolitan Water Sup-
ply).
Town,
Turners Falls Fire District,
Millers Falls Water Supply Dis-
trict.
Lake Pleasant Water Supply
District.
Montague Village (Edgar L.
Bartlett).
Monterey Water Company,
Town (Metropolitan Water Sup-
ply).
Wannacomet Water Company, .
Town (supply at Siasconset),
Town
Town,
City,
City
Surface,
Ground,
Surface,
City,
City.
39,038
2,956
18,204
961
Ground,
2,173
Ground,
15,189
Ground, .
8,453
-
280
Surface,
1,195
Surface and
13,471
ground.
Ground,
5,653
Ground, .
1,485
-
2,224
Surface,
9,382
-
173
Ground,
4,826
Surfaxie,
7,675
Surface,
282
-
229
-
73
Surface,
1,318
Surface and
ground.
Ground, .
2,797
Ground, .
10,907
Ground, .
7,012
-
116
Surface,
121,217
-
394
-
1,303
Surface and
ground.
15,618
1,010
-
512
Ground,
46,054
-
1,159
Surface and
ground.
22,282
S39,159,850
2,407,055
21,085,400
811,820
1,728,342
18,712,925
5,914,217
291,584
1,119,101
12,046,230
4,371,128
2,047,446
1,328,130
21,293,325
401,507
2,090,308
9,174,190
477,102
218,018
166,375
4,159,697
5,659,990
9,754,425
10,945,340
88,815
182,889,883
509,416
1,623,781
11,919,502
1,503,567
514,800
86,376,380
1,330,423
20,639,900
82
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
City or Town.
Date
of In-
troduc-
tion.
Ownership.
Ground
or Surface
Supply.
Popu-
lation in
1920.
Municipal
Valua-
tion April 1,
1920.
Northampton,
North Andover,
North Attleborough,
Northborough,
Northbridge, .
North Brookfield,
Northfield, .
North Reading,
Norton, .
Nor well,
Norwood,
Oak Bluffs,
Oakham,
Orange, .
Orleans, .
Otis,
Oxford, .
Palmer, .
Paxton, .
Peabodt,
Pel ham, .
Pembroke,
Pepperell,
Peru,
Petersham,
Phillipston,
PiTTSFIELD,
Plainfield,
Plainville,
Plymouth,
Plympton,
Prescott,
Princeton,
Provincetown,
QUINCT, .
Randolph,
1871
1898
1884
1882
1889
1893
1879
1900
1912
1885
1890
1873
1906
1908
1920
1799
1909
1855
1909
1855
City
Town
Town
Town,
Whitin Machine Works (Whitins-
ville).
Town,
Northfield Schools, Inc., .
Northfield Water Company,
Norton Water Company, .
Town
Cottage City Water Company,
Town,
Oxford Water Company, .
Boston Duck Company (Bonds-
ville).
Palmer Fire District No. 1
(Palmer).
City
Town
City
Town (North Attleborough Water
Supply).
Town
Surface,
Surface,
Ground,
Surface,
Ground,
Surface,
Surface and
ground.
Surface,
Ground,
Surface and
ground.
Ground,
Surface and
ground.
Ground,
Ground,
Surface,
Surface,
Ground,
Surface,
Ground,
Surface,
1893
1884
1888
Town,
City (Metropolitan Water Sup-
pl.v).
Town, ......
Ground,
Surface,
Surface,
21,951
6,265
9,238
1,753
10,174
2,610
1,775
1,286
2,374
1,348
12,627
1,047
477
5,393
1,012
361
3,820
9,896
489
19,552
503
1,358
2,468
149
642
354
41,763
332
1,365
13,045
469
236
682
4,246
47,876
4,756
$22,203,961
7,296,129
8,623,600
2,045,808
6,006,224
2,173,100
1,739,103
1,517,842
2,073,450
1,341,430
18,647,488
2,624,580
439.394
4,612,575
1,641,920
409,363
2,435,268
9,683,698
488,633
20,623,635
550,311
1,449,065
2,721,233
288,691
1,385,576
348,506
43,759,915
260,471
1,188,194
20,860,000
570,668
265,082
1,118,828
3,796,555
56,577,605
3,008,600
No. 34.] DIVISION OF SANITARY ENGINEERING.
83
CiTT OR Town.
Date
of In-
troduc-
tion.
Ownership.
Ground
or Surface
Supply.
Raynham,
Reading,
Rehoboth,
Revere,
Richmond,
Rochester,
Rockland,
Rockport,
Rowe,
Rowley, .
Royalston,
Russell, .
Rutland,
Salem, .
Salisbury,
Sandisfield,
Sandwich,
Saugus, .
Savoy, .
Scituate,
Seekonk,
Sharon, .
Sheffield,
Shelburne,
S her born,
Shirley, .
Shrewsbury,
Shutesbury,
Somerset,
Somerville,
Southampton,
Southborough,
Southbridge, .
South Hadley,
Southwick,
Spencer, .
Springfield,
1891
1884
1887
1895
1911
1896
1868
1915
1878
1901
1885
1897
1912
1903
1915
1867
1880
1872
1911
1883
1874
Town,
City (Metropolitan Water Sup-
ply) •
Town,
Town,
Town,
Town
City,
Salisbury Water Supply Com-
pany.
Town (Lynn Water Supply;
Metropolitan Water Supply).
Scituate Water Company, .
Town
Sheffield Water Company,
Shelburne Falls Fire District, .
Shirley Village Water District, .
Town,
City (Metropolitan Water Sup-
ply).
Southbridge Water Supply Com-
pany.
South Hadley Fire District No. 1,
South Hadley Fire District No. 2,
Ground,
Surface,
Surface,
Surface,
Town,
City,
Surface,
Surface,
Surface,
Ground,
Surface,
Surface and
ground.
Ground,
Ground,
Surface,
Ground,
Ground,
Surface,
Surface,
Surface,
Ground,
Surface,
Surface,
Popu-
lation in
1920.
1,695
7,439
2,065
28,823
561
1,047
7,544
3,878
333
1,249
819
1,237
1,743
42,529
1,701
460
1,458
10,874
436
2,534
2,898
2,467
1,435
1,436
1,558
2,260
3,708
242
3,520
93,091
814
1,838
14,245
5,527
1,194
5,930
129,614
Municipal
Valua-
tion April 1,
1920.
$1,365,849
9,196,445
1,747,213
28,537,600
590,847
1,172,526
6,629,853
4,545,204
278,324
1,098,021
998,704
2,256,682
1,074,503
45,985,245
2,334,699
511,071
1,590,625
8,462,188
245,790
7,295,345
2,547,588
3,829,222
1,189,910
2,337,539
1,760,870
1,964,565
4,585,653
394,683
2,884,343
83,910,855
764,000
2,380,611
11,144,369
5,508,097
1,099,914
3,810,507
231,696,735
84
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
City ok Town.
Date
of In-
troduc-
tion.
Ownership.
Ground
or Surface
Supply.
Popu-
lation in
1920.
Municipal
Valua-
tion April 1,
1920.
Sterling, .
-
_ _ _ _
-
1,305
$1,459,310
Stockbridge, .
1862
Stockbridge Water Company, .
Surface,
1,764
5,745,797
Stoneham,
1883
Town (Metropolitan Water Sup-
ply).
Town
Surface,
7,873
7,396,820
Stoughton,
1886
Surface,
6,865
5,867,198
Stow,
-
- - - -
-
1,101
1,579,593
Sturbridge,
-
_ _ _ _
-
1,573
1,097,250
Sudbury,
-
_ _ _ _
-
1,121
1,490,085
Sunderland, .
1883
Sunderland Water Company,
Surface,
1,289
921,109
Sutton, .
-
_ _ _ _
-
2,578
1,693,259
Swampscott, .
1885
Town (Metropolitan Water Sup-
ply).
Surface,
8,101
15,324,854
Swansea,
-
-
2,334
2,106,786
Taunton,
1876
City
Surface,
37,137
34,811,725
Templeton,
-
- -
-
4,019
2,595,342
Tewksbury,
-
- - - -
-
4,450
2,889,746
Tisbury,
1887
Town,
Ground,
1,275
2,428,159
Tolland, .
-
_ _ _ _
-
192
345,616
Topsfield,
-
- , -
-
900
2,361,460
Townsend,
-
_ _ _ -
-
1,575
2,069,544
Truro, .
-
_ _ _ _
-
554
650,395
Tyngsborough
-
_ _ _ _
-
1,044
940,055
Tyringham,
-
- - -
-
267
399,655
Upton, .
-
_ _ _ _
-
1,693
1.482,953
Uxbridge,
1879
Town,
Ground,
5,384
6,244,860
Wakefield,
1883
Town
Surface,
13,025
13,550,701
Wales, .
-
_ _ _ _
-
419
359,407
Walpole, .
1896
Town
Ground,
5,446
8,109,828
Waltham,
1873
City
Ground,
30,915
38,249,575
Ware, .
1886
Town,
Ground,
8,525
6,594,755
Wareham,
1894
1908
Onset Water Company,
Wareham Fire District,
Surface,
Ground,
4,415
8,240,584
Warren, .
-
_ _ _ -
-
3,467
3,822,662
Warwick,
-
- - -
-
327
472,048
Washington,
-
_ _ - _
-
240
311,408
Watertown,
1885
Town (Metropolitan Water Sup-
ply).
Town,
Surface,
21,457
28,892,703
Wayland,
1878
Surface,
1,935
3,015,300
Webster,
1881
Town
Ground,
13,258
10,365,216
Wellesley,
1884
Town,
Ground,
6,224
18,234,610
Wellfleet,
-
_ - _ _
-
826
879,700
No. 34.] DIVISION OF SANITARY ENGINEERING.
85
City or Town.
Date
of In-
troduc-
tion.
Ownership.
Ground
or Surface
Supply.
Ponn- I Municipal
lopu- Valua-
lationin
1920.
tion April 1,
1920.
Wendell,
Wen ham,
West borough.
West Boj'lston,
West Bridgewater,
West Brookfield,
Westfield, .
Westford,
Westhampton,
Westminster, .
West Newbury,
Weston, .
Westport,
West Springfield,
West Stockbridge,
West Tisbury,
West wood,
Weymouth,
Whately,
Whitman,
Wilbraham,
Williamsburg,
Williamstown,
Wilmington,
Winchendon,
Winchester,
Windsor,
Winthrop,
WoBtTRN,
Worcester,
Worthington,
Wrentham,
Yarmouth,
1879
1911
1913
1874
1908
1896
1875
1873
1885
1883
1903
1859
1896
1873
1884
1873
1845
1911
1908
Town
Town (Brockton Water Supply),
Town,
City
Westford Water Company, .
Weston Water Company, .
Town,
East Mountain Water Company,
Town
Town (Brockton Water Supply),
Town
Williamstown Water Company, .
Town,
Town,
Town (Metropolitan Water Sup-
ply).
City
City
Worthington Fire District, .
Town
Ground,
Surface,
Ground,
Surface,
Ground,
Ground,
Surface,
Ground,
Surface,
Surface,
Surface,
Ground,
Ground,
Surface,
Surface,
Ground,
Surface,
Surface and
ground.
Ground,
346
1,090
5,789
1,624
2,908
1,281
18,604
3,170
305
1,343
1,492
2,282
3,115
13,443
1,058
345
1,358
15,057
1,234
7,147
2,780
1,866
3,707
2,581
5,904
10,485
403
15,455
16,574
179,754
409
2,808
1,229
S666,726
2,708,410
3,712,997
1,281,697
2,077,244
1,140,391
14,167,407
2,735,339
316,210
1,156,051
1,082,889
5,411,290
4,637,925
17,777,12]
751,670
600,168
2,760,223
14,811,209
954,599
6,262,978
2,120,623
1,192,074
5,154,178
2,441,419
4,883,380
22,322,125
388,165
18,229,450
16,377,302
232,004,780
486,006
1,908,254
2,023,424
Note. — East Brookfield not considered as a town in this report.
Of the above cities and towns in Massachusetts, all of the 39 cities
and 177 of the towns are provided with public water supplies. The
following table shows the cities and towns having and not having
pul)lic water supplies at the end of the year 1920: —
86
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Population, 1920.
Number of
Places of Given
Population
having
Public Water
Supplies.
Total
Population of
Places
in Preceding
Column.
Number of
Places of Given
Population
not having
Public Water
Supplies.
Under 500, .
500-999,
1,000-1,499, .
1,500-1,999, .
2,000-2,499, .
2,500-2,999, .
3,000-3,499, .
3,500-3,999, .
4,000 and over,
Totals, .
6
3
24
10
17
17
7
11
121
216
2,453
2,403
30,799
17,468
38,811
46,408
22,386
40,833
3,500,988
3,702,549
Total
Population of
Places
in Preceding
Column.
44
32
28
15
6
8
2
1
2
138
13,667
23,872
34,471
25,377
12,787
21,062
6,582
3,520
8,469
149,807
The following table indicates when a fairly complete system of
water supply was introduced in each city and town : —
Yeabs.
Number of
Public Water
Supplies
introduced.
Yeabs.
Number of
Public Water
Supplies
introduced.
Previous to 1850
1850-1859, inclusive,
1860-1869, inclusive,
1870-1879, inclusive,
5
4
9
45
70
1890-1899, inclusive,
1900-1909, inclusive,
1910-1919, inclusive,
1920
Total
34
21
27
1
1880-1889, inclusive.
216
At the end of the year 1920 the water supplies in all of the cities
in Massachusetts and in 134 of the towns were owned either by the
city or town or by a water supply or fire district. In 43 towns the
works were owned by private companies.
The following table gives the classification by population of the
cities and towns which own their water works, and those which are
supplied by private water companies: —
No. 34.] DIVISION OF SANITARY ENGINEERING.
87
Population, 1920.
Number of
Places of Given
Population
owning
Water Works.
Total
Population of
Places
in Preceding
Column.
Number of
Places of Given
Population
supplied with
Water by
Private Com-
panies.
Total
Population of
Places
in Preceding
Column.
Under 1,000,
1,000-1,999, .
2,000-2,999, .
3.000-3,999. .
4,000-4,999. .
5,000-5,999, .
6,000-6,999, .
7,000-7,999, .
8,000 and over,
Totals. .
4
23
26
12
6
13
10
9
70
1,730
32,382
64,418
41,951
26,678
72,131
63,926
66,707
3,167,050
173
3,536,973
5
11
8
6
2
3
1
2
5
43
3,126
15,885
20,801
21,268
8,921
16,807
6,887
14,761
57,120
165,576
The following table shows, for the census years since 1890, the total
population of all cities and towns supplied with water, and the total
population of those supplied by private companies, with the percentage
of the total population so supplied: —
Year.
Total
Population
of All Places
supplied
with Water.
Population
of Places
supplied
by Private
Companies.
Per Cent of
Total
Population.
1S90
1,924,812
318,319
16.5
1895,
2,237,017
212,579
9.5
1900,
2,565,301
236,869
9.2
1905
2,792,490
193,290
6.9
1910
3,171,055
159,730
5.0
1915,
3,528,769
174,760
5.0
1920
3,536,973
165,576
4.7
The foregoing table shows that the total population of the places
supplied with water by private companies is only 4.7 per cent of the
total population of all the places supplied with water. Of the towns
supplied by private water companies, only 11 have a population in
excess of 5,000. These towns are as follows: —
88
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Town.
Population,
1920.
Town.
Population,
1920.
Southbridge
Milford • .
Dedham,
Northbridge
Bridgewater,
Ludlow,
14,245
13,471
10,792
10,174
8,438
7,470
Fairhaven,
Grafton
Millbury,
Hingham,
Amherst,
7,291
6,887
5.653
5,604
5,550
Consumption of Water.
The consumption of water in 1920 in the various cities and towns in
which records are kept is shown in the following table, and the jfigures
represent all the public supplies in any one municipality: —
Consumption of Water in Various Cities and Towns in 1920.
Popula-
Average Daily
Consumption.
Popula-
Average Daily
Consumption.
CiTT OR Town.
tion,
Census
of 1920.
Gallons.
Gallons
per
Inhabit-
ant.
City or Town.
tion,
Census
of 1920.
Gallons.
Gallons
per
Inhabit-
ant.
Metropolitan Water
District:! —
Arlington, .
1,206,849
18,665
127,265,500
1,055,600
106
57
Abington and Rock-
land.
Acushnet,
13,331
3,075
657,000
48,000
49
16
Belmont,
10,749
591,400
55
Agawam,
5,023
179,000
36
Boston,
748,060
94,297,400
126
Amesbury,
10,038
564,000
56
Chelsea,
43,184
3,316,400
77
Andover,
8,268
621,000
75
EVEBETT,
40,120
3,455,200
86
Ashburnham,
2,012
142,000
71
Lexington,
6,350
424,300
67
Athol, .
9,792
798,000
81
Malden,
49,103
2,793,300
57
Attleboro, .
19,731
1,151,000
58
Medford,
39,038
1,739,700
45
Avon,
2,176
94,000
43
Melrose,
18,204
1,108,100
61
Barnstable, .
4,836
159,000
33
Milton,
9,382
430,900
46
Bedford,
1,362
41,000
30
Nahant,
1,318
192,600
146
Beverly,
22,561
1,590,000
70
QUINCY,
47,876
4,472,500
93
Billerica,
3,646
513,000
141
Revere,
28,823
1,975,900
69
Braintree,
10,580
742,000
70
Somerville,
93,091
7,177,300
77
Bridgewater, .
8,438
223,000
26
Stoneham, .
7,873
789,600
100
Brockton,
66,254
2,931,000
44
Swampscott,
8,101
657,200
81
Brookline,
37,748
3,451,000
91
Watertown,
21,457
1,911,700
89
Cambridge, .
109,694
11,435,000
104
Winthrop, .
15,455
876,400
57
Chelmsford, .
5,682
130,000
23
I Figures for metropolitan consumption are exclusive of Newton and are based entirely on meter read-
ings. District result based on pumpage will vary slightly from the above.
No. 34.] DIVISION OF SANITARY ENGINEERING.
89
Consumption of Water in Various Cities and Toims in 1920 — Continued.
Popula-
tion,
Census
of 1920.
Average Daily
Consumption.
City or Town.
Popula-
tion,
Census
of 1920.
Average Daily'
Consumption.
City or Town.
Gallons.
Gallons
per
Inhabit-
ant.
Gallons.
Gallons
per
In labit-
ant.
Clinton, .
12,979
758,000
58
Littleton,
1,277
44,000
34
Cohasset,
2,639
346,000
131
Longmeadow,
2,618
96,000
37
Concord,
6,461
585,000
91
Lowell,
112,759
7,144,000
63
Danvers and Mid-
12,303
1,510,000
123
Ludlow, .
7,470
202,000
27
dleton.
Dedham,
10,792
799,000
74
Lynn and Saugus,
110,022
9,084,000
83
Dracut, .
5,280
97,000
18
Manchester, .
2,466
293,000
119
Dudley, .
3,701
106,000
29
Mansfield,
6,255
531,000
85
Duxbury,
1,553
74,000
48
Marblehead, .
7,324
635,000
87
Easthampton,
11,261
723,000
64
Marion, .
1,288
95,000
74
East Longmeadow,
2,352
32,000
14
Marlborough,
15,028
698,000
46
Easton, .
5,041
182,000
36
Mattapoisett,
1,277
55,000
43
Edgartown, .
1,190
84,000
71
Maynard,
7,086
330,000
47
Fairhaven,
7,291
353,000
48
Medway,
2,956
122,000
41
Fall River, .
120,485
6,376,000
53
Merrimac,
2,173
111,000
51
Falmouth,
3,500
383,000
109
Methuen,
15.189
762,000
50
FiTCHBURG, .
41,029
4,406,000
107
Middleborough,
8,453
405,000
48
Foxborough, .
4,136
322,000
78
Milford and Hope-
dale.
Millbury,
16,248
987,000
61
Framingham,
17,033
1,111,000
65
5,653
334,000
59
Franklin,
6,497
513,000
79
Millis, .
1,485
61,000
41
Gardner,
16,971
862,000
51
Nantucket, > .
2,797
271,000
97
Gloucester,
22,947
1,567,000
68
Natick, .
10,907
669,000
61
Grafton,
6,887
226,000
33
Needham,
7,012
450,000
64
Greenfield,
15,462
1,614,000
104
New Bedford,
121,217
10,085,000
83
Groton, .
2,185
120,000
55
Newburyport,
15,618
1,339,000
86
Groveland,
2,650
33,000
13
Newton,
46,054
3,687,000
80
Haverhill, .
53,884
6,031,000
112
North Andover,
6,265
371,000
59
Holliston,
2,707
119,000
44
North Attleborough,
9,238
503,000
54
HOLYOKE,
60,203
7,154,000
119
North Brookfield, .
2,610
268,000
103
Hudson,
7,607
366,000
48
Norton, .
2,374
189,000
80
Ipswich,
6,201
383,000
62
Norwood,
12,627
1,191,000
94
Lancaster,
2,461
81,000
33
Oak Bluffs, .
1,047
189,000
181
Lawrence, .
94,270
4,624,000
49
Orange, .
5,393
150,000
28
Lenox, .
2,691
303,000
113
Peabody,
19,552
3,967,000
203
Lincoln, .
1,042
221,000
212
Pepperell,
2,408
164,000
66
' Does not include supply at Siasconset.
90
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Consumption of Water in Various Cities and Towns in 1920 — Concluded.
Popula-
Average Daily
Consumption.
Popula-
Average Daily
Consumption.
City or Town.
tion,
Census
of 1920.
Gallons.
Gallons
per
Inhabit-
ant.
City or Town.
tion,
Census
of 1920.
Gallons.
Gallons
per
Inhabit-
ant.
PiTTSFIELD, .
41,763
5,926,000
142
Tisbury,
1,275
130,000
107
Plainville,
1,365
26,000
19
Uxbridge,
5,384
279,000
52
Plymouth,
13,045
1,419,000
109
Wakefield,
13,025
620,000
48
Province town,
4,246
310,000
73
Walpole,
5,446
893,000
164
Randolph and Hol-
brook.
Reading,
7,917
531,000
67
Waltham,
30,915
1,960,000
63
7,439
287,000
39
Ware, .
8,525
514,000
60
Roekport,
3,878
312,000
80
Wareham,
4,415
186,000
42
S.iLEM, .
42,529
5,700,000
134
Webster,
13,258
708,000
53
Salisbury,
1,701
100,000
59
Wellesley,
6,224
536,000
86
Scituate,
2,534
349,000
138
West Brookfield, .
1,281
23,000
18
Sharon, .
2,467
207,000
84
Westfxeld, .
18,604
2,254,000
121
Shirley, .
2,260
93,000
41
Westford,
3,170
143,000
45
Shrewsbury, .
3,708
94,000
25
Weston, .
2,282
159,000
70
Southbridge, .
14,245
916,000
64
Weymouth,
15,057
1,464,000
97
Springfield,
129,614
12,520,000
97
Whitman,
7,147
244,000
34
Stockbridge, .
1,764
260,000
147
WOBURN,
16,574
2,104,000
127
Stoughton,
6,865
423,000
62
Worcester, .
179,754
16,517,000
92
Taunton,
37,137
3,395,000
91
Wrentham,
2,808
89,000
32
Rainfall.
The normal yearly rainfall in Massachusetts as deduced from long
continued observations in various parts of the State is 44.60 inches.
The average rainfall for the year 1920 in these places was 49.67, an
excess of 5.07 inches over the normal. There was an excess of pre-
cipitation in the months of February, March, April, May, June, Sep-
tember, November and December, and a deficiency in the other four
months of the year. The greatest excess in any month occurred in
June, when the average rainfall was 6.21 inches, or 2.93 inches greater
than the normal, and the greatest deficiency occurred in October, Avhen
the average rainfall was 1.36 inches, or 2.37 inches less than the normal.
The following table gives the normal rainfall in the State for each
month as deduced from observations at various places for a long
No. 34.] DIVISION OF SANITARY ENGINEERING.
91
period of years, together with the average rainfall at those places
for each month during the year 1920, and the departure from the
normal: —
Month.
Normal
Rainfall
(Inches).
Rainfall
in 1920
(Inches).
Excess or
Defi-
ciency in
1920
(Inches).
Month.
Normal
Rainfall
(Inches).
Rainfall
in 1920
(Inches).
Excess or
Defi-
ciency in
1920
(Inches).
January, .
February,
March,
April,
May,
3.74
3.69
3.94
3.60
3.66
3.28
3.75
2.92
5.72
3.98
5.37
3.94
6.21
2.67
-.82
-f2.03
+ .04
+1.77
+ .28
+2.93
—1.08
August, .
September,
October, .
November,
December,
Totals,
4.21
3.50
3.73
3.82
3.68
3.18
4.59
1.36
4.96
4.77
—1.03
+1.09
—2.37
+1.14
+1.09
June,
July,
44.60
49.67
+5.07
Flow of Streams.
Sudbury River.
The average flow of the Sudbury River during the year 1920 was
1,239,000 gallons per day per square mile of drainage area, or about
24 per cent in excess of the normal flow for the past forty-six years.
The flow was above the normal in the months of March, April, May,
June, July and December, but less than the normal in the other six
months of the year. The greatest excess occurred in the month of
March, and the greatest deficiency in the month of February. The
average flow for the driest six months, June to November, inclusive,
was 360,000 gallons per day per square mile, or about 5 per cent below
the normal flow for that period during the past forty-six years.
In order to show the relation between the flow of the Sudbury
River during each month of the year 1920 and the normal flow of that
stream, as deduced from observations during forty-six years, from
1875 to 1920, inclusive, the following table has been prepared. The
drainage area of the Sudbury River above the point of measurement is
75.2 square miles.
92
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Table showing the AveracjC Daily Flow of the Stidbvry River for Each Month in
the Year 1920, 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 Flow.
Normal Flow.
Actual Flow in 1920.
Excess or Deficiency.
Month.
Cubic Feet
per
Second
per Square
Mile.
Alillion
Gallons per
Day
per Square
Mile.
Cubic Feet
per
Second
per Square
Mile.
Million
Gallons per
Day
per Square
Mile.
Cubic Feet
per
Second
per Square
Mile.
Million
Gallons per
Day
per Square
Mile.
January
1.761
1.138
.483
.312
—1.278
—.826
February, .
2.509
1.622
1.149
.743
-1.360
—.879
March,
4.245
2.744
8.033
5.192
-f3.788
+2.448
April, .
3.078
1.990
4.503
2.911
+1.425
+ .921
May, .
1.680
1.086
2.856
1.846
-1-1.176
+ .760
June, .
.787
.509
2.625
1.696
4-1.838
+1.187
July, .
.284
.184
.439
.284
+ .155
+ .100
August,
.351
.227
-.061
—.039
— .412
— .266
September,
.355
.230
.099
.064
—.256
— .166
October,
.614
.397
— .040
—.026
—.654
— .423
November,
1.134
.733
1.035
.669
— .099
— .064
December, .
1.510
.954
1.857
1.200
+ .347
+ .246
Average for w
fhole
year.
1.518
.981
1.917
1.239
+ .399
+ .258
The following table gives the rainfall upon the Sudbury River
watershed and the total yield expressed in inches in depth upon the
watershed (inches of rainfall collected) for each of the past five
years, from 1916 to 1920, inclusive, together with the average for a
period of forty-six years, from 1875 to 1920: —
Rainfall, in Inches, received and collected on the Sudbury River Drainage Area.
1916.
1917.
1918.
Month.
Rain-
fall.
Rain-
fall
col-
lected.
Per
Cent
col-
lected.
Rain-
fall.
Rain-
fall
col-
lected.
Per
Cent
col-
lected.
Rain-
fall.
Rain-
fall
col-
lected.
Per
Cent
col-
lected.
January, ....
1.53
1.680
109.8
3.50
.909
25.9
3.47
.486
14.0
February,
5.91
2.262
38.2
2.68
1.216
45.5
3.58
2.914
81.3
March, ....
• 4.16
3.245
78.1
4.96
3.940
79.4
2.50
3.896
156.2
April, ....
4.19
5.243
125.1
2 41
2.425
100.5
4.43
2.530
57.1
No. 34.] DIVISION OF SANITARY ENGINEERING.
93
Rainfall, in Inches, received and collected on the Sudbury River Drainage Area ■
Concluded.
1916.
1917.
1918.
Month.
Rain-
fall.
Rain-
fall
col-
lected.
Per
Cent
col-
lected.
Rain-
fall.
Rain-
fall
col-
lected.
Per
Cent
col-
lected.
Rain-
faU.
Rain-
fall
col-
lected.
Per
Cent
col-
lected.
May,
3.43
2.567
74.9
4.93
2.632
53.4
1.16
1.141
98.8
June,
4.77
2.068
43.4
4.23
1.802
42.7
3.65
.319
8.7
July,
5.17
1.044
20.2
1.11
.076
6.8
4.07
.171
4.2
August,
2.01
.139
6.9
6.40
.361
5.6
1.61
—.096
—6.0
September,
1.80
.044
2.5
1.52
.100
6.6
8.60
1.100
12.8
October, .
1.49
— .009
— .6
5.65
.860
15.2
1.04
.490
47.0
November,
2.28
.189
8.3
1.31
.757
57.6
2.75
.843
30.7
December,
3.22
.562
17.4
2.81
.678
24.2
3.68
1.673
45.5
Totals and :
ivera
ges, .
39.96
19.034
47.6
41.51
15.756
38.0
40.54
15.467
38.2
1919.
1920.
1
Mean for
FoRTY-si.x- Ye.\rs,
1875-1920.
Month.
Rain-
fall.
Rain-
fall
col-
lected.
Per
Cent
col-
lected.
Rain-
fall.
Rain-
fall
col-
lected.
Per
Cent
col-
lected.
Rain-
fall.
Rain-
fall
col-
lected.
Per
Cent
col-
lected.
January, .
3.52
2.329
66.1
3.26
.556
17.1
4.02
2.031
50.5
February,
3.40
1.477
43.4
6.49
1.239
19.1
4.15
2.635
63.5
March,
4.79
4.916
102.7
4.45
9.262
207.9
4.33
4.894
112.9
-April,
2.93
2.957
101.0
5.19
5.017
96.6
3.58
3.435
95.9
May,
4.60
2.301
50.0
3.45
3.292
95.6
3.31
1.936
58.6
June,
1.86
.193
10.4
6.67
2.929
43.9
3.15
.878
27.8
July,
5.47
.533
9.8
2.04
.506
24.9
3.64
.328
9.0
August,
3.75
.164
4.4
1.78
— .070
—4.0
3.81
.405
10.6
September
5.28
1.232
23.3
3.53
.110
3.1
3.42
.396
11.6
October,
2.16
.498
23.1
1.01
-.046
-^.6
3.67
.708
19 3
November
5.90
2.202
37.3
5.68
1,154
20.3
3.75
1.265
33.8
December,
1.98
1.952
98.6
5.11
2.141
41.9
3.79
1.702
44.9
Totals
and:
ivera
ges, .
45.64
20.754
45.5
48.66
26.090
53.6
44.62
20.613
46.2
94
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
The following table gives the record of the yield of the Sudbury
River watershed for each of the past five years and the mean for
forty-six years, the flow being expressed in gallons per day per square
mile of watershed: —
Yield of the Sudbury River Drainaqe Area in Gallons per Day per Square Mile. *
Mean for
Month.
1916.
1917.
1918.
1919.
1920.
Forty-six
Years,
1875-1920.
January, . . . .
942,000
510,000
273,000
1,306,000
312,000
1,138,000
February,
1,356,000
755,000
1,809,000
917,000
743,000
1,622,000
March, .
1,820,000
2,209,000
2,187,000
2,759,000
5,192,000
2,744,000
April, .
3,037,000
1,405,000
1,466,000
1,713,000
2,911,000
1,990,000
May,
1,439,000
1,476,000
639,000
1,290,000
1,846,000
1,086,000
June, .
1,198,000
1,044,000
185,000
112,000
1,696,000
509,000
July, .
585,000
43,000
96,000
299,000
284,000
184,000
August,
78,000
202,000
—54,000
92,000
—39,000
227,000
September,
26,000
58,000
637,000
713,000
64,000
230,000
October,
—5,000
482,000
274,000
279,000
—26,000
397,000
November,
110,000
438,000
489,000
1,275,000
669,000
733,000
December,
hole year.
315,000
380,000
938,000
1,095,000
1,200,000
954,000
Average for w
904,000
750,000
736,000
988,000
1,239,000
981,000
Average for driest sLx
months.
186,000
267,000
209,000
458,000
360,000
378,000
' The drainage area of the Sudbury River used in malcing up these records included water surfaces
amounting to about 2 per cent of the whole area from 1875 to 1878, inclusive, subsequently increasing by
the construction of storage reservoirs to about 3 per cent in 1879, to 3.5 per cent in 1885, to 4 per cent in
1894, and to 6.5 per cent in 1898. The drainage area also contains extensive areas of swampy land, which,
though covered with water at times, are not included in the above percentages of water surfaces.
Nashua River.
The average flow of the South Branch of the Nashua River at the
outlet of the Wachusett Reservoir, Clinton, during the year 1920 was
1,629,000 gallons per day per square mile of drainage area, or 50
per cent in excess of the normal flow for the past twenty-four years.
The flow was greater than the normal in the months of March, April,
May, June, July, September, November and December, and less than
the normal in the other four months of the year. The greatest excess
occurred in the month of March, and the greatest deficiency in the
month of February. The average flow for the driest six months,
June to November, inclusive, was 870,000 gallons per day per square
mile, or about 59 per cent in excess of the normal flow for that
period during the past twenty-four years.
No. 34.] DIVISION OF SANITARY ENGINEERING.
95
In order to show the relation between the flow of the Nashua
River during each month of the year 1920 and the normal flow of that
stream as deduced from observations during twenty-four years, 1897
to 1920, inclusive, the following table has been prepared. The drainage
area of the Nashua River above the point of measurement was 119
square miles from 1897 to 1907, and 118.19 square miles from 1908
to 191-3, inclusive. Since Jan. 1, 1914, the city of Worcester has been
diverting water from 9.35 square miles of this drainage area for the
supply of that city, leaving the net drainage area 108.84 square miles.
In the calculations of yield, allowance has been made for water over-
flowing from the Worcester area.
Table sJwxcing the Average Daily Flow of the South Branch of the Nashua River
for Each Month in the Year 1920, 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 Flow.
Normal Flow.
Actual Flow in 1920.
Excess or Deficiency.
Month.
Cubic Feet
per
Second
per Square
Mile.
Million
Gallons per
Day
per Square
Mile.
Cubic Feet
per
Second
per Square
Mile.
Million
Gallons per
Day
per Square
Mile.
Cubic Feet
per
Second
per Square
Mile.
Million
Gallons per
Day
per Square
Mile.
January, ....
1.798
1.162
1.000
.646
— .798
— .516
February, .
2.104
1.360
1.122
.725
— .982
— .635
March,
4.122
2.664
7.248
4.685
+3.126
+2.021
April, .
3.334
2.155
5.413
3.498
+2.079
+1.343
May, .
1.948
1.259
3.205
2.071
+1.257
+ .812
June, .
1.256
.812
2.974
1.922
+1.718
+ 1.110
July, .
.686
.443
1.252
.809
+ .566
+ .366
August,
.628
.406
.506
.327
122
— .079
September,
.571
.369
.835
.540
+ .264
+ .171
October,
.742
.480
.634
.409
— .108
— .071
November,
1.203
.777
2.013
1.301
+ .810
+ .524
December, .
1.815
1.173
4.007
2.590
+2.192
+ 1.417
Average for vi
,'hole
year.
1.682
1.087
2.521
1.629
+ .839
+ .542
The following table gives the rainfall upon the Nashua River
watershed and the total yield expressed in inches in depth upon the
watershed (inches of rainfall collected) for each of the past five years,
1916 to 1920, inclusive, together with the average for the past twenty-
four vears : —
96
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Rainfall, in Inches, received and collected on the Nashua River Drainage Area.
1916.
1917.
1918.
Month.
"3
a
"3
Pi
o
II
^8
3
"3
Rainfall
collected.
o
II
Pm
■3
0
.5 8
03
i
January, .
1,60
2.346
146.7
3.37
1.224
36.3
2.97
.864
29.1
February,
5.98
3.030
50.7
3.05
1.476
48.3
4.25
3.260
76.6
March,
3.32
3.374
101.5
4.21
4.409
104.8
2.24
4.614
206.0
April,
3.65
5.696
156.0
1.80
2.535
140.6
3.47
2.775
80.0
May,
3.34
3.028
90.7
3.89
2.350
60.5
1.07
1.201
112.8
June
6.57
3.546
53.9
4.47
2.122
47.4
4.57
.902
19.8
July,
5.66
1.937
34.2
1.22
.471
38.8
2.80
.499
17.8
August, .
1.72
.506
29.5
4.46
.552
12.4
2.82
.284
10.1
September,
4.21
.506
12.0
1.20
.144
12.0
7.18
1.041
14.5
October, .
1.42
.250
17.6
6.03
.990
16.4
1.58
.609
38.6
November,
3.15
.554
17.6
1.25
.540
43.1
3.08
1.004
32.6
December,
2.81
.820
29.2
2.31
.694
30.0
3.74
1.884
50.4
Totals and
avers
iges .
43.43
25.593
58.9
37.26
17.507
47.0
39.77
18.937
47.6
1919.
1920.
Mean
FOUK 1
FOR TwENTY-
EAKs, 1897-1920.
Month.
3
■3
.5 8
73
II
0
1
c
■3
0
!58
■6
3
"s
■3
Pi
— 0
•3.S
■d
0
Pi
January, .
3.23
2.392
74.1
3.17
1.153
36.4
3.59
2.073
57.6
February,
3.51
1.279
36.5
6.26
1.210
19.3
3.89
2.208
56.7
March,
5.27
5.621
106.7
4.26
8.356
196.0
4.09
4.752
116.1
April,
2.57
2.954
115.0
6.13
6.031
98.4
3.76
3.721
99.0
May,
6.06
3.931
64.9
4.01
3.695
92.1
3.43
2.246
65.6
June,
2.01
.798
39.6
6.07
3.317
54.6
3.78
1.400
37.0
July,
5.00
.713
14.3
4.33
1.443
33.3
4.09
.791
19.3
August,
4.17
.467
11.2
2.91
.584
20.1
4.09
.724
17.7
September
6.78
1.887
27.8
6.39
.931
14.6
3.84
.638
16.6
October,
2.35
.884
37.6
.63
.731
116.1
3.23
.856
26.5
November
6.01
3.168
52.7
5.49
2.246
40.9
3.47
1.342
38.6
December,
2.09
2.305
110.4
6.01
4.619
76.9
4.06
2.093
51.5
Totals
and !
ivera
ges, .
49.05
26.399
53.8
55.66
34.316
61.7
45.32
22.844
50.4
No. 34.] DIVISION OF SANITARY ENGINEERING.
97
The following table gives a record of the yield of the Nashua River
for each of the past five years and the mean for the past twenty-four
years, the flow being expressed in gallons per day per square mile of
watershed : —
Yield of thb Nashua River Drainage Area in Gallons per Day per Square Mile. ^
Month.
1916.
1917.
1918.
1919.
1920.
Mean for
Twenty-
four Years,
1897-1920.
January,
February, .
March,
April, .
May, .
June, .
July, .
August,
September,
October,
November,
December, .
1,315,000
1,816,000
1,891,000
3,300,000
1,697,000
2,054,000
1,086,000
284,000
294,000
140,000
321,000
460,000
686,000
916,000
2,472,000
1,468,000
1,317,000
1,229,000
264,000
309,000
84,000
555,000
313,000
389,000
484,000
2,024,000
2,590,000
1,608,000
673,000
523,000
280,000
159,000
603,000
341,000
582,000
1,056,000
1,341,000
794,000
3,155,000
1,711,000
2,204,000
462,000
400,000
262,000
1,093,000
495,000
1,835,000
1,292,000
646,000
725,000
4,685,000
3,498,000
2,071,000
1,922,000
809,000
327,000
540,000
409,000
1,301,000
2,590,000
1,162,000
1,360,000
2,664,000
2,155,000
1,259,000
812,000
443,000
406,000
369,000
480,000
777,000
1,173,000
Average for v
year.
Average for (
six months
vhole
Iriest
1,215,000
432,000
834,000
320,000
902,000
412,000
1,257,000
752,000
1,629,000
870,000
1,087,000
546,000
1 The drainage area used in making up these records included water surfaces amounting to 2.2 per
cent of the whole area from 1897 to 1902, inclusive, to 2.4 per cent in 1903, to 3.6 per cent in 1904, to 4.1
per cent in 1905, to 5.1 per cent in 1906, to 6 per cent in 1907, to 7 per cent in 1908, 1909 and 1910, to 6.5
per cent in 1911, to 6.8 per cent in 1912, to 7 per cent in 1913, to 7.4 per cent in 1914 and 1915, to 7.6 per
cent in 1916, to 7.4 per cent in 1917 and 1918, and to 7.5 per cent in 1919 and 1920.
Merrimack River.
The flow of the Merrimack River has been measured for many
years at Lawrence, above which place the river has a total drainage
area of 4,663 square miles, which includes 118^ square miles on the
South Branch of the Nashua River, 75 square miles on the Sudbury
River, and 18 square miles tributary to Lake Cochituate, or a com-
bined area of 211^ square miles from which water is drawn at the
present time for the supply of the Metropolitan Water District. The
flow as measured at Lawrence includes the water wasted from these
three drainage areas, the aggregate quantity of which, in the wet
months of the year, is considerable, but which becomes very small in
* Including 9.35 square miles from which water is drawn for the supply of the city of Worcester.
98
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
the dry months. Records of the quantity of water wasted have been
kept by the Boston Water Board and by the Metropolitan Water and
Sewerage Board, and these quantities have been deducted from the
flow as measured at Lawrence. In presenting the record of the flow
of the river, these three drainage areas have been deducted from the
total above Lawrence, so that the net drainage area above that
point was 4,567 square miles in 1880, 4,570 square miles in the years
1881 to 1897, inclusive, and 4,452 square miles since the latter year.
The average flow of the Merrimack River during the year 1920
amounted to 1.98 cubic feet per second, or 1,280,000 gallons per
day, per square mile of drainage area, or 35 per cent in excess of the
normal flow for the past forty-one years for which records are avail-
able. The flow was in excess of the normal in the months of March,
April, May, June, July, August, September, October and December,
and less than the normal in the other three months of the year.
In order to show the relation between the flow of this stream
during each month of the year 1920 and the normal flow as deduced
from observations during forty-one years, from 1880 to 1920, inclusive,
the following table has been prepared: —
Table shoicing the Average Monthly Flow of the Merrimack River at Lawrence
for the Year 1920, in Cubic Feet per Second per Square Mile of Draina{)e
Area; also, Departure from the Normal Flow.
Month.
January
February, . . . .
March,
April,
May,
June,
July,
August, . . . .
September
October, . . . .
November
December
Average for whole year.
Normal Flow,
1880-1920.
Actual Flow
in 1920.
1.267
1.382
2.747
3.457
2.218
1.266
.741
.677
.652
.814
1.117
1.269
1.467
.570
.618
4.082
6.002
3.545
1.607
.746
.678
.680
1.051
.921
3.258
1.980
Excess or
Deficiency.
— .697
—.764
+1.335
+2.545
+1.327
f .341
f .005
+ .001
+ .028
+ .237
— .196
+1.989
+ .513
No. 34.] DIVISION OF SANITARY ENGINEERING.
99
The following table gives the record of the flow of the Merrimack
River at Lawrence for each of the past five years and the mean for
forty-one years, the flow 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.
MOXTH.
1916.
1917.
1918.
1919.
1920.
Mean for
Forty-one
Years,
1880-1920.
January,
1.527
1.023
.466
1.314
.570
1.267
February, .
1.674
.770
.819
.872
.618
1.382
March,
1.735
2.316
1.983
3.383
4.082
2.747
April, .
4.323
3.242
3.337
2.542
6.002
3.457
May, .
2.733
2.124
1.540
2.741
3.545
2.218
June, .
3 101
3.037
.757
1.007
1.607
1.266
July, .
1.531
1.024
.553
.539
.746
.741
August,
.924
.629
.470
.401
.678
.677
September,
.972
.549
.847
.653
.680
.652
October,
.798
.613
.991
.699
1.051
.814
November,
.743
.882
1.126
1.648
.921
1.117
December, .
1.154
.569
1.492
1.331
3.258
1.269
Average for whole
1.768
1.398
1.198
1.427
1.980
1.467
year.
Average for driest
six months.
1.020
.711
.791
.825
.947
.878
Sudbury, Nashua and Merrimack Rivers.
The following table shows the weekly fluctuations during the year
1920 in the flow of the Sudbury River at Framingham, the South
Branch of the Nashua River at the outlet of the Wachusett Reservoir,
Clinton, and the Merrimack River at Lawrence. The flow of these
streams, particularly that of the Sudbury River and of 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 118.19 square miles, and of the Merrimack River 4,452 square
miles.
100
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Table showing the Average Weekly Flow of the Sudbury, South Branch of the
Nashua and the Merrimack Rivera for the Year 1920, in Cvhic Feet per Sec-
ond per Square Mik of Drainage Area.
Flow in Cubic Feet per
Flow in Cubic Feet per
Second
PER Square Mile.
Week ending
Second
PER Square Mile.
Week ending
Sunday —
South
Merri-
mack
River.
Sunday —
South
Merri-
mack
River.
Sudbury
Branch,
Sudbury
Branch,
River.
Nashua
River.
River.
Nashua
River.
Jan. 4,
.488
.916
.669
July 4,
1.529
1.633
.976
11,
.426
1.175
.575
11,
.703
.935
.779
18,
.293
.987
.573
18,
.142
1.318
.701
25, . .
.775
1.033
.560
25,
.392
1.740
.741
Feb. 1,
.683
.885
.559
Aug. 1,
—.072
.538
.630
8,
1.425
1.511
.578
8,
—.306
.343
.533
15,
.828
1.134
.641
15,
.202
.996
.678
22,
1.260
1.068
.683
22,
.032
.512
.919
29,
.881
.858
.635
29,
.206
.219
.651
Mar. 7,
2.285
1.813
.777
Sept. 5,
.185
.155
.514
14,
6.879
6.230
1.667
12,
.248
.703
.523
21,
11.949
9.042
5.010
19,
.000
.226
1.032
28,
12.517
11.188
6.335
26, . .
.092
.260
.640
Apr. 4,
7.809
8.368
8.148
Oct. 3,
.475
3.495
1.653
11,
4.989
5.399
5.783
10,
.006
.553
1.412
18,
3.536
4.131
5.669
17,
.119
.313
.727
25,
3.523
4.609
5.852
24,
.257
.364
.615
31,
.149
.446
.653
May 2,
4.273
5.542
6.379
9,
3.001
3.706
3.972
Nov. 7,
.275
.760
.983
16,
3.116
2.763
3.413
14,
.021
.304
.721
23,
2.800
4.318
2.748
21,
1.200
2.054
.754
30,
2.511
2.212
3.466
28,
2.666
4. 968
1.198
June 6,
2.406
3.178
1.653
Dec. 5,
1.480
4.257
1.145
13,
1.857
1.937
1.916
12,
1.789
3.723
3.923
20,
3.479
4.650
1.440
19,
2.965
6.439
5.343
27, . .
3.150
2.539
1.663
26,
1.362
2.552
2.736
Sewerage and Sew^age Disposal.
Notwithstanding the difficulty and cost of construction work during
the past year, a considerable amount of essential sewerage work has
been carried on by a number of municipalities.
At Andover a large extension has been made to the sewerage
system to provide for the Shawsheen or Frye Village district, which
is increasing very rapidly in population.
At Billerica the sewage disposal system has been materially in-
creased in size, and at Northbridge an additional area of filter beds
has been provided. At Brockton new works, comprising a series of
large settling tanks and 1^ acres of trickling filters, have been under
construction during the year.
At Worcester the w^ork of improving the sewerage system, required
by the provisions of chapter 171 of the Special Acts of the year 1919,
has been carried on during the year, and the amount of work done and
No. 34.] DIVISION OF SANITARY ENGINEERING. 101
the expenditure made during 1920 comply fully with the requirements
of the act.
The year has been a favorable one for the disposal of sewage into inland
waters, especially running streams, on account of the excessive rainfall
and the great quantity of water available for the dilution of the sewage.
The flow of streams has been the highest, judging from the measure-
ments of the flow of the Nashua River, that has occurred probably
for more than a quarter of a century; and the flow was not only
greater than usual in the colder and wetter months of the year, but
also was much higher than usual in the months which are warmer
and usually dry, with the exception of August and October. The
amount of pollution from cities and towns is constantly increasing,
in a general way approximating the increase in the use of water,
while the amount of manufacturing waste, though varying from
time to time, also has a tendency to increase from one period of
manufacturing activity to another. When dry seasons again occur,
the effect of these increases will inevitably result in far worse con-
ditions than have occurred under similar circumstances in the past,
since little has been done for a number of years towards relieving
streams from pollution by sewage or manufacturing waste.
These conditions, while favorable for the dilution of sewage dis-
charged into streams, have been less favorable for the operation of
sewage disposal works on account of the increase in the quantity of
sewage requiring disposal. A number of the sewage disposal works
of the State have already become inadequate, on account of the
growth of the municipalities which they serve, for the proper care of
all of the sewage requiring disposal. In a number of these cases, owing
to the increased flow of sewage in the past year, considerable quan-
tities of sewage have in many instances been discharged untreated
into the streams. This condition has obtained at times at Pittsfield,
Clinton, Spencer and Southbridge, among others, while, at the same
time, municipalities which have adequate works for the treatment and
purification of the sewage have found no difficulty in producing a
very satisfactory effluent. This has been the case, for example, at
Attleboro, Concord, Framingham, Hopedale, Hudson, Marlborough,
North Attleborough, Northbridge, Norwood and Westborough. A
new sewerage system has been introduced at Millis. This, when
completed, will remove much of the excessive pollution from a stream
in the valley of which is situated the well used as a source of water
supply for the town.
The average results of analyses of samples of sewage and effluent
and statistics concerning the more important sewage disposal works
in the State are presented in the following tables : —
102
DEPARTINIENT OF PUBLIC HEALTH. [Pub. Doc.
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103
as
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8.05
10.62
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3.28
1.60
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1
Tank, .
None, .
None, .
Basins,
None, .
Tanks,
Imhoff tanks
None, .
Tanks,
None, .
Tanks,
Tanks,
Tanks,
Tanks,
None, .
Tanks,
Tanks,
None, .
Tanks,
Tanks,
Tank, .
None, .
Tanks,
None, .
None, .
:5
?:
0
H
0
6
... . . .
Andover,
Brockton, 2 , , . .
Clinton
Concord, ^ . , . .
Easthampton, 3
FiTCHBURG,
Framingham,^
Franklin, 1
Gardner (Gardner area),*
_
rf • • • •
C3
bC K
5 w
2 ^
a) C
Gardner (Templeton
Hopedale, ^
Hudson, .
Leicester,^
Marion,
Marlborough,
Milford, .
Natick,2 .
North Attleborough,
Northbridge, 1 .
1 a § S.I
104
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
CO
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6.42
10.62
3.39
2.57
3.67
4.38
4.16
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10.85
52.03
6.40
5.66
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Chemical prec
tion.
!i5
0
0
a
0
. _ _
Andover
Clinton, . . . .
FiTCHBURG
Gardner (Templeton area),
Hopedale,
Hudson,
Marlborough,
Milford,
North Attleborough,
Northbridge,
Norwood, . . .
Southbridge,
Worcester, .
13
<u
o
3
o
XI
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No. 34.] DIVISION OF SANITARY ENGINEERING.
105
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fie
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o 6.5 feet
one from
s in size,
te of oper-
t 1,580,000
B per day.
nder con-
mentation
t one and
s. Tank
er week.
i
E =2
^ tn^ 2 o o ==
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once
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area of
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gallons
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DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
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I
No. 34.] DIVISION OF SANITARY ENGINEERING. 107
Table No. 5. — Average Results of the Analyses of Monthly Samples of Effliient
from Sand Filters.
[Parts in 100,000.1
Free
Am-
monia.
Total
Albu-
minoid
Am-
monia.
Chlor-
ine.
Nitrogen as —
CiTT OR Town.
Ni-
trates.
Ni-
trites.
Iron.
Andover, 1
1.74
.1308
6.45
.3012
.0367
.458
Brockton, i .
3.40
.1014
8.35
.1515
.0015
1.716
Clinton, 1 ....
1.85
.0822
4.66
.3035
.0024
2.283
Concord, 2 ....
.04
.0130
3.65
.7288
.0056
.015
Easthampton, ^ . . .
1.36
.1204
4.60
.3300
.0279
1.070
Framingham, i
2.36
.1292
7.02
.3747
.0201
1.365
Franklin, ^ . . . ,
1.05
.0514
3.23
.2667
.0050
.156
Gardner (Gardner area), ■•
1.34
.4333
5.83
4.5410
.0360
.273
Gardner (Templeton area),'
1.82
.3716
8.85
1.7768
.0639
.089
Hopedale,'
2.00
.1710
6.33
2.6586
.0169
.082
Hudson,
.92
.1227
10.34
1.3179
.0218
.202
Leicester,^
.55
.0564
2.58
.1983
.0129
.059
Marion
.36
.0344
2.72
.6551
.0030
.049
Marlborough,! ,
.78
.0840
6.45
1.5182
.0102
.083
Milford
2.02
.1002
7.06
.4415
.0114
.777
Natick
2.22
.0907
7.47
.1833
.0047
.847
North Attleborough, - .
.06
.0130
3.42
.5983
.0055
.016
Northbridge,2
.39
.0375
2.47
.5797
.0127
.182
Norwood,
1.06
.0751
13.11
.1759
.0199
.543
PiTTSFIELD,' .
.70
.0753
4.81
.6132
.0231
.201
Southbridge, ^
2.02
.1191
5.30
.1694
.0005
1.642
Spencer,'
.16
.0214
3.15
.8753
.0005
.180
'Stockbridge.i
.25
.0387
1.98
.4002
.0168
.170
Westborough, i
.97
.0892
4.57
.2741
.0127
.580
Worcester, ^
1.87
.2360
11.12
1.0558
.0110
1.400
1 Regular samples from two or more underdrains combined in one average. *
' Six samples. '
3 Five samples.
Four samples.
Fourteen samples.
\
108
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
I
Table No. 6.
Efficiency of Sand Filters (Per Cent of Free and Albuminoid
Ammonia removed).
[Parts in
100,000.1
Free Ammonia.
Total Albumi-
noid Ammonia.
Chlorine.
Rate of Operation with
Even Distribution (Gal-
lons per Acre per Day).'
City or Town. '
6
us
-0
2
1
<
-.J
o
>
1
a
o
O
6
CO
+3
13
>
i
£
a
o
O
Pi
M
0)
W
■a
.2
"E
0.
<
a
Andover,
4.17
1.74
58
.73
.1308
82
7.39
6.45
68,000
Brockton
4.76
3.40
29
1.06
.1014
90
9.39
8.35
55,000
Clinton
3.17
1.85
42
.68
.0822
88
5.74
4.66
42,000
Concord
1.35
.04
97
.37
.0130
96
3.73
3.65
124,000
Eaathampton,
3.06
1.36
56
.85
.1204
86
5.90
4.60
-
Framingham,
3.76
2.36
37
1.55
.1292
92
7.89
7.02
60,000
Franklin,
1.88
1.05
44
.21
.0514
76
3.28
3.23
65,000
Gardner (Gardner area).
10.11
1.34
87
3.47
.4333
88
7.73
5.83
1
!■ 80,000
Gardner (Templeton area),
3.55
1.82
49
.50
.3716
26
7.36
8.85
Hopedale,
6.39
2.00
69
.86
.1710
80
7.95
6.33
23,000
Hudson,
4.15
.92
78
.65
.1227
81
10.10
10.34
49,000
Leicester,
1.31
.55
58
.36
.0564
84
3.33
2.58
-
Marion,
1.62
.36
78
.35
.0344
90
3.19
2.72
76,000
Marlborough,
4.00
.78
80
.72
.0840
88
7.70
6.45
52,000
Milford
3.49
2.02
42
.58
.1002
83
9.08
7.06
105,000
Natick,
3.14
2.22
29
.50
.0907
82
8.42
7.47
119,000
1.50
.06
96
.21
.0130
94
4.92
3.42
111,000
Northbridge, . . ...
2.02
.39
81
.25
.0375
85
2.48
2.47
49,000
2.66
1.06
60
.54
.0751
86
18.49
13.11
114,000
PiTTSFIELD,
2.46
.70
72
.45
.0753
83
4.71
4.81
86,000
Southbridge,
3.86
2.02
48
.53
.1191
78
6.98
5.30
-
Spencer
2.93
.16
95
.64
.0214
97
4.10
3.15
-
Stockbridge,
1.34
.25
81
.29
.0387
87
2.28
1.98
-
Westborough,
2.16
.97
55
.71
.0892
87
5.21
4.57
91,000
Worcester,
2.59
1.87
28
1.07
.2360
78
14.04
11.12
59,000
1 See also Table No. 7.
No. 34.] DIVISION OF SANITARY ENGINEERING.
109
Estimated
Rate of
Operation
with
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tribution
(Gallons
per Acre
per Day).
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No. 34.] DIVISION OF SANITARY ENGINEERING. Ill
Examination of Rivers.
The condition of the polluted rivers of the State has been less
objectionable than for many years. This has been due to two causes:
(1) the excessive rainfall and flow of streams throughout the year;
and (2) a great reduction in the polluting matter discharged from
factories and mills, many of which have been closed or operated only
on part time during the latter part of the year.
Assabd River.
The Assabet River in the upper part of its course has been in
rather better condition than usual, but below Hudson the quantity of
organic matter in the river water, notwithstanding the high flow of
the river, was greater than usual. Below Maynard the river was
offensive during the latter part of the summer, but, on the whole,
not as objectionable as usual.
Blackstonc River.
The Blackstone River below Cherry Valley has shown less pollution
than at any time in the last four years, but at the outlet of Curtis
Pond the pollution was slightly greater than last year, and this is
true, also, of the stream above the Worcester sewage disposal works.
Below the disposal works the condition of the river appears to have
been much the same, as last year. At Uxbridge and Millville its
condition has shown little change in the last few years.
Charles River.
The condition of the Charles River has shown marked improve-
ment throughout its course as compared with last year, a result due
very largely to the reduced quantity of polluting matter discharged
into the stream from factories and mills, since this river receives
comparatively little sewage. Many of the factories in the upper part
of the drainage area were either closed or operated only on part time
during the latter half of the year. One of the largest mills in the lower
portion of the watershed reduced its output for the year to about
one-eighth of that of 1919. Under such conditions the effect of the
discharge of manufacturing waste into the stream naturally has been
much less noticeable than formerly.
112 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Chicopee River.
The condition of the Chicopee River and its tributaries has been
better than for many years. The flow of the river has been unusually
great, and its pollution by manufacturing waste less than usual.
Concord and Sudbury Rivers.
The Sudbury River has been in better condition than usual, and
the same is true of the Concord River, as far as the city of Lowell.
Its condition in the city of Lowell continues to be objectionable, and
no action appears to have been taken by the city or other parties
interested as advised by the Department at various times, notably in
a communication to the municipal council of Dec. 10, 1912.
Connecticut River.
The Connecticut River and its tributaries show little change as
compared with previous years. While this river receives large quanti-
ties of polluting matter from the cities and towns along its course,
its flow" is so great in proportion to the population that practically
no evidence of this pollution is noticeable, except by chemical analysis.
Local pollutions along the banks, due to the discharge of sewage or
other refuse too close to shore, have been objectionable at certain
points for many years, and some of the tributaries, notably the Mill
River below Northampton and the Manhan below Easthampton, are
very badly polluted and objectionable in years of less than average
rainfall.
Deerfield River.
The Deerfield River receives but little pollution at any point ex-
cepting near its mouth, where the sewage of the town of Greenfield
enters the stream. Its condition has not been objectionable during the
past year.
French River.
The French River, which is badly polluted at several points,
especially by sewage and manufacturing waste at Webster, was less
offensive than usual during the year.
No. 34.] DIVISION OF SANITARY ENGINEERING. 113
Hoosich River.
There has been a marked increase in the pollution of the Hoosick
River below Adams, but below North Adams and at Williamstown its
condition was somewhat less objectionable than usual.
Ilousatonic River.
The Housatonic River has been polluted during the year by the
discharge of untreated sewage from the city of Pittsfield, but the
effect of this pollution has been diminished by the unusually high flow
of the river.
Merrimack River.
The Merrimack River, like most of the other streams, has shown
less evidence of pollution during the past year than usual. The
reduction in the quantity of manufacturing waste discharged into the
river at Lawrence had a marked effect in reducing the pollution of the
river at that point during the latter part of the year.
Millers River.
The Millers River watershed contains few large towns, and the
stream has never been very seriously polluted by sewage. It receives
the sewage of the towns of Athol and Orange and small amounts of
sewage at other points.
•
Nashua River.
The Nashua River below Fitchburg, but above the outlet of the
city sewage disposal works, has shown more evidence of pollution than
in any year for several years. At North Leominster its condition
has been much the same as usual. The condition of Monoosnock
Brook, a tributary which receives the sewage of Leominster, was
worse than in the previous year, and the same is true of the main
stream below Monoosnock Brook. In this portion of its course the
stream was very offensive during the drier part of the year. Farther
down the river the unusual dilution reduced considerably the effect
of this pollution, and the condition of the river, on the whole, was
about the same as in the previous year.
I
114 DEPARTMENT OF PUBLIC HEALTH. [P. D. No. 34.
Neponset River.
The results of chemical analyses of the water of the Neponset
River and its tributaries at a number of points show that the river
has been less polluted than usual during the past year, a condition
due no doubt to a reduction in manufacturing activity in this water-
shed. Additional disposal works for the treatment of manufacturing
wastes have been built in this valley during the past year, which have
no doubt contributed to the improvement in the condition of the
river. One of these works treats the waste of a tannery in Walpole
and another the wastes from a finishing works at Canton.
North River in Peahody and Sahvi.
The North River, one of the most polluted rivers in the State,
has shown no improvement during the past year. Much of the
sewage of Peabody has overflowed into the river, and the stream has
been very offensive during the past year. Certain minor changes
have been made at the Salem pumping station, but the main im-
provements needed to insure efficient operation of the trunk sewer and
outfall works have been postponed, in common with other necessary
public works.
Taunton River.
The Taunton River below Brockton has been more noticeably
polluted than usual, notwithstanding the high flow of the river. The
condition of the river has been less objectionable than usual in other
parts of its course, due to its unusual flow.
Other Rivers.
The remaining rivers of the State are less affected by pollution
than those mentioned, and no change in their condition worthy of
note has occurred during the past year.
Division of Watee and Sewage
Laboeatoeies
H. W. Clark, Director
[1151
i
1
Keport of Division of Water and Sewage
Laboratories.
The activities of this Division are divided between analytical
work and research. During the year 1920, in the State House labora-
tories of this Division and at the Lawrence Experiment Station,
13,413 chemical, microscopical and bacterial analyses were made, as
shown by the following summary. A large percentage of these
analj'ses was made to ascertain the condition during the year of
public water supplies, ice supplies, rivers and domestic wells, the
efficiency of municipal water filters and the safety of their effluents
for domestic use, the quality of the sewage applied to and of the
effluents from sewage filters, the character of trade wastes for the
furtherance of studies regarding their disposal, and the condition, as
regards bacterial pollution, of shellfish from different sources, etc.
Besides this a large amount of analytical work was done for the new
Commission upon Water Supply Needs and Resources of the State.
Most of the analyses made in the State House laboratories are
summarized in the tables presented in the annual reports of the
Division of Sanitary Engineering.
Research was carried on during the year in regard to the corrosion
of pipes in many cities and towns of the State, and at the experiment
station many studies were made upon methods for the disposal of
trade wastes; upon important modifications of the activated sludge
tank process of sewage disposal; upon seasonal and other variations
in the bacterial quality of shellfish from different areas of the State;
of the relative significance of B. coli and B. aerogenes in bacterial
water examinations and methods for the differentiation of these two
bacteria; in regard to the efficiency in water treatment of liquid
chlorine at low temperatures; of the effect of certain wastes upon
municipal filtration areas, etc. Many experimental water and sewage
filters, septic tanks, etc., are in operation at the station for various
purposes.
One of the interesting and exceedingly important and promising
lines of research carried on at the station during the past three years
has been in regard to the removal of color from water by the precip-
itation of the usual color removing chemicals in the sand of filters
118 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
instead of by the direct application of such chemicals to the water
undergoing filtration, as is universal in the so-called mechanical
filtration of water. By this method of color removal the chemicals
are used over and over again, thus reducing the cost of such water
treatment very materially. In fact, the longer such filters continue
in operation the smaller grows the cost per million gallons of water
treated, owing to the continual re-use of the chemicals. Among other
advantages of the method is the absence of carbonic acid in the
filter effluents, thus lessening the danger of corrosion common with
mechanical filter effluents and the absolute prevention of acid effluents
due to the passage through the filters of undecomposed aluminum
sulphate.
The analytical work can be classified as follows: —
State House Laboratories.
Samples from public water supplies: —
Surface waters, 2,440
Ground waters, 1,030
Samples from rivers, 768
Samples from sewage disposal works : —
Sewages, 380
Filter effluents, 570
Samples of wastes and effluents from factories, 173
Samples of sea water from various locations, 22
Miscellaneous samples (color, hardness, chlorine, etc.), .... 212
5,595
Special examinations of water for manganese, lead, etc., .... 556
Determinations of fats, alkalinity, etc., 406
Microscopical examinations, 1,983
Determinations of dissolved oxygen, carbonic acid, etc. (field work), . 240
3,185
Lawrence Experiment Station.
Chemical examinations on account of investigations concerning the
disposal of domestic sewage and factory wastes, filtration and other
treatment of water supplies and suammmg pools, 1,072
Mechanical and chemical examinations of sand, 56
Bacterial examinations of water from pubHc water supplies, rivers,
sewage effluents, ice, etc., 807
Bacterial examinations in connection with methods of purification of
sewage and water, 2,358
Bacterial examinations of sheUfish, 342
4,635
No. 34.] WATER AND SEWAGE LABORATORIES. 119
Investigations in Regard to Corrosion of Pipes.
In the condensed reports of the work of this Division as now written,
it is impossible to describe very fully all the investigations made, but
the following pages give information in regard to some of them.
Owing to the occurrence twenty-five years ago of many cases of lead
poisoning in the State, an investigation was then made in regard to
the cause of this poisoning and the corrosion of service pipes. At
that time a large amount of research work was done and the results
of all that work were incorporated in two articles concerning the
action of water upon metals, — one published in the report for 1898
and the other in the report of this Department for the year 1900.^
The summary of this latter article was as follows : —
The results of the investigation up to the time of writing the report given in
1898 seemed to show that the cause of the taking of lead from the service pipes
by the water of certain towns and cities was the presence of a considerable
volume of free carbonic acid in the ground waters, which actively attacked
lead, and further investigation has confirmed this conclusion. . . . Wliile pure
soft water, especially when containing some dissolved oxygen, attacks lead,
and while the presence of coloring matter, free ammonia, nitrates and nitrites
in soft water also causes considerable solvent action, . . . j^et, taking into
consideration the results of our entire investigation we find that in actual prac-
tice, with the conditions prevailing in the service pipes of a distribution system,
a potable water in Massachusetts to have any dangerous lead-dissolving action
must contain considerable free carbonic acid.
It was shown, also, that the greater the hardness of a water, as
compared with its free carbonic acid, the less effect did this carbonic
acid have upon lead. At that time much work was done, as described
in these two articles, in regard to the action of waters upon tin,
zinc, brass, etc., as well as lead.
In modern chemistry the reason that some waters corrode metals
while others do not is explained by stating that the two essential
factors in corrosion are the hydrogen ion and dissolved oxygen. The
hydrogen ion is the active principle of acidity and this is the present
way of stating that the more acid a water is the more corrosive it is.
The old statement holds true, however, that the greater the acidity
shown by the carbonic acid present and the purer the water, that is,
the freer from mineral and other matters, the more corrosive is its
action upon metals.
I Action of Water upon Metallic or Metal-lined Pipes, etc., by H. W. Clark and Fred B. Forbes, pages
487 to 506, inclusive. Report of State Board of Health for 1800.
120
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Early in 1920 further investigations were begun upon this subject
of corrosion, due to troubles experienced in some of the cities and
towns of the State by the destruction, apparently by water, of certain
parts of iron, copper and brass piping, this trouble occurring invariably
in cities and towns having ground water supplies.
In the course of this investigation twenty-three municipalities have
been visited and many determinations of alkalinity, free and half-
bound carbonic acid and dissolved oxygen have been made, these
determinations being made on the supplies at the source, and also
considerable work has been done to determine the quality in these
three particulars of private wells adjacent to the public supplies.
As a result of this work, it has been found, as was determined more
than twenty years ago, that the active factor in corrosion is the acidity
of the water, and this acidity is best ascertained by the determination
of the carbonic acid present. Ground water supplies containing free
carbonic acid in amounts greater than 1.70 parts in 100,000 have,
according to this new investigation, caused corrosion, while those
containing carbonic acid in quantities less than this do not apparently
cause trouble with brass, copper and iron pipes.
The following table shows cities and towns where corrosion occurs,
together with the amount of carbonic acid present in parts in 100,000,
and cities and towns where examinations have been made and found
to be comparatively free from corrosion, together with the carbonic
acid figures of the water supplies in these municipalities.
List of Cities and Towns having and not having Corrosion Trouble.
City or Town having
Corrosion.
Ayer, .
Lowell,
Billerica,
Brookline,
Dedham,
Weston,
Acton, .
Walt HAM,
Wellesley,
Tewksbury,
Newton,
Norwood,
Carbonic Acid
(Parts
in 100,000).
3.78
3.67
3.52
3.26
2.90
2.86
2.51
.46
.20
.06
.02
.80
City or Town not having
Corrosion.
Medway,
Hopkinton,
Needham,
Dracut,
Chelmsford
Littleton,
Walpole,
Natick,
Bedford,
Groton,
Westford,
Carbonic Acid
(Parts
in 100,000).
1.69
1.63
1.58
1.28
1.14
1.06
1.01
1.01
.84
.70
.44
In the course of this work it has been found that the presence of
cemeteries upon the watersheds apparently had a direct effect upon
the amount of carbonic acid present in the water supplies. For
instance, in one of the cities of the State using ground water entirely
and having a large area covered with driven wells, it was found that
No. 34.] WATER AND SEWAGE LABORATORIES. 121
while carbonic acid was comparatively high in the water of all these
wells, the higher amounts found were from the side of the driven
well field on the edge of the watershed bordered by a continuous line
of cemeteries laid out on sandy soil and extending for about half a
mile in a line parallel with the well field.
Bacillus Coli and Bacillus Aerogenes.
B. coli has long been used as an index of the bacterial pollution of
water, but by the usual methods of determination the results recorded
include two general groups, — B. coli proper, which gives a positive
methyl red test and negative Voges-Proskauer test, and B. aerogenes,
which gives a negative methyl red and a positive Voges-Proskauer
test. The aerogenes group so differentiated is further divided by
liquefaction or non-liquefaction of the gelatin into B. cloacae and B.
aerogenes proper. The standard methods of bacterial analysis in
general use in water laboratories further differentiate B. aerogenes as
to its origin, whether fecal or non-fecal, by its ability to ferment
adonite. As bacterial work along this line continued, the belief grew
that aerogenes was not necessarily of fecal origin and that its presence
in water did not have the same significance as did B. coli proper,
consequently much work has been done by various investigators on
the coli-aerogenes group.
In studying this problem in the laboratories of this Division during
the present year 1,560 coli-like cultures from many sources have been
isolated and differentiated into B. coli, B. aerogenes and B. cloacae.
The cultures isolated were from human and animal faeces, sewage and
the effluents from sewage and water filters, ground water, surface
water and sea water, ice, soils, grains and shellfish, and a following
table summarizes the results of this work.
The notable things shown in the table are that 98 per cent of the
coli-like cultures isolated from human faeces proved to be coli proper
and only 2 per cent aerogenes, and of the colonies isolated from the
animal faeces, 96 per cent were coli proper and 4 per cent aerogenes;
on the other hand, 20 per cent of the cultures isolated from sewage
proved to be aerogenes and 3 per cent cloacae; and from rivers,
filtered water, ground water and surface water, 33, 34, 40 and 42
per cent, respectively, of the isolated cultures were aerogenes.
From this work and from the work of others it appears that
aerogenes is not common in faeces and that there is evidence that they
are normal inhabitants of the soil or at least the surface of the ground,
and their presence in water is due to this fact. The only feature of
this belief not entirely satisfactory is that one would expect to find
I
122
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
them, if this is true, in comparatively large numbers in surface waters.
Such is not the case, however, especially with unpolluted waters.
Another hypothesis is that aerogenes found in water is a degenerate
or modified form of coli, that is, one that can uniformly lose certain
properties of coli proper when existing for a considerable period under
adverse conditions.
Various experiments were made during the year in the laboratory
to transform coli to aerogenes by subjecting them to different con-
ditions of growth. So far this attempt has not been successful al-
though great modification of the coli cultures has been accomplished.
In further work along this line as many coli-like cultures as possible
have been isolated from samples of well and spring waters examined in
our routine work. These coli-like cultures have been further dif-
ferentiated into coli proper and aerogenes and the results compared
with the surroundings of the wells examined and the chemical analysis
of these waters.
While not enough work has been done as yet on this particular
question to give conclusive data, it can be said that the majority of
samples of B. coli proper came from wells with poor surroundings or
which showed pollution by the chemical analysis, while aerogenes
were found generally in well waters good chemically and with satis-
factory surroundings.
Source.
Number of Cultures isolated.
B. Coli.
B. Aero-
genes.
B.
Cloaca? .
Human faeces, .
Animal fteces, .
Sewage, ....
Effluents from sewage filters,
Soils
Grains, ....
Bath water,
Ice, .....
Rivers, ....
Filtered river waters,
Ground waters.
Surface waters, .
Shellfish
Sea water.
Miscellaneous, .
57
26
50
87
6
18
21
68
62
109
18
141
54
113
1
1
14
28
7
26
14
7
34
34
126
26
69
25
_i
-I
2
21
_i
16
_i
-1
4
92
17
52
57
33
Total.
58
27
64
136
7
32
48
28
102
100
327
61
262
136
148
Per Cent of Cultures
isolated.
B. Coli.
B. Aero-
genes.
98
96
77
64
19
39
75
67
62
33
30
54
40
2
4
20
21
100
81
28
25
33
34
40
42
26
18
B.
CloaciB.
-1
-1
3
15
_i
33
-1
-1
4
27
28
20
42
> No differentiation made between B. aerogenes and B. cloacfe.
No. 34.] WATER AND SEWAGE LABORATORIES. 123
Studies of Shellfish.
During the past two years a very extensive investigation has been
made by this Division in regard to the determination of the suitability
for consumption of clams from different sources based upon the
bacterial contents of their shell water. When the pollution of clam
flats is evident by inspection, bacterial examinations are probably
more or less unnecessary, but many cases are brought to the attention
of the Department yearly where inspection of the areas does not
give positive information.
For purposes of this study three areas were selected, namely, (1)
Newburyport, (2) Ipswich River and (3) Treadwell Island Creek.
The Joppa flats at Newburyport were selected as typical of a badly
polluted area. These flats are extensive and on their upper portion
the main sewer of the city of Newburyport empties. Besides this
they are polluted by the Merrimack River water which receives all
the sewage of the cities and towns along its course and which empties
into the sea at Newburyport.
The Ipswich River flat was selected as one of probably slight
pollution but one from which clams might be used. The flats from
which the clams were taken are about 500 feet below the town boat
landing at Ipswich and the river is moderately polluted, although the
town, with a population of 6,201, is unsewered.
The flats at Treadwell Island Creek are as free from pollution as
could be found on the shore of the northerly part of Massachusetts.
Owing to the large area of the Newburyport flats, clams were col-
lected invariably from five stations, the nearest station to the sewer
outlet being 3,000 feet below this outlet and near low-water mark;
Station No. 2 was in shore at right angles to the river and 935 feet
from Station No. 1 ; Station No. 3 was 4,375 feet below the sewer
outlet near low-water mark; Station No. 4 was 1,025 feet in shore
from Station No. 3, and Station No. 5 was 5,800 feet from the sewer
outlet.
The average B. coli score of a series of samples of clams collected
from each of these stations during this period of study is given in a
following table and includes samples collected each month through
two seasons. The volume of sewage reaching the Newburyport flats
is fairly constant and the only things influencing the amount of
pollution reaching the various stations from which clams were collected
were the tide and the height of the river.
The following table gives the B. coli score and the maximum and
minimum scores obtained at each area: - —
124
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Numerical Value of B. Coli in the Shell Water of Clams by the Scoring Method.
Place of Colt.ection.
Average.
Maximum.
Minimum.
Newburyport : —
Station No. 1
Station No. 2,
Station No. 3 .
Station No. 4
Station No. 5
Ipswich River
Treadwell Island Creek,
3,000
910
1,100
340
570
230
7
23,000
4,100
5,000
2,300
4,000
500
32
30
23
4
4
3
4
0
It will be seen that while the average B. coli score of the Newbury-
port clams was high and the maximum very high, yet at times samples
were collected from every station having a very low score, clams at
these times being in a bacterial condition which would have allowed
them to have passed the American Public Health standard. Such
results might be very misleading if only one or two sets of samples
had been taken. The average maximum and minimum score of the
clams from the Ipswich River flats show that these clams were only
slightly polluted compared with the Newburyport clams, while the
results of many series of samples taken at Treadwell Island Creek
show the clams from this source to be practically free from pollution,
the average score being but 7, the maximum 32 and the minimum 0.
There appeared from our examinations to be no regular seasonal
variation in the B. coli scores as has been stated by various workers.
A second table is given showing the average number of bacteria in
the shell water of the clams at different stations, and also in the sea
water covering the flats at different times.
Kuviber of Bacteria per Cubic Centimeter in Shell Water and Sea or River Water.
Average.
Maximum.
Minimum.
Pl.\ce of Collectiox.
20° C.
37"
C.
20° C.
37°
C.
20° C.
37°
C.
Total.
Red.
Total.
Red.
Total.
Red.
Newburyport : —
Shell water of clams: —
Station No. 1, .
32,300
4,100
2,700
150,000
21,000
17,500
1,000
420
270
Station No. 2, .
26,000
5,800
3,700
60,000
30,000
25,000
800
75
60
Station No. 3, .
21,500
2,7C0
2,400
75,000
23,000
20,000
600
30
10
Station No. 4, .
16,200
1,100
470
57,000
6,000
2,000
800
38
20
Station No. 5, .
24,000
2,200
430
81,500
19,000
2,500
900
70
0
Sea water: —
Station No. 1, .
37,300
4,000
920
100,000
22,000
5,000
2,500
70
18
Station No. 3, .
2,600
45
14
4,800
80
20
1,100
11
1
Station No. 5, .
7,900
100
20
25,000
330
90
600
6
0
Ipswich River: —
Shell water of clams, .
7,000
2,170
760
16,000
6,600
3,300
1,000
60
40
River water.
9,900
3,600
650
25,000
19,500
2,300
1,300
43
9
Treadwell Island Creek: —
Shell water of clams, .
5,100
520
81
21,000
2,500
700
700
60
0
Sea water, ....
1,100
48
4
2,800
240
25
160
3
0
No. 34.] WATER AND SEWAGE LABORATORIES; 125
Purification of a Gas Company's Wastes.
During the year an interesting experiment was made in regard to
the purification of wastes from the plant of a gas company by filtration
through a deep filter of shavings at a rate of 1,000,000 gallons per
day, — the process and rate proposed by this company. The wastes
as received were very turbid brown liquors containing a large amount
of matters in suspension and 111 parts tar in 100,000. By filtration
through the filter of shavings the tar was reduced in amount to 27
parts and the matters in suspension from 131 to 40 parts. The
effluent, however, was still an exceedingly polluted, foul-looking
liquid, and the filter of course became very rapidly clogged. Treat-
ment of the waste as received with lime at the rate of 10,000 pounds
per 1,000,000 gallons of waste effected a good precipitation, producing
a clear, straw-colored liquor, having only .2 parts tar in 100,000.
These results were similar to those obtained through previous years
when investigating wastes of this kind. The volume of waste which it
was proposed to treat varied from 5,000 to 10,000 gallons a day.
B. CoLi IN THE Water of Swimming Pools.
In the study of swimming pools used by a large number of bathers
it has seemed more or less surprising that more B. coli were not
found in the water examined, and during the year a special study
was made in regard to the coli pollution of water per bather per
given volume of water used. It was found by this study that when
an average cleanly person bathed in a certain measured volume of
water, having a temperature of not over 98" F., this water would,
when soap was not used, contain 4 B. coli per cubic centimeter, and
the number was, with the use of soap, increased to 7 per cubic centi-
meter. Bacterial determinations by the four-day count averaged
857,000 and 1,610,000 per cubic centimeter under the conditions
mentioned, that is, with or without the use of soap in bathing.
Applying these results to swimming pools, the following facts can be
deduced, namely, if 100 bathers per day use, without previous shower
baths, a swimming pool of 60,000 gallons' capacity and full of clean
water, the water on examination should show approximately 11,000
bacteria per cubic centimeter determined by the four-day counts and
one colon bacillus in 20 cubic centimeters in addition to the number
primarily present before use. These figures are, of course, approxi-
mate only, but are of considerable interest taken in connection with
the bacterial results obtained in swimming pool examinations.
126 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Operation of Trickling Filters.
During the year ten trickling filters receiving sewage clarified by
sedimentation have been in operation at the station. One of these,
No. 135, has now been in operation for twenty-one years and is
probably the oldest trickHng filter in America, and hence is of par-
ticular interest in giving data upon the permanence of such filters
and the care or expense necessary to keep them in operation year
after year. This filter is constructed 10 feet in depth of fine broken
stone, all of which passes a 1-inch screen but is retained by a f-inch
screen. During the twenty-one years of operation it has been neces-
sary to dig over the surface of the filter to a depth of from 3 to 8
inches only eight times. Besides this the upper 18 inches of stone
was removed, washed and replaced in April, 1918.
The eight filters used in studies of the economy and efficiency of
different depths have been continued in operation. Four of these,
Nos. 452 to 455, inclusive, were started in 1913, and four, Nos. 472
to 475, inclusive, in 1915. The first series, 4, 6, 8 and 10 feet in
depth, respectively, is constructed of broken stone, all of which passes
a 1^-inch screen and is retained by a f-inch screen. The second
series, Nos. 472 to 475, inclusive, while of the same depth, that is,
4, 6, 8 and 10 feet, is constructed of broken stone of a larger grade,
the average volume of pieces ranging from 25.2 to 29.4 cubic centi-
meters. With this coarser material each filter has only about one-half
as much filtering surface per foot in depth of filter as given by the
finer material in Filters Nos. 452 to 455, inclusive.
A following table gives the average rate of operation for each of
these filters per foot of filter depth, and the per cent of samples of
effluent which were stable. It has been intended to operate the first
series of filters at the same rate per foot of depth, or approximately
170,000 gallons per foot a day per acre. Various experiments made with
the second series of filters, namely, Nos. 472 to 475, inclusive, have pre-
vented comparative studies of efficiency and economy of deep and shal-
low filters, except Nos. 472 and 474, 4 and 8 feet in depth, respectively.
Filter No. 474 has been operated at an average rate of 2,050,000
gallons per acre daily, while Filter No. 472 has been operated at a rate
of 578,000 gallons per acre daily, or, expressed in foot per depth per
day, 256,600 and 144,000 gallons, respectively; that is, the deep
filter has been operated at a rate of 112,000 gallons greater per foot,
this giving a rate per acre three and one-half times as great as the
shallow filter. Notwithstanding this, it has produced an effluent of
practically the same character as that obtained from Filter No. 472.
No. 34.] WATER AND SEWAGE LABORATORIES.
127
The two following tables give the results of operation of these
filters during the year: —
Average Rates and Results. — Trickling Filters.
Filter Number.
Depth (Feet).
Gallons filtered
per Acre
daily per Foot
of Filter
Depth during
1920.
Per Cent of
Samples Stable
during 1920.
452,
453,
454,
455,
472,
473,
474,
475,
4
6
8
10
4
6
8
10
171,500
161,200
169,600
175,100
144,000
516,500
256,600
177,900
85
90
95
100
65
5
60
Average Analyses.
Effluents from Trickling Filters Nos. 135, /t52, 453, 454, 455, 472, 473, 474, 475 and 502.
[Parts in 100,000.)
Quantity
applied.
Gallons
per Acre
Daily.
Ammonia.
Kjel-
dahl
Nitro-
gen.
Chlo-
rine.
Nitrogen
AS —
Oxygen
con-
sumed.
Bacteria
per
Cubic
Cen-
timeter.
Filter
Free.
ALfiUMINOID.
Number.
Total.
In So-
lution.
Ni-
trates.
Ni-
trites.
135,
1,337,000
3.50
.55
.32
.99
7.8
1.79
.0180
3.63
854,000
452,
686,000
3.71
.73
.44
1.33
8.0
1.26
.0237
4.03
1,323,000
453,
967,000
3.21
.58
.34
1.04
7.9
2.10
.0256
3.24
637,000
454,
1.357,000
3.00
.58
.32
.99
7.8
1.83
.0298
3.43
532,000
455,
1,751,000
2.77
.52
.28
1.00
7.7
2.05
.0313
3.38
553,000
472,
578,000
3.62
.64
.38
1.18
7.8
.92
.0282
3.84
812,000
473,
3,099,000
4,07
.88
.45
1.65
7.8
.63
.0655
4.81
1,733,000
474,
2,050,000
3.68
.66
.37
1.17
7.7
.94
.0367
3.64
1,943,000
475,
1,779,000
3.32
.63
.36
1.15
7.7
1.76
.0330
3.80
1,332,000
502,
3,396,000
2.95
.38
.25
.68
7.9
1.64
.0436
1.95
2,204,000
During the year careful records have been made of the solids in
suspension in the effluents from all the trickling filters at the station,
this being along the line of studies of recovery of valuable fertilizing
k
128
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
material just as so many studies are being made at the present time
in regard to the retention and utilization of sludge from the activated
sludge tank process of purification.
The following table presents the results of this work in pounds per
1,000,000 gallons of suspended matter in these effluents. During the
year, moreover, as during previous years, an experiment was made
in regard to settling these solids and it was found that two hours'
sedimentation was sufficient to settle out about 90 per cent of the
suspended matters. This settled effluent was applied to trickling
Filter No. 502, 6 feet in depth and operated at a rate of 6,000,000
gallons per acre daily. The results of operation of this filter, as shown
by analytical work, are given in the tables.
Average Suspended Solids in Trickling Filter Effluents, etc.
Effluent from Filters.
No. 135
No. 452
No. 453,
No. 454
No. 455
No. 472
No. 473
No. 474,
No. 475,
No. 502,J
Settled sewage applied to trickling filters,
Suspended Solids
(Pounds per
Million Gallons).
1,291
,642
,249
,424
940
,441
,275
,708
,615
589
,524
1 Receives settled effluent from Filter No. 473.
Average Solids.
Effluents from Trickling Filters Nos. 135, 452, 453, 454, 455, 472, 473, 474, 475 and 502.
[Parts in 100,000.]
Unfiltebed.
Filtered.
In Suspension.
FiLTEB Number.
Total.
Loss
on Ig-
nition.
Fixed.
Total.
Loss
on Ig-
nition.
Fixed.
Total.
Loss
on Ig-
nition.
Fixed.
135
452,
453
454
455
472
473
474
475
502,
61.3
66.3
62.5
63.8
58.2
60.7
72.4
67.9
67.4
48.1
24.4
30.1
26.4
26.8
28.5
25.0
28.9
26.1
27.4
16.6
36.9
36.2
.36.1
37.0
29.7
35.7
43.5
41.8
40.0
31.5
45.7
46.6
47.5
46.7
46.9
43.4
45.1
47.4
48.0
41.0
17.1
17.3
18.3
18.7
20.4
17.3
17.0
19.1
17.0
13.8
28.6
29.3
29.2
28.0
26.5
26.1
28.1
28.3
31.0
27.2
15.6
19.7
15.0
17.1
11.3
17.3
27.3
20.5
19.4
7.1
7.3
12.8
8.1
8.1
8.1
7.7
11.9
7.0
10.4
2.8
8.3
6.9
6.9
9.0
3.2
9.6
15.4
13.5
9.0
4.3
No. 34.] WATER AND SEWAGE LABORATORIES.
129
Intermittent Sand Filters in Operation Thirty-three Years.
Filters Nos. 1, 4 (md 9 A.
At the end of 1920 Filters Nos. 1 and 4 had been in operation for
nearly thirty-three years and Filter No. 9A for thirty years. Each
filter is ^/l>oo of an acre in area and approximately 5 feet in depth.
During practically all this period regular station sewage without
preliminary clarification has been applied to them. For many years,
moreover, it has been the custom to apply only as much sewage to
each filter as can be received by them without materially increasing
the amount of stored organic matter.
The following table shows the construction, period of operation,
etc., of each filter.
FiLTFR Number.
Depth
(Feet).
Effective
Size of
Sand
(Millimeter).
Date 6rst
operated.
Actual
Volume of
Sewage
applied since
Start
(Gallons).
Volume of
Sewage
applied daily
during 1920
(Gallons per
Acre).
No. 1
No. 4
No. 9A
5
5
5
.48
.04
.17
Dec. 10, 1888
Dec. 19, 1887
Nov. 18, 1890
3,150,100
1,113,000
2,636,200
35,200
18,600
33,700
These are undoubtedly the oldest sand filters in point of operation
in the country, and it is notable that each has been operated without
sand removal since 1893, — a period of twenty-seven years. There
has been, however, a gradual increase in the amount of stored organic
matter in the upper foot of each filter as shown by yearly examina-
tions, although the amount fluctuates from time to time. During
the past few years this stored matter has increased more rapidly than
usual owing to the increasing strength of the sewage applied, and
because of this the rate of application of sewage to Filters Nos. 1 and
9A was reduced on January 23 from 50,000 to 40,000 gallons daily.
The effluents from these filters are practically always slightly acid,
this being partly due to lack of sufficient base in the sewage to com-
bine with the nitric acid formed during the process of purification.
As it is possible that this acid condition may interfere with the best
working condition of these filters, an experiment was made on October
9 whereby 100 pounds of hydrated land hme were scattered over the
surface of Filter No. 9A. The application of this lime, however, has
not been effective so far in changing the character of the effluent.
At the end of the year it was decided to remove temp.orarily the upper
\
130
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
foot of sand loaded with organic matter from Filter No. 9A, and on
November 26 this was done. This removal of 12 inches in depth is
equal to less than one-half inch per year of operation since the last re-
moval. Moreover, this removal was not at all necessary, but, as stated,
was simply to ascertain certain facts. At one of the municipal sewage
areas of the state much washing of dirty sand, at an expense of $1.75
per cubic yard, has been done during recent years, and it is probable
that the removed sand in this instance will be washed before replace-
ment. The surfaces of Filters Nos. 1 and 9A are always trenched and
ridged late in the fall and leveled in the spring. During the winter
these trenches are covered with boards to imitate as nearly as possible
the ice coverings formed in cold weather over the municipal filtration
areas. Analyses of sands and effluents are shown in the following
tables: —
Sand Analyses.
Albuminoid Ammonia in First Foot of Sand in Filters Nos. 1 and 9 A.
[Parts in 100,000.]
Average Analyses.
Effluent from Filter No. 1.
[Parts in 100,000.]
Temper.^tuke
(Degrees F.).
Ammonia.
Chlo-
rine.
Nitrogen
AS —
Oxygen
con-
sumed.
Alka-
linity.
Bacteria
per
Cubic
Ap-
plied.
Efflu-
ent.
Free.
Total
Albumi-
noid.
Ni-
trates.
Ni-
trites.
Cen-
timeter.
59
51
.7774
.0624
7.6
3.90
.0017
.56
—2.1
7,650 •
Effluent from Filter No. 4-
59
53
.0885 .0230
7.2
2.82
.0017
.35
—3.2
Effluent from Filter No. 9A.
59
53
.7067 I .0598
7.6
.87
.0014
.63
—2.1
1,020
9,655
No. 34.] WATER AND SEWAGE LABORATORIES. 131
Removal of Color from Water.
One of the most important Investigations carried on at the experi-
ment station during the past three years has been in regard to the
removal of color from water by filtration through sand filters im-
pregnated with aluminum or ferric hydroxide. In ordinary sand filtra-
tion it is seldom that more than from 30 to 40 per cent of the color
of the applied water is removed, and, while all coloring matter can be
removed by the ordinary mechanical filters, so called, there are, in
certain parts of the country at least, some objections to the use of
these filters. This is due to the application of chemicals to water
undergoing filtration, the additional corrosive properties given to the
water by such treatment, etc.
By the method of color removal previously described, namely, by
sand filtration through filters impregnated with ferric or aluminum
hydroxide, the corrosive properties of the water treated are not in-
creased, little or no carbonic acid is present in their effluents, and the
cost of operation is small when compared with mechanical filtration
and the direct application of chemicals to the water undergoing
treatment.
During the year three filters, each containing 4 feet in depth of sand
with an effective size of 0.25 millimeter, were operated at a rate of
5,000,000 gallons per acre daily. The results, as a whole, have been
better than obtained during previous years, and it is probable that
with a greater precipitation of chemicals within the filters a much
greater color removal can be obtained. Filter No. 488, put into
operation in May, 1917, has had applied to it 58.5 tons per acre of
ferric sulphate which has been precipitated throughout the body of
the filter as ferric hydroxide; Filter No. 494, put into operation in
January, 1918, has had applied to it 66.5 tons per acre of commercial
aluminum sulphate precipitated within the filter as aluminum hy-
droxide; Filter No. 496, put into operation in September, 1918, has
had applied to it 27 tons per acre of ferric sulphate precipitated
within the filter as hydroxide. In the case of each filter practically
the entire amount of chemical has been precipitated in the sand at
the time of filter construction. Merrimack River water was applied
to Filters Nos. 488 and 494 during the year, while Filter No. 496
received the effluents from these two filters. Trial was made of a
fourth filter containing 4 feet in depth of pea-size coke and 135 tons
per acre of ferric sulphate precipitated as hydroxide, but this filter
was more or less of a failure, however.
Such filters when first put into operation remove practically all the
132 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
color of the water applied. Eventually, when the color removal falls
to about 50 per cent, it is our custom to treat them with caustic soda
at the rate of 5 or 10 tons an acre. Generally the volume of solution
used has been equal to about one-fifth the water capacity of the sand
of the filter and the solution has been passed through four or five
times, this method apparently giving better renewal results than when
the open space of the sand has been filled with a more dilute solution
and this solution allowed to remain within the filter for a matter of
twelve hours or more. After such treatment it requires about three
days' operation of the filter to remove the excess soda applied. The
volume of water used during this period as wash water is about 7.5
per cent the total volume of the amount filtered between such treat-
ments. This treatment with caustic is very efficient in removing the
organic coloring matter, the organic matter determined as albuminoid
ammonia and that determined as oxygen consumed, which accumu-
lates in the filter during each period of operation, the percentage
removals of each averaging about 74, 45 and 50, respectively. The
period between these necessary treatments has averaged forty-seven
days in the case of Filter No. 488, forty-five days in the case of
Filter No. 494 and one hundred and sixteen days in the case of
Filter No. 496. The amount of chemicals per gallon of water filtered
through each of these filters has been as follows: Filter No. 488, .15
grain of ferric sulphate and .50 grain of caustic soda; Filter No. 494,
.34 grain and .55 grain, respectively; Filter No. 496, .12 grain and
.23 grain, respectively. These amounts are exceedingly small com-
pared with the amounts necessary when treating Merrimack River
water by the usual mechanical filter methods. Comparing amounts
and costs shows that by the new method the cost for chemicals up
to the present time has been less than one-third of mechanical filter
costs and the cost per 1,000,000 gallons treated by this method is
continually growing less owing to the fact that the treatment with
caustic renews the efficiency of the aluminum or ferric hydroxides in
these filters and hence these chemicals are used over and over again.
Owing to the treatment with caustic, moreover, little surface scraping is
necessary. Filters Nos. 488 and 494 being scraped but once during 1920.
The increase in mineral matter in the effluents from these filters
during the year has been .26, .24 and .69 parts in 100,000, respectively.
The filters are not efficient in the removal ol bacteria, this undoubtedly
being due to the removal of the sticky organic matter on the sand
grains by the caustic soda applied from time to time to remove the
color and other organic matters accumulated within the filter.
Average analyses of the water applied to and of the effluent from
these filters follow: —
No. 34.] WATER AND SEWAGE LABORATORIES.
133
Average Analyses.
Canal Water applied to Filters Nos. 488 and 494.
[Parts in 100,000.]
Ammonia.
NiTH
naw.TC
Oxygen
con-
sumed.
Iron.
Alka-
linity.
Color.
Free.
ALBUMINOID.
AS —
Soap
Hard-
ness.
Total.
In So-
lution.
Ni-
trates.
Ni-
trites.
.40
.0175
.0181
.0133
.023
.0004
.62
.0570
1.0
1.1
Effluent from Filter No. 488.
.13
.0091
.0076
.027
.0007
.25
.0229
1.3
1.3
Effluent from Filter No. 494.
.15
.0093
.0087
.024
.0005
.25 .0220
1.3
1.3
Effluent from Filter No. 496.
.07
.0046
.0050
.028
.0003
.14
.0136
1.3 1.3
The Effect of Low Temperatures upon Sterilization of Water
BY Means of Liquid Chlorine or Bleach.
It is becoming well recognized that liquid chlorine, or bleach, is
less efficient in cold than in warm weather, and during the year
certain laboratory experiments were made at the experiment station
to study this difference. The few tests given in the following table
are characteristic of results along this line. A solution of Hquid
chlorine of known strength was added to portions of Merrimack
River water having temperatures of 78° F. and 46° F., samples being
taken and platings made thirty minutes after treatment. Similar
tests were made with bleach at temperatures of 69° F. and 41° F., the
available chlorine being .4, .6 and .8 part per milHon. The results
are shown here: —
h
134
DEPARTMENT OF PUBLIC HEALTH. [P. D. No. 34.
Average Bacterial Anahjses before and after Chlorination at Different Tem-peratures.
Tem-
perature
(Degrees
F.).
Control,
Liquid chlorine: —
.4 part per million,
.6 part per million,
.8 part per million,
.4 part per million,
.6 part per million,
.8 part per million,
Control,
Chlorine from bleach:
.4 part per million,
.6 part per million,
.8 part per million,
.4 part per million,
.6 part per million,
.8 part per million,
78
78
78
78
46
46
46
69
69
69
69
41
41
41
Bacteria per Cubic
Centimeter.
20° C.
37° C.
Total.
Red.
4,600
270
36
305
23
1
154
15
0
58
11
C
700
39
5
180
16
1
250
13
1
2,900
140
28
2,500
15
2
490
11
1
330
5
0
790
19
3
1,640
12
3
640
13
1
B. Coli
in 100
Cubic
Centi-
meters.
6,C00
442
62
4
640
244
44
5,5C0
550
100
55
550
550
100
Bacterial Measurement of the Degree of Pollution of Water.
In considering the pollution of surface waters as shown by bacterial
examinations, it is often of interest to know what this pollution would
be if expressed in added gallons of sewage per 1,000,000 gallons of
water, and in considering this question many samples of Lawrence sew-
age examined for B. coli according to the standard methods showed an
average of 60,000 coli per cubic centimeter or 227,000,000 per gallon.
Hence, if B. coli are regularly found in 1 cubic centimeter of water
tested, it indicates by bacterial measurement a pollution equivalent to
approximately 17 gallons of such sewage as we have examined in
1,000,000 gallons of water otherwise unpolluted. These figures are, of
course, only approximate and neither allow for unequal distribution or
other modifying factors.
1
Division of Food and Deugs
Hermann C. Lythgoe, S.B., Director
[135]
I
i
i
Eeport of Division of Food and Drugs.
During the year 1920 the Food and Drug Division of the Massa-
chusetts Department of Public Health has been engaged in the usual
routine work relative to the enforcement of the milk, food, drug, cold
storage, slaughtering and bakery laws, and in the examination of
samples submitted by the police authorities and by the Department
of Public Welfare, and also in the manufacture of arsphenamine.
There have been a few changes in the scientific portion of the per-
sonnel. Two of the chemists, Mr. Williams and Mr. Wells, left the
Department to accept positions offering greater remuneration. They
were replaced by the transfer of Mr. John J. May from the Division
of Standards, Department of Labor, and by the employment of Mr.
Harry J. Fisher. There were no changes in the personnel of the in-
spectors nor of the clerical force, except that one additional clerk was
employed on account of additional work due to the bakery law.
In the work connected with the manufacture of arsphenamine, one
male laboratory assistant left and was not replaced because of improve-
ments made in the processes which reduced the amount of work.
Two female laboratory helpers left and were replaced by the transfer
of one from the Antitoxin Laboratory. A change in the method of
ampouling the drug has reduced the amount of work.
The following table gives a comparison of the work done during the
past five years : —
i 1916.
1917.
1918.
1919.
1920.
Milk samples,
7,958
7,060
7,738
9,576
8,960
Food samples, .
2,330
1,704
2,142
1,382
1,720
Drug samples,
874
794
396
262
220
Police samples,
232
360
210
1,511
1,644
Public welfare samp
es,
-
-
-
12
45
Total samples,
11,394
9,918
10,486
12,743
12,589
Prosecutions, .
250
307
337
262
311
Fines imposed,
$8,021.80
S5,560 60
$8,143.10
$7,880.00
$10,068.18
Confiscations,
325
124
87
97
86
Weight of confiscated articles (pounds), .
128,710
305,000
157,557
250,462
39,529 1
And 226 cans of apricots.
L
138
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
This table does not include any record of the cold-storage inspec-
tions, slaughtering inspections, bakery inspections or arsphenamine pro-
duction. It should be noted that during the past year 45 analyses
were made for the Department of Public Welfare. This was in con-
nection with purchases made by that Department for the State
institutions, the price to be paid for the articles being governed by
the composition of the articles actually delivered.
The total number of samples collected was nearly as large as that
collected last year. It should be borne in mind, however, that during
the present fiscal year the railroad traffic was blocked for a consider-
able length of time, thereby rendering travel and collecting of samples
difficult, and in some cases impossible; otherwise, the amount of work
done would have been greater than that reported last year.
The number of court cases in 1920 was greater than in any year
of the five-year period, and the fines were the heaviest. This is due,
to some extent, to the violations of the cold-storage law, growing out
of the fish cases tried last year by the Attorney-General, upon which
cases sentences were not imposed until the present fiscal year.
The number of confiscations and amount of confiscated food is
much less than in former years.
The following table gives a summary of the court cases disposed of
during the year: —
Convic-
tion.
Not
Guilty.
Nol-
prossed.
Filed
without
Plea.
Milk: —
Low standard,
Cream removed
Watered,
Cream: —
Low standard, .......
Adulterated food,
Misbranded food,
Decomposed food,
Violation of food regulations,
False advertising of food, ......
Cold-storage eggs not so labeled, in many instances
sold as fresh eggs.
Other cold-storage violations, . . . . .
Slaughtering violations, ......
Obstruction of inspector,
Totals
23
6
77
1
33
13
12
3
5
71
26
23
1
294
13
No. 34.]
DIVISION OF FOOD AND DRUGS.
139
The police authorities have submitted 215 samples which were
examined for poisons. Of these samples, 107 were morphine, 1 was
codeine, 1 was heroin, 1 was a morphine derivative obtained in in-
sufficient quantity for complete identification, and 2 were opium,
making 112 samples of opium and its derivatives. There were 66
samples of cocaine, 1 of strychnine, 1 sample of aloes and ferrous
carbonate pills, 1 sample of griddle cakes which contained arsenic and
34 samples which were examined for poisons, with negative results.
A sworn certificate of the analysis is delivered to the officer leaving
/O 20 30 i-0 SO 60 70
PeRC£:A/r Alcohol.
80 90 /CO
the sample, which certificate, in most instances, is accepted in court,
but in a few instances the analyst is summoned to appear as a witness
at the trial.
The amount of liquor submitted by the police has been unusually
large. In fact, the number of samples has been greater than that
submitted last year. This Department has been doing this work
since 1902. Between 1902 and 1918, the maximum number of samples
submitted was 238 in 1904, and the minimum was 51 in 1916. In
1919 there were 1,411 samples submitted, nearly all of which were re-
140 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
ceived after July 1. It was explained in the report for 1919 that this
was due to samples submitted by the Internal Revenue Department
to the police officers of the cities and towns in Massachusetts. This
was stopped during the present year because of a change in the law
which permitted the Department to refuse to examine any sample of
liquor submitted by the police authorities unless the Department was
satisfied that the analysis was to be used in the enforcement of
criminal law in the Massachusetts courts. All the samples examined
this year have been samples which the Department could legitimately
analyze.
Cities sending more than 100 samples each were Boston, Lynn and
Cambridge. Localities submitting more than 24 samples each were
Gloucester, Lawrence, Fall River, Chelsea and Lowell. Boston and
Lynn submitted samples each month during the year. Cambridge
submitted samples each month in the year except two.
There were in all 50 cities and towns submitting samples. Of the
samples submitted, 108 were classified as beer, 47 as cider, 165 as
wine, 248 as whiskey, 207 as Jamaica ginger and 454 as miscellaneous.
Most of these miscellaneous samples were distilled liquors of some
sort. Of these samples, 256 contained less than 1 per cent of alcohol.
A chart has been prepared showing the variation in alcohol content
of the samples received during 1920 in comparison with the variation
in alcohol content of the first 1,000 samples of liquor received. It will
be noted that there has been a marked change in the character of the
samples submitted. In former years nearly half the samples con-
tained between 1 and 5 per cent of alcohol. During the present year
less than 28 per cent of the samples were of such nature. Note the
fact that the distilled beverages have more than doubled in com-
parison with those submitted in former years, and the heavy alcoholic
preparations, such as ginger extracts and pure alcohol, are now nearly
four times as much in quantity as were formerly submitted.
In this work the analyst or assistant analyst has always made a
certificate as prescribed in the statutes. There was, however, an error
made when the work was transferred from the Assayer of Liquors to
the State Board of Health in not prescribing that the certificate of the
assistant analyst or the analyst, as the case may be, should be prima
facie evidence in court. This was discovered after the close of the
fiscal year, and it will be necessary to request certain changes in our
legislation to correct this defect, or there will be unusual demands
upon the chemists of this Division to testify in court upon liquor cases.
Considerable co-operative work has been done during the past year.
Analyses have been made for the milk inspectors or health officers of
Barnstable, Lawrence, Newton, North Adams, Fitchburg, Weymouth,
No. 34.] DIVISION OF FOOD AND DRUGS. 141
Arlington, New Bedford and Woburn, and in many of these instances
the chemists of this Department have testified in court for these milk
inspectors or board of health agents.
The milk inspector of Springfield has notified the Department of
violations of the milk law, which resulted in the prosecution of a
farmer living outside the jurisdiction of Springfield and sending
watered milk to the city of Springfield. The Fitchburg and the Fall
River inspectors have furnished information of violations of the milk
law where the persons involved were outside of their own jurisdiction.
The milk inspector of Somerville furnished the Department upon
several occasions with complete evidence of the collection and ex-
amination of adulterated milk intended for sale in Somerville but
produced in other cities and towns, and this Department has success-
fully prosecuted upon the evidence submitted.
The agents of the board of health of Newton submitted evidence of
violation of the cold-storage law, and assisted the inspector of this
Department in collecting evidence for prosecution. Owing to the
death of Mr. Berg, the milk inspector of Worcester, the Department
was requested by the agent of the Worcester Board of Health to make
rather more examinations of milk sold in Worcester than were usually
made. This request was complied with, resulting in the prosecution
and conviction of a farmer living in Auburn, who was selling watered
milk to a retail milk dealer in Worcester.
Rather more co-operative work than usual has been carried on be-
tween this Department and the United States Department of Agri-
culture. Several interstate shipments of adulterated olive oil have
been found, the evidence collected, and turned over to the United
States Department of Agriculture for prosecution. A shipment of
wormy and decomposed cocoa beans was sent from Brooklyn, N. Y,,
to a cocoa factory in Massachusetts, and this Department was notified
by the New York Health Department. A sample was taken by an
inspector of* this Department, which sample was submitted to the
United States Department of Agriculture for examination, the goods
being held under seizure by our inspector. Since a part of the ship-
ment had been opened, samples for interstate work could be taken
only from unbroken packages. The United States Department of
Agriculture declined to proceed in this case to the United States
courts since the ultimate disposition would be identical to the dis-
position ultimately carried out by this Department, namely, sorting
the beans under supervision and destroying all those which were unfit
for food. Samples were collected for the United States authorities in
the town of Westfield.
There were 8,960 samples of milk examined, of which 8,614 were
142
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
collected by the inspectors. Of these samples, 6,159 were above the
legal standard; 20 were skimmed milk sold in accordance with the
law; 145 were samples from which a portion of the cream had been
removed; and 582 contained added water. There was an unusually
large percentage containing added water. This does not mean, how-
ever, that the quality of milk which has been sold in the State is lower
than has been sold in the past. By following up the producers sup-
plying milk dealers selling low standard milk, we have found a num-
ber of farmers selling milk containing added water, which milk when
mixed with the milk of the other producers furnishing legal milk was
not watered sufficiently to be detected in the mixture. Many of the
dealers have been particularly helpful to the Department in assisting
in this work.
Tables Nos. 1 and 2 give the summary of the milk statistics by
months during the past year.
The average composition of milk not declared adulterated was rather
better than during the past three years. These figures for the past
twelve years are given in the following table : —
Average Composition of Milk not declared Adidteraled.
Year.
Number
of
Samples.
Solids
(Per Cent).
Fat (Per
Cent).
1909,
1910,
1911,
1912,
1913,
1914,
1915,
1916,
1917,
1918,
1919,
1920,
4,242
5,032
4,341
4,516
6,154
5,502
6,765
7,458
6,317
6,995
8,890
7,852
12.78
12.85
12.83
12.66
12.69
12.70
12.68
12.66
12.53
12.47
12.40
12.49
4.10
4.02
4.00
3.89
3.84
3.82
3.82
3.72
3.73
3.76
3.73
3.78
Solids not
Fat
(Per Cent).
8.68
8.83
8.83
8.77
8.85
8.88
8.86
8.94
8.80
8.71
8.67
8.71
It will be noted that there has been a steady decrease in the com-
position of milk sold upon the market, but since the average is con-
siderably above the legal standard, there seems to be no great need
at present of any reduction in the standard, although it may be
No. 34.J
DIVISION OF FOOD AND DRUGS.
143
possible that if the present slow decrease in the composition of milk
keeps on, eventually some change may be desirable.
This Department has the most extensive and complete set of milk
statistics of any similar Department in the country. A study of the
figures for a number of years shows a gradual increase in the number
of samples between 11 and 11.9 per cent total solids; a steady in-
crease in the number of samples between 12 and 12.9 per cent solids,
and a decrease in the samples between 13 and 15 per cent total
solids. These figures have been plotted and are shown in the ac-
companying chart. Bj extrapolation upon this chart, it appears
probable that in 1924 about 25 per cent of the Massachusetts market
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milk will have solids between 11 and 11.9 per cent; about 63 per cent
of the milk will have solids between 12 and 12.9 per cent; and only
about 8 per cent of the milk will have solids above 13 per cent. The
increase in the milk between 11 and 11.9 per cent is due to the in-
crease in the number of Holstein cows, which give the greatest quan-
tity of milk with the lowest quality of any breed of cattle. The
decrease in the milk above 13 per cent solids is due to a decrease in
that type of cattle giving milk of high quality, and it is also due to
the disappearance of the small dealer handling milk from but few
producers. The increase of the samples between 12 and 12.9 per cent
solids is due to the decrease in the small dealers and corresponding
144 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
increase in quantity of milk sold by large dealers; the milk sold by
the large dealers being mixtures of milk of varying quality is in-
variably between 12.2 and 12.8 per cent solids, while the milk sold by
small dealers is liable to vary between 11.8 and 13.5 per cent.
This consolidation of the milk business in the hands of large dealers
probably will have a tendency to cause a decrease in the sale of milk
between 11 and 11.9 per cent solids, as well as a decrease in the sale
of milk above 13 per cent solids.
In the Journal of Industrial and Engineering Chemistry for 1914
(page 899) the Director of the Division pubHshed an article upon the
composition of milk. The article resulted from the compilation of
the analyses of about 500 samples of milk of known purity, of which
63 represented herds and the balance represented milk from individual
cows. A summary of this work will be found in the report of the
State Board of Health for 1913.
The conclusions recorded in the article were based upon the best
judgment of the results obtained and were not intended to represent
the last word upon milk analysis and milk composition, neither were
they intended to give milk handlers the right to adulterate the prod-
uct they sold until it conformed with the worst milk that could be
produced by a cow or a small herd of cows and to use the conclusions
of the article as evidence in court that the adulterated milk was pure.
The adulteration of milk with water is risky, and will eventually be
detected, although the profits are high and the detection of small
quantities of added water is difficult, and in many instances impossible.
Adulteration by the removal of cream or, in other words, by the
addition of skimmed milk is highly profitable, is difficult of detection
and probably is not uncommon. Owing to the demand for cream
there is a large surplus of skimmed milk left upon the dealers' hands,
and it is much more profitable to pass this on to the consumer as
whole milk at 19 cents per quart than as skimmed milk at 5 cents
per quart, particularly since the public has not shown any desire to
purchase this skimmed milk at the prices at which the dealers desire
to sell, and this skimmed milk therefore is practically a waste product.
In the conclusions of the article referred to, the following state-
ments occur: "The protein-fat ratio in all cases has been less than 1.
If this figure exceeds 1, skimming is indicated, the amount being
greatest in samples possessing the highest ratio." "If the protein-fat
ratio is less than 0.7 or the percentage of fat in the solids is above
35.0, samples may be declared watered by a low refraction of the
serum, not necessarily below the minimum for all samples of known
purity. This is particularly true when dealing with herd milk."
No. 34.] DIVISION OF FOOD AND DRUGS. 145
The legal mind has attempted to misconstrue the first statement by
claiming that it is capable of converse construction, and means that
If the protein-fat ratio is less than one the milk is pure. The falseness
of this contention can be easily understood by any one of average
mentality, particularly so when one realizes that the average market
milk has a protein-fat ratio of 0.82 and the mixed milk of the Guernsey
and Jersey type of cows has a protein-fat ratio as low as 0.6. Con-
siderable skimmed milk therefore can be added to such milk before
the ratio of proteins to fat reaches one. Milk with a fat content of
4 per cent and a protein-fat ratio of 0.82 can be adulterated with 15
per cent of skimmed milk and still possess a protein-fat ratio less
than one. It is evident, therefore, that the use of a protein-fat ratio
less than one as a criterion that milk is not skimmed is faulty, and,
therefore, when dealing with the composite milk of a number of herds
it is reasonable to use a lower figure for the detection of skimming,
particularly so if other figures point to the fact that the sample
before being tampered with naturally had a low or average protein-fat
ratio.
The second quotation reported here is of interest in this respect:
that if milk of a low protein-fat ratio naturally possesses a high re-
fracting serum, milk with a high refracting serum naturally possesses
a low protein-fat ratio. In other words, it is not usual for milk to
possess both a high refraction of the serum and a high protein-fat
ratio.
In the samples referred to the copper serum refraction and the pro-
tein-fat ratio was determined upon 362 samples. The average pro-
tein-fat ratio has been computed for each 0.1 variation in the serum
refraction, each computation representing from 1 to 24, averaging 10.4
samples, and the results were plotted, from which a resultant of the
averages was computed to show this relation if more samples had been
available.
From this computation the following deductions were drawn: —
In all cases when the average protein-fat ratio was above 0.85 the
average refraction was below 37. In all cases when the average re-
fraction was above 38 the average protein-fat ratio was below 0.81.
Deductions from the computed averages indicate that mixtures of
milk from many dairies with a copper serum refraction above 38
would have a protein-fat ratio less than 0.80, and it therefore may be
assumed that milk representing a composite sample from many
dairies, with a protein-fat ratio of 0.90 or above, has in some manner
been diluted with skimmed milk, particularly so if the refractive index
of the copper serum is 38 or above.
146 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
The above statements are from an article prepared in 1919 and
withheld from publication in order that a more detailed study be
given to the protein-fat ratio of milk and its relations to various other
milk ingredients. As first shown by Van Slyke^ the protein-fat ratio
is a characteristic of the breed, and in all natural milk less than one;
if it exceeds one, skimming is indicated. This has been confirmed by
work of the Massachusetts Department of Public Health. Other
variations of the protein-fat ratio possibly of minor character, but,
nevertheless, of significance, are variations with changes in solids, fat
and serum refraction, as well as variations in herd milk compared with
that from individual cows. All these variations have a bearing upon
the interpretation of analyses when the possibility of skimming is to
be considered and the protein-fat ratio is less than one.
In order to properly compile and study these variations the arith-
metic probability paper of Hazen & Whipple was employed. For a
complete description of this paper and of the mathematical principles
upon which it is constructed see "The Element of Chance in Sanita-
tion," by George C. Whipple.^ The ordinates of this paper may be
either arithmetic or logarithmic, but the abscissae constitute a prob-
ability scale of such nature that if " the items of a serious observation
plotted on this paper fall in a straight line it indicates that they form
a probability series. That is, they occur according to the laws of
chance."
In all statistical work a large series of observations are desirable for
satisfactory work, but by the use of this paper in the case of a rela-
tively small number of observations, it is possible to ascertain whether
or not the observations are of such a nature that conclusions can be
drawn from them. In other words, this paper eliminates the freaks
from a series of observations.
In carrying out this study I had at my disposal the analyses of the
milk of over 1,000 individual cows and of 116 herds, the samples
being milked in the presence of an inspector or a chemist of the Massa-
chusetts Department of Public Health. The cows were representations
of all the usual dairy breeds and cross-breeds; they were of various
ages; represented all periods of lactation; and the samples were col-
lected at all seasons of the year.
A study made in 1919 of the herd milk figures gave the surprising
information that, although the average protein-fat ratio is about 0.83,
11 per cent had a protein-fat ratio of above 0.90, and, except for the
maximum value 0.96 and the 3 minimum values 0.55, 0.56 and 0,60,
• Journal American Chemical Society, 30, 1166.
2 Journal Franklin Institute, July and August, 1916.
No. 34.] DIVISION OF FOOD AND DRUGS. 147
the data plotted approximately upon a straight line on the probability
paper. A subdivision of these figures into milk below 12 per cent in
solids and above 13 per cent in solids showed a much larger percentage
of milk with high protein-fat ratio in the case of those samples below
12 per cent than in the case of the entire number. For example, 3
per cent of the samples above 13 per cent in solids had a protein-fat
ratio above 0.90, and 13 per cent of those below 12 per cent in solids
were above 0.90, and of those between 12 and 12.9 per cent solids
20 per cent were above 0.90. This compilation of samples below 12
per cent in solids, representing but 13 samples, does not plot in a
straight line, and, therefore, definite conclusions cannot be drawn
from these figures; but from the similarity between the different plots
with the same general direction in all cases, it is evident that the per
cent of samples with high protein-fat ratio in herd milk with solids
less than 12 per cent must necessarily greatly exceed that in herd milk
above 12 per cent in solids. It appears from the figures in Chart I
that it is impracticable to call commercial milk skimmed if relying
entirely upon a protein-fat ratio between 0.90 and 0.98.
A more complete study of the protein-fat ratio was made specifically
in relation to its variation with breed, solids, fat and copper serum
refraction; and the comparison between milk from individual cows and
from herds. Chart II gives the comparison of milk from 746 in-
dividual cows with that from 116 herds. It will be noticed that
while a large number of low protein-fat ratios found in individual
cows disappear in herd milk, a much less number of the high ratios
disappear in the herd milk. This is in marked contradistinction to
other figures, such as solids and fat taken from analyses of the same
samples, in which cases about equal quantity of high and low figures
in milk from individual cows are not to be found in herd milk. This
is further emphasized by the fact that the median, which in these
figures closely approximates the average, is about 0.80, while the
arithmetic mean of the maximum and the minimum is about 0.70,
showing a far greater preponderance of milk with a high protein-fat
ratio than with a low protein-fat ratio. It is possible that the un-
derlying cause for this condition is due to the preponderance of cer-
tain breeds of cattle.
The 746 samples from individual cows were obtained according to
breeds, as follows: —
From pure-bred Holsteins, 167
From pure-bred Ayrshires and a few grades, 126
From pure-bred and grades of the Jersey and Guernsey types, . . . 180
From grade cows of the Holstein type, 273
148
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
A study of the variation in protein-fat ratio in relation to the breed
showed that in the Holstein breed 25 per cent, in the Ayrshire breed
13 per cent and in the Jersey and Guernsey breeds 5 per cent of the
cows gave milk with a protein-fat ratio above 0.90.
It is evident that the question of breeds must be eliminated if
ff/^y^ ■d-y^-'^^^-^^i^a!:
No. 34.]
DIVISIOx\ OF FOOD AND DRUGS.
149
figures below 0.99 are to be used in detecting skimming, and, there-
fore, the protein-fat ratio was studied in respect to its variations with
variations in other milk constituents, and it was found that the protein-
fat ratio was to some extent a function of the fat, of the copper serum
refraction, and to a less extent of the solids.
§o
O/jL
^ uy^ . 4//^j. o^/
k
150
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
The samples were grouped as above and below 12 per cent solids,
as per varying fat content, as per varying copper refraction of the
milk serum, and the variation in protein-fat ratio was plotted. The
relative variation of the copper serum refraction with, different fat
percentages was also plotted. These studies all illustrated the pre-
o/-ci^^ J-iTj^ -y^^^u-Ohfc^
No. 34.]
DIVISION OF FOOD AND DRUGS.
151
ponderance of high protein-fat ratios in contradistinction of those of
low protein-fat ratios, and also showed that more low and less high
protein-fat ratios disappeared in herd milk. Thirteen per cent of the
samples with copper serum refraction from 37.5 to 38.3 were above
0.90 in protein-fat ratio, thus showing the fallacy of the conclusions
in the preliminary discussion of this question.
C5N
6^
P/ufri^ -^k^ -A'^S'^Ch'c^
6^- Qo'
S^<5
152
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
It is manifest that conclusive opinions relative to the removal of
cream cannot be given in the cases referred to unless they occur so
extensively that the probability of their natural occurrence has been
eliminated by an overwhelming number of samples of unusual com-
position. For comparative purposes and for ease of study that por-
tion of the variation of the protein-fat ratio between 0.85 and 0.99,
as compared with variation of serum refraction, fat and solids, together
with the variation of the serum refraction between 37 and 39, as
compared with the variation in fat, will be found in Chart IV. The
plots being prepared, largely from analyses of individual cow's milk,
should give sufficient margin of safety for conclusive opinions.
The figures presented are the analyses of three samples of milk of
known purity and the computed analyses resulting from assumed
skimming.
From Table III, in the publication previously referred to, showing
the expected relation between the fats and solids, samples B, E and
F are highly suspicious of being skimmed. The protein-fat ratio
alone indicates nothing except suspicion in the cases of examples B,
D and F. The figures on page 153 are computed from Chart IV, and
show the probability expressed in per cent of these figures occurring.
In the cases of examples E and F the very low frequency of these
copper refraction and fat figures occurring at the same time, taken
with the other data, is sufficient evidence to call the samples skimmed.
In the cases of A and B, notwithstanding the high frequency of the
occurrence of the observed protein-fat ratio compared wuth the fat,
such samples maj' be declared skimmed if obtained from one dealer
in sufficient quantities to overcome the probabilities of the copper,
refraction-fat comparison and the copper refraction comparison with
the protein-fat ratio being natural. In the case of example C the
sale of such milk should be almost a continual performance before
skimming could be proved, and in the case of example D at least 15
per cent of the samples obtained from the dealer should be like the
example.
Solids.
Fat.
Proteins.
Protein-Fat.
Copper
Refraction.
Cream
removed
(Per Cent).
Fat corre-
sponding to
Solids not
less than —
12.07
11.42
11.22
12.40
12.10
11.90
13.30
12.50
12.30
3.55
3.00
2.80
3.60
3.30
3.10
4.00
3.20
3.00
2.68
2.68
2.68
2.99
2.99
2.99
2.86
2.86
2.86
.76
.89
.96
.83
.91
.96
.72
.89
.96
38.3
38.3
38.3
38.0
38.0
38.0
39.5
39.5
39.5
None
15 — A
21 — B
None
8-C
14— D
None
20 — E
25 — F
3.30
2.90
2.80
3.60
3.40
3.20
4.10
3.60
3.50
No. 34.]
Probability o:
Probability o
Probability o:
Probability o
Probability o:
Probability o:
Probability o:
Probability o
Probability o:
Probability o:
Probability o
Probability o
Probability o
Probability o
Probability o:
Probability o:
Probability o:
Probability o:
Probability o
Probability o:
Probability o:
Probability o;
Probability o:
Probability o:
DIVISION OF FOOD AND DRUGS.
protein-fat .89 occurring with copper refraction of 38.30,
protein-fat .89 occxirring with solids of
protein-fat .89 occurring with fat of
11.42,
3.00,
3.00,
protein-fat .96 occurring with copper refraction of 38.30,
protein-fat .96 occurring with solids of 11.22,
protein-fat .96 occurring with fat of 2.80,
copper refraction 38.30 occurring with fat of
copper refraction 38.30 occurring with fat of
protein-fat .91 occurring with copper refraction of
protein-fat .91 occurring with solids of
protein-fat .91 occurring with fat of
copper refraction 38.00 occurring with fat of
protein-fat .96 occurring with copper refraction of 38.00,
protein-fat .96 occurring with solids of 11.90,
protein-fat .96 occurring with fat of 3.10,
3.10,
2.80,
38.00,
12.10,
3..30,
3.30,
.96 occurring with copper refraction of
.96 occurring with solids of
.96 occurring with fat of
copper refraction 38.00 occurring with fat of
protein-fat .89 occurring with copper refraction of 39.50,
protein-fat .89 occurring with solids of 12.50,
protein-fat .89 occurring with fat of 3.20,
copper refraction 39.50 occurring with fat of 3.20,
protein-fat .96 occurring with copper refraction of 39.50,
protein-fat .96 occurring with solids of 12.30,
protein-fat .96 occurring with fat of 3.00,
copper refraction 39.50 occurring with fat of 3.00, .
16%
30%
55%
6%
5%
11%
20%
6%
15%
19%
25%
26% J
6% ]
8%
12%
14%
10%
24%
34%
.6%
4%
8%
22%
•07% J
153
A — 15% skimmed.
B— 21% skimmed.
C — 8% skimmed.
D — 14% skimmed.
E — 20% skimmed.
F— 25% skimmed.
Protein-fat ratio less than one is no criterion that milk is not
adulterated.
The protein-fat ratio is a function of the solids, fat and serum
refraction, as well as of the breed; and when less than one, if used in
the interpretation of analyses, should be studied in relation to such
figures of which it is a function.
Milk representing the mixed milk of many dairies can be declared
skimmed when the protein-fat ratio is less than one; provided, how-
ever, that other analytical data is obtained to substantiate the con-
clusion, and provided, further, that a sufficient number of samples
have been obtained to exclude the probability of the natural occurrence
of such milk.
Owing to the greater prevalence of high protein-fat ratios compared
with low protein-fat ratios in milk from the average dairy herds, it is
inaccurate to assume that the mixed milk of a number of herds would
not greatly exceed in protein-fat that of the average protein-fat ratio
of the analvses on record.
154 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
In comparing the composition of milk from individual cows with
milk from herds both the maximum and minimum figures obtained
from individual cows, as a rule, are not found in herd milk; the pro-
tein-fat ratio, however, is an exception, for but few of the highest
figures so disappear because of greater frequency of protein-fat ratios
above the average.
There were 1,720 samples of food collected for examination, of which
502 were adulterated. The list of foods examined is given in Table
No. 3. Of 36 samples of butter examined, 6 were found to be either
rancid or to be of high moisture content. Some of the rancid samples
were submitted by the public. A hotel keeper was convicted for serv-
ing butter which was one-half milk. One of the guests at the hotel made
a complaint and an inspector of this Department went to the hotel,
obtaining the necessary evidence.
There were a number of samples of clams collected, many of which
were found to contain added water. Some of these clams were shipped
from New Hampshire, and in those instances arrangements were
made whereby this Department assisted the United States Depart-
ment of Agriculture in collecting evidence for reference to the United
States courts. A number of cases were tried, some of which were
acquitted. The justice of the Chelsea Police Court found the de-
fendants not guilty on the ground that the addition of water to clams
was a good thing. The justice of the Newburyport Court stated that
assuming the truth of the contention of the defendants that it was
necessary to add water to clams in order to keep them from spoiling, it
would in no way affect their criminal liability for selling adulterated food.
One of the clam dealers at the hearing given by the Division director
stated that it was necessary to put a cake of ice in the clams in order
to keep them from spoiling. When he was asked if the same procedure
was necessary in the case of milk, he said it would take too much ice
to put around the cans in order to keep the clams. The analogy is
apparent. When a cake of ice is placed in some fresh opened clams,
the ice will eventually melt and will be absorbed by the clams. When
a cake of ice is placed in a can of milk the ice will eventually melt
and will be absorbed by the milk. Clams under this treatment will
absorb nearly an equal quantity of water; therefore, a citizen buying
a quart of soaked clams gets a pint of water and a pint of clams.
A number of samples of dried fruits were obtained from retail
stores and were found to contain sulphur dioxide, the dried fruits
being sold without the necessary label. Hearings were given to the
dealers, and the subject was then taken up with the Retail Grocers'
Association, and a representative of the dried fruit interests. This
No. 34.] DIVISION OF FOOD AND DRUGS. 155
resulted in a letter being sent to the grocers by the secretary of the
association, calling attention to the necessity of stamping the packages
in which such articles were sold. Subsequent collections indicated
that the grocers were complying with the law.
There were 288 samples of eggs collected, of which 193 were found
to be in violation of the law. This does not mean that this ratio of
good to poor eggs exists in the markets, since the inspectors of the
Department have reason to suspect violations, and wherever their
experience leads them to the belief that the dealer is complying with
the law no samples are taken. This matter of poor eggs is difficult
of control since it is confined only to the winter months of the year.
In the spring and summer all the eggs sold are fresh eggs. They are
delivered within a week or so of the time they are laid because they
are produced in such quantities. In the winter months, however, the
price of fresh eggs is very high because hens are not laying and in
many instances the temptation of the small dealer to sell cold-storage
eggs with a fresh egg label on them is too much.
A number of samples of adulterated olive oil were obtained during
the latter part of the year. Complaints were received from certain
dealers to the effect that there was a large amount of adulterated
olive oil on the market. This Department investigated violations,
which were traced back to a few wholesale dealers. These dealers
have been prosecuted, but the cases were not completed during the
fiscal year. There has been considerable difficulty in tracing ship-
ments in barrels, which difficulty, however, has not been encountered
in the case of shipments in cans. There were one or two cases where
evidence of interstate shipment was secured, and this evidence was
referred to the United States Department of Agriculture. The adul-
terants used were soy bean oil, corn oil and cottonseed oil.
A complaint was received from a citizen relative to a sample of
salad dressing which he purchased, to the effect that it caused terrific
physiological action to which he did not object, but he was curious
to know what was the nature of the salad dressing because of difficulty
involved in washing the clothing, there being grease spots which
apparently could not be taken out by soap and water. The nature
of the adulterant was at once evident and an inspector dispatched to
the factory found that the proprietor was using white mineral oil
instead of an edible oil in the manufacture of his salad dressing.
Samples of all the salad dressings sold in the State were collected and
the factories where they were made were inspected, and only in two small
factories was this practice carried on. Both of these persons withdrew
the article from sale, took back their old stock and destroyed it.
156 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
In the early part of the present fiscal year there was a strike in the
packing houses in this State under United States inspection. This
curtailed the number of sausages upon the market, and an investiga-
tion was made of sausages sold by those dealers not under United
States inspection. It was found that most of them were taking ad-
vantage of market conditions and were using excessive amounts of
starch or flour in their sausages. After they were all prosecuted, this
practice ceased. Examinations of sausages made in the fall of this
year showed that these persons were complying with the law.
A number of soft drinks were examined and many of them were
found to contain saccharine. An attempt had been made to take up
a test case on the validity of the regulations prohibiting the use of
saccharine. These attempts were futile, and this year the Depart-
ment began a systematic investigation of all the soft drinks sold or
manufactured in this State. After the samples were taken hearings
were held, and the manufacturers were notified of the fact that they
were violating the law, and then second samples were taken. Wherever
the second samples were found to be bad, prosecutions were in-
stituted.
There were 220 samples of drugs examined, of which 20 were
found to be adulterated. Of these samples, 10 were solution of mag-
nesium citrate, 6 were spirit of nitrous ether, 2 were turpentine, 1
was denatured alcohol, and 1 was spirit of camphor. A few of these
have not yet been disposed of, but all the other violations were taken
care of by means of warnings or through hearings.
The various cold-storage warehouses located in the State have been
inspected a number of times during the year, and have, in general,
been found to be complying with the law. The depositors of cold-
storage food have also been found to be, in general, complying with
the law. A summary of the violations has already been given. It
should be again noted, however, that many of the cases involved
were sentences imposed on cases instituted during the previous year.
The warehouses first made quarterly reports of the amounts of food
placed in cold storage, together with the amounts of butter and eggs
on hand on the first day of the month in which the report was filed.
A study of these statistics was printed in the 1916 report of the
Department. Since April, 1917, the warehouses have reported
monthly instead of quarterly the amounts of food placed in storage,
and the amounts of butter and eggs on hand in storage the first day
of each month. Since August, 1920, additional reports of holdings
have been made upon all foods in storage. These latter statistics will
be of greater value as time goes on, but their significance at present
No. 34.]
DIVISION OF FOOD AND DRUGS.
157
is problematical because they cannot be compared with statistics of
similar data for' a period of years.
Massachusetts is engaged to a considerable extent in foreign com-
merce, in consequence of which a great deal of meat is stored here
pending shipment to foreign countries. Meat intended for foreign
shipment is shipped from Chicago to Albany, and stored there pending
shipping facilities. It is then shipped to either Boston or New York,
according to the availability of vessels for foreign shipment. This
Colo Storage: of F/sh /n Massachusetts.
100
% ^ ^
•^ :i <j
^ -:» O
^3/7
/3/&
■vi k: ^' Qt: -.4 k ^ Q: -vi k ^ Q: ^■
/9/3 J3Z0 /92/
business, of course, has greatly increased since 1914, in which year,
for the twelve months ending September 30, only 26,053,586 pounds
of meat were placed in storage in Massachusetts. The volume of this
business had increased so that during the twelve months ending
Feb. 28, 1919, 142,056,249 pounds of meat were so stored. This has
been reduced one-half since that time, the decrease during the present
year being about 25 per cent.
Massachusetts is a fish-producing State; the larger part of the
fish stored here Jan. 1, 1921, consisted of whiting, all of which is
158
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
exported to other States. Considerable herring and squid for bait
purposes, as well as for food purposes, constitute much of the balance
of the fish so stored.
Three charts show statistics of storage of fish, meat and poultry in
Massachusetts. They are prepared upon logarithmic scales rather
than arithmetic scales, so that the annual as well as the monthly
storage can be given upon the same chart; and so that comparison
can be made of the rate of increase and decrease of storage. Since
May 1 the Department of Public Health has received monthly reports
Cold Stor/^gf of A/e/it /a/ Afytss^c/^usFrrs.
"^ 5, C
/3/7
/3/3
sj k: ^" £>: ^' K 5! S^ M K
/*/5 JSgO
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'^r '^^ ^ ,i^
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of storage of food in this State, and since Aug. 1, 1920, has in addi-
tion received reports of amounts of food on hand in storage. The
variation in annual storage is shown by the upper line of each chart,
each point giving the total annual storage for twelve months ending
in the month designated. The dotted line is one-twelfth of the heavy
line, and each point represents the average monthly storage for the
twelve months ending in the month upon which it is plotted. This
facilitates comparison of the actual storage each month with the aver-
age storage of the previous year. The fish chart shows a 50 per cent
No. 34.]
DIVISION OF FOOD AND DRUGS.
159
reduction in the fish storage between 1918 and 1920. The highest
annual storage was 61,480,656 pounds for the year ending Aug. 30,
1918, and the lowest storage was 30,806,150 pounds for the year end-
ing June 30, 1920. The fish on hand in storage was apparently at its
height this past year on November 1 when 66 per cent of the previous
twelve months' storage was available. In all probability this will drop
very rapidly and will reach a minimum about March 1. The meat
chart, in a manner similar to the fish chart, shows a decrease in meat
foe.
Cold Storage oFPoutr/^r /AfAfy4SSyicHusETrs.
e./}-T
^ ^" h" ^' ^ ^" h-' ^' 8^' -•■•-■ ^" S^ :J' *^ ^ ^ -«■
/3/7 /3/e J9/9 I3Z0 /92t
storage. In this case, the maximum annual storage was 142,485,920
pounds for the year ending Feb. 28, 1919, and the minimum annual
storage was 77,387 110 pounds for the year ending June 30, 1920, and
represented 54 per cent of the maximum annual storage. Although
the amount of meat placed in storage appears at present to be slightly
increasing, the amount on hand is considerably less than the annual
storage; the highest figure so reported being that of August 1, rep-
resenting 40 per cent of the previous twelve months' storage. It will
be noticed that the maximum annual fish storage occurred shortly
160
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
before, and the maximum annual meat storage occurred shortly after,
the armistice. If these two plots are superposed so that the maximum
figures coincide, and the horizontal dimensions are parallel, it will be
seen that the descending parts of the two curves very nearly coincide,
showing the same percentage of reduction in storage in the case of both
meat and fish. The poidtry chart, similar to the meat and fish
ToTyiL /^MO UA/r FlACED /N StO R/i G£,
AA/D^AfOU/vr 0A////1AfD rA^ Stor/i(?£.
^;^l [ 1 I 1 1 1 1 1 1 I 1 1 1 1 1 1 1
BUTTSR.
59
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charts, tells a different story. The high points of monthly storage all
occur in the months of November, December and January, when the
roasters, fowl, turkeys, ducks and geese are stored. The low storage
is in the spring month of April when the birds are laying eggs and
raising their young. About June and July there is another increase
in storage, slight, however, in this case, when the storage of broilers
No. 34.]
DIVISION OF FOOD AND DRUGS.
161
^ "^ ^ ^ ^
i X <-; ^ ^ Q
24.
f
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Food Pi/icfd /n Cold Sto^/ige
/A/ A//iSS/}CHUS£TTS /A/ fouR YifJim.
CUMUl/IT/V£ VyIT/i
Foul mr:- /jf^/i/^fA/Dz/yG Dsc. 3/, /d/9 -- S'-^ Pounds.
dUTT£R-- " »' /^/?. 5/, 13/9 :- Q^ ^•>
M£/IT:- « *♦ f£3. 28, J9I$.: Sli
9f
162
DEPARTINIENT OF PUBLIC HEALTH. [Pub. Doc.
and superannuated male birds takes place. The holdings of storage
poultry are probably at the lowest in October, and should be at the
highest in January, February or March. It is not improbable that
the poultry statistics may somewhat parallel those of the butter and
egg statistics when sufficient data are available. For practical purposes
it may be stated that all the poultry, butter and eggs stored here are
consumed locally, the term "locally" being used to represent New
England. The chart giving the holdings and cumulative storage of
butter and eggs is based on the fact that the season for such storage
begins in the spring. Note how the dotted lines showing the hold-
ings on the first day of each month closely parallel the heavy lines
showing the cumulative storage inclusive of the storage of the pre-
vious month.
In the case of eggs this condition continues for four months, and in
the case of butter, for three months; but in the case of butter, the
cumulative storage after the goods begin going out is much greater
than in the case of eggs. Another chart shows the annual cumulative
storage of meat, fish, poultry and butter during four years, and the
total maximum annual storage per person. Note the variance in the
storage of meat, fish and poultry in the different years, and note the
comparative unity of this storage in the case of butter. The reasons
for this variance have been previously given. The figures showing
the maximum yearly storage per person indicate how little is the
effect of this business upon each of us. Nine and three-quarters pounds
of butter, and five and one-quarter pounds of poultry is not an un-
usual year's reserve supply for one person. The actual holdings per
capita give a still more remarkable demonstration of the smallness of
our reserve supply of perishable foods, and for the seven months are
as follows : —
In Cold Storage Per Capita in Massachusetts.
Date.
1920.
August 1,
September 1,
October 1,
November 1,
December 1,
January 1,
February 1,
1921.
Individual
Eggs.
48
301/4
mi
4?i
Butter
(Pounds).
4M
5
5%o
4»io
3^
2H
Poultry
(Pounds).
%
1%
Fish
(Pounds).
4
4M
5H
4J4
3K
2H
Meat
(Pounds).
8H
8»Ao
No. 34.] DIVISION OF FOOD AND DRUGS. 163
These figures seem unusually small when viewed individually, but
if an average of the six months' holdings is taken and is multiplied
by the number of persons in your family, you will see that it con-
stitutes about one month's supply of the food in question.
There were 215 extensions of time in storage granted, 139 of which
related to meat. This was mostly pork, namely, a special cut used
only in the foreign markets. Under ordinary circumstances this
would have gone abroad earlier, but owing to war conditions and
possible difficulties in exchange, the British Ministry of Food de-
clined to have the pork shipped until some time after the close of
the year's storage.
A study of the storage extensions shows that each year the majority
of extensions are applied to one article of food. In some years it is
poultry, in other years butter, in other years fish, and in the present
year it wao meat.
There were 30 instances where extensions were not granted; 3 in-
stances where permission was granted to remove goods from storage;
and in 85 instances lots were ordered out of storage after they had
been in storage for twelve calendar months. A summary of this part
of the cold-storage work is as follows: —
Requests for extension granted, 215
Broken-out eggs, 6
Butter, 4
Game, 2
Meat, 139
Fish, 64
Requests for extension not granted, 30
Broken-out eggs, 5
Meat, 4
Fish, 19
Condensed milk, 2
Requests for removal granted, ........... 3
Butter, 2
Meat, 1
Ordered out of storage at the end of twelve months, 84
Broken-out eggs. 2
Butter, 4
Oleomargarine, 5
Poultry, 12
Game, 3
Meat, 35
Fish, 23
164 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Very few violations of the cold-storage law were found in retail
stores, except those already noted in connection with the sale of cold-
storage eggs. It is unfortunate that such eggs are not sold during the
entire year. Under the present condition where such goods are sold
for only about five months of the year, the dealers have seven months
in which to forget the law.
The veterinary inspectors have been following out their usual work
of examining the qualifications of local inspectors of slaughtering; act-
ing as instructors to such inspectors; and investigating the conditions
under which the local inspection is carried out. During the present
year a number of violations were found in Berkshire County, and a
number of cases were prosecuted, all of which resulted in conviction.
A case tried by the board of health of Orange showed the lax pro-
cedure which has been carried out by certain local' boards of health
regarding the appointment of inspectors. The inspector was called
to a farm to inspect an animal about to be slaughtered. The animal
was slaughtered in the presence of the inspector and condemned by
him. As he was pouring kerosene upon the carcass, the owner of the
carcass approached the inspector with a pitchfork and assaulted and
battered him. The local authorities prosecuted the farmer for assault
and battery and for obstruction of the inspector. This Department
was represented both in the lower and Superior Court in connection
with the case, and in the latter court was called upon to show that
the inspector was a duly appointed inspector. The records of the
Department showed that the inspector was nominated and was duly
approved, but the records of the local board of health showed that he
had been appointed two days before he was approved. Mr. Justice
Callahan of the Superior Court then ordered the jury to bring in a
verdict of not guilty in one of the cases since the inspector was not
an inspector, he having been appointed before the State Department
of Public Health confirmed the nomination. Incidentally, it might be
stated that the jury convicted for assault and battery upon the in-
spector as a citizen.
As the result of this case, each local board of health was sent a
form, which, when filled out, stated the name of the inspector, the
date of his nomination, the date of his approval by this Department,
the date of his appointment by the local board of health, and the date
on which he was sworn into office by the local authorities. Judging
from the many replies received to this circular, it was rather unusual
for the local inspector to be properly qualified for the position.
During the past year the Legislature passed a new bakery law and
repealed most of the old bakery laws. This law was introduced by
one of the bakers' organizations, and had the unanimous support of
No. 34.]
DIVISION OF FOOD AND DRUGS.
165
the other bakers. It introduces a new feature in health legislation, —
that of supervision by the State Department of Health over the ac-
tivities of local boards of health as far as bakeries are concerned. It
also introduces a new feature of medical examination of workers in
bakeries, such examination to be made upon the order of the boards of
health. It further provides that regulations should be made by the
Department of Public Health.
After this law was signed by the Governor, a number of confer-
ences were held by representatives of this Department with various
local boards of health and with various representatives of the baking
industry, at which conferences all were requested to submit proposed
regulations and to discuss the regulations thus submitted. Confer-
ences were held in Springfield, Worcester and Boston, there being in
all five such conferences.
A special committee of 15 was appointed to draft the regulations,
and after these regulations were submitted they were put in final shape
by Dr. Simpson, District Health Officer, and Mr. Lythgoe, Director
of the Food and Drug Division. These regulations were then care-
fully considered by a committee of 5, — 2 members from this Depart-
ment, 2 from the baking industry, and 1 representative from a local
board of health. After a careful discussion, the regulations that were
satisfactory were presented to the Massachusetts Association of Boards
of Health and were then presented to the Pubhc Health Council and
adopted with only a few minor changes. It was decided to put one
inspector upon the bakery work and to go through all the bakeries in
the State, working in one locality until all the bakeries in that locality
had been inspected.
Before doing this work, however, an inspection form was devised by
a conference of local board of health officials with this Department.
This form was tried out, found to be defective, and was revised in
this Department. Using the new form, all of the bakeries in four
cities have been examined. The results of these examinations will be
reported to the local boards of health with the request that they call
the bakers in to their office for hearings, at which hearings this De-
partment may be represented.
The bakeries inspected are as follows : —
Boston, .
Brockton,
Cambridge, .
Chelsea, .
Framingham,
Lawrence,
Lowell, .
8 1 Maiden,
4]
5
10
4
57
83
Springfield,
Watertown,
Worcester,
7
14
16
6
251
166 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
In the manufacture of arsphenamine the Department has been
unusually successful. At the beginning of the fiscal year work in the
new laboratory had hardly begun. About the middle of December
actual production was started and has been kept up during the entire
year. A change in the process has been put into practical effect
which has cut down the labor in the factory end to such an extent
that when one of the laboratory assistants left he was not replaced.
A change in the method of ampouling resulted in reducing the amount
of labor to such an extent that when two of the female laboratory
helpers left, only one additional one was employed.
Mr. Christianson, assistant to Dr. Reid Hunt, has developed a unique
change in the process of manufacturing arsphenamine, which process
is also advantageous in recovering toxic batches. This process was
tried out several times before Mr. Christianson's work was pre-
sented for publication, and the results carried out by this Department
and tested by Dr. Hunt confirmed the character of the reports sub-
mitted to him by his assistant.
We have recovered a number of toxic batches and have sent the
product so recovered to certain selected clinics, requesting special
reports. These reports indicate that the product is decidedly superior
to that made by the old process. The clinical reports in these in-
stances confirm the pharmacological reports. This work was com-
pleted at the end of the fiscal year, and it is proposed to change our
process of manufacture next year by adopting this new process, which
will represent a saving in heat, labor and, to some extent, in the cost
of chemicals.
The largest item of expense in the manufacture of arsphenamine is
the bottling. In making intermediates and in making the end product,
the work can be carried out in large quantities, but the bottling is of
necessity applied to individual doses, which must be very carefully
weighed, carefully packed in ampoules, and sealed after exhausting
the air. It is probable that this cost cannot be reduced below 15
cents per ampoule. At present, however, we are making this article
at less than the cost of the commercial article, notwithstanding the
relatively small demand for the drug. Many of the commercial
houses have a capacity per day equal to our demand per month,
which of course would necessarily reduce the cost. It seems feasible,
however, that the State should keep on making this article even were
the commercial cost to be less than the cost to us, first, because there
probably is a trade war being carried on between the commercial
houses, and, second, because of the condition of our dye stuff industry.
Because of probable German competition, unless appropriate legis-
No. 34.] DIVISION OF FOOD AND DRUGS. 167
lation practically prohibiting the importation of German made dye-
stuffs and medicinals is not passed by Congress before the passage of
a peace resolution, the future of the United States dyestuff industry
will be subjected to such a severe setback that American dyes and
synthetic medicinals will disappear from the market.
168
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
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No. 34.]
DIVISION OF FOOD AND DRUGS.
169
Table No
2. — Milk Statistics by Months.
Average of
All Samples.
Average of All Samples not
declared skimmed or watered.
Month.
Num-
ber.
Solids
(Per
Cent).
Fat (Per
Cent).
Solids
not Fat
(Per
Cent).
Num-
ber.
Solids
(Per
Cent).
Fat (Per
Cent).
Solids
not Fat
(Per
Cent).
1919.
December,
370
12.62
3.82
8.80
352
12.70
3.87
8.83
1920.
January, ....
315
12.30
3.71
8.60
261
12.80
3.94
8.86
February,
312
12.18
3.62
8.56
265
12.58
3.72
8.86
March,
1,015
12.38
3.70
8.68
955
12.51
3.75
8.76
April, .
872
12.26
3.66
8.20
804
12.40
3.71
8.69
May, .
901
12.17
3.64
8.53
810
12.37
3.70
8.67
June, .
914
12.29
3.66
8.63
848
12.45
3.74
8.71
July, .
722
12,18
3.73
8.45
620
12.49
3.87
8.62
August,
747
12.06
3.64
8.42
681
12.22
3.73
8.49
September,
912
12.15
3.70
8.45
810
12.53
3.82
8.71
October. .
685
12.54
3.87
8.67
657
12.63
3.90
8.73
November,
849
12.40
3.76
8.64
762
12.60
3.86
8.74
Totals,
8,614
12.29
3.71
8.58
7,825
12.49
3.78
8.71
Table No. 3. — Summary of Statistics of Food exclusive of Milk.
Character of Sample.
Genuine.
Adulterated.
Total.
Butter, .
Buttermilk, .
Cheese, .
Clams, .
Cocoa, .
Condensed milk, .
Confectionery,
Cream, .
Dried fruit, .
Evaporated milk.
Eggs, .
Flavoring extracts,
Flour, .
Honey, .
30
3
1
52
1
53
21
1
95
15
6
1
37
2
1
1
2
24
193
2
36
3
1
89
3
1
1
55
45
1
288
17
6
1
170
DEPARTINIENT OF PUBLIC HEALTH. [Pub. Doc.
Table No. 3. — Summary of Statistics of Food exdusivc of Milk — Concluded.
Characteb of Sample.
Genuine.
Adulterated.
Total.
Ice cream,
Maple sugar,
Miscellaneous,
Molasses,
Nuts, .
Olive oil,
Salad dressing.
Sausage,
Shrimp,
Soda water syrup.
Soft drinks, .
Spices, .
Sugar, .
Vinegar,
Totals, .
29
2
16
1
2
95
23
571
4
1
115
8
11
61
1,218
33
4
87
97
2
10
502
29
3
16
1
2
128
27
658
4
1
212
8
13
71
1,720
Table No. 4. — Sximmary of Drug Statistics.
Chahacteb of Sample.
Genuine.
Adulterated.
Total.
Almond oil, ....
Alcohol, ....
Camphorated oil,
Citrate magnesium,
Denatured alcohol,
Dobell's solution,
Hamamelis water,
Magnesium sulphate, .
Miscellaneous,
Proprietary medicine, .
Solution of magnesium citrate,
Spirits of camphor,
Spirits of nitrous ether.
Turpentine
Totals
1
1
27
9
52
13
1
1
5
1
24
14
9
42
200
20
1
1
27
12
53
13
1
1
5
1
31
15
15
44
220
No. 34.]
DIVISION OF FOOD AND DRUGS.
171
Table No. 5. — Summary.
Requests for extension of time granted, . . . . ' . . . . 215
Eges, 6
Butter, 4
Game, 2
Meat, 139
Fish, 64
Requests for extension of time not granted, 30
Eggs, 5
Meat, 4
Fish, 19
Condensed milk, 2
Requests for permission to remove granted, 3
Butter, 2
Meat, 1
Articles ordered removed from storage (no requests made"), . . . .84
Eggs, 2
Butter 4
Oleomargarine, 5
Poultry, 12
Game, 3
Meat, 35
Fish, 23
Requests for Extension of Time granted on Goods in Cold Storage from Dec. 1 ,
1919, to Dec. 1, 1920.
[Reason for such extension being that goods were in proper condition for further storage]
Article.
Weight
(Pounds).
Placed in
Storage.
Extension
granted to —
Name.
Eggs, canned,
Eggs, canned,
Eggs, canned.
Eggs, canned.
Egg whites.
Eggs, mixed,
Butter,
Butter,
Butter,
Butter,
Ducks,
Moose,
120
120
240
1,260
4,740
18,360
1,900
2,160
1,920
1,140
742
150
Aug.
Aug.
Aug.
May
Apr.
Apr.
Aug.
Sept.
Sept.
June
Aug.
Oct.
6, 1919
6, 1919
6, 1919
23, 1919
18, 1919
18, 1919
29, 1919
4, 1919
11, 1919
16, 1919
6, 1919
10, 1919
Oct.
Oct.
Oct.
June
June
May
Oct.
Dec.
Jan.
Oct.
Oct.
Apr.
1, 1920
1, 1920
1, 1920
30, 1920
28, 1920
18, 1920
29, 1920
29, 1920
29, 1921
1, 1920
24, 1920
15, 1921
Armour & Co.
Armour & Co.
Armour & Co.
Goldsmith-Wall-Stockwell Com-
pany.
Goldsmith-Wall-Stockwell Com-
pany.
Goldsmith-Wall-Stockwell Com-
pany.
Lipsky, Jacob.
Lipsky, Jacob.
Lipsky, Jacob.
Massachusetts Department of
Education.
LawTence, H. L., Company.
Brundage, Lawrence F.
172
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Requests for Extension of Time granted on Goods in Cold Storage from Dec. /,
1919, to Dec. 1, ^9^0 — Continued.
Abticle.
Beef,
Beef,
Beef,
Beef,
Beef,
Beef,
Beef,
Beef,
Beef,
Beef briskets.
Beef briskets.
Beef chucks.
Beef loins.
Beef shoulders
Beef shoulders
Beef strips.
Beef tongues.
Beef trimmings
Beef trimmings
Pork,
Pork,
Pork,
Pork,
Pork,
Pork,
Pork,
Pork,
Pork,
Pork,
Pork,
Pork,
Pork,
Pork,
Pork,
Pork,
Weight
(Pounds)
Placed in
Storage.
Extension
granted to —
Name.
16,324
15,693
14,769
15,280
4,769
11,666
4,638
33,278
32,813
2,300
4,698
4,683
417
23,842
8,847
4,560
5,647
1,908
10,547
51,579
52,049
61,162
41,751
43,345
53,181
54,423
59,283
50,075
50,215
50,290
52,792
55,266
55,671
35,501
51,694
Dec.
Dec.
Dec.
May
Aug.
Aug.
Nov.
Oct.
Oct.
Dec.
Dec.
Dec.
Dec.
Dec.
Dec.
Nov.
Aug.
Nov.
July
Feb.
Feb.
Feb.
Feb.
Feb.
Feb.
Feb.
Feb.
Feb.
Feb.
Feb.
Feb.
Feb.
Feb.
Mar.
Mar.
13, 1918
14, 1918
18, 1918
3, 1919
9, 1919
12, 1919
26, 1919
10, 1919
11, 1919
2, 1918
16, 1918
16, 1918
18, 1918
12, 1918
18, 1918
26, 1919
13, 1919
21, 1919
24, 1919
17, 1919
17, 1919
17, 1919
18, 1919
18, 1919
18, 1919
18, 1919
18, 1919
20, 1919
20, 1919
20, 1919
20, 1919
21, 1919
21, 1919
3, 1919
3, 1919
Feb. 12, 1920
Feb. 14, 1920
Feb. 12, 1920
June 15, 1920
Nov. 9, 1920
Nov. 12, 1920
Mar. 26, 1921
Dec. 10, 1920
Dec. 10, 1920
Feb. 2, 1920
Feb. 16, 1920
Feb. 16, 1920
Feb. 12, 1920
Feb. 1, 1920
Feb. 18, 1920
Mar. 26, 1921
Nov. 13, 1920
Dec. 21, 1920
Aug. 24, 1920
Apr. 17, 1920
Apr. 17, 1920
Apr. 17, 1920
Apr. 18, 1920
Apr. 18, 1920
Apr. 18, 1920
Apr. 18, 1920
Apr. 18, 1920
Apr. 2C, 1920
Apr. 20, 1920
Apr. 20, 1920
Apr. 20, 1920
Apr. 21, 1920
Apr. 21, 1920
May 3, 1920
May 3, 1920
Dorr, Arthur E., & Co., Inc.
Dorr, Arthur E., & Co., Inc.
Dorr, Arthur E., & Co., Inc.
Horrigan & Doe.
Libby & Libby Company.
Libby & Libby Company.
Strong, Marson Company.
Swift, E. C, & Co.
Swift, E. C, & Co.
Dorr, Arthur E., & Co., Inc.
Dorr, Arthur E., & Co., Inc.
Dorr, Arthur E., & Co., Inc.
Dorr, Arthur E., & Co., Inc.
Handy, H. L., Company.
Dorr, Arthur E., & Co., Inc.
Skinner, George E., Company.
Libby & Libby Company.
Fickett, Oscar A., Company.
Libby & Libby Company.
North Packing and Provision
Company.
North Packing and Provision
Company.
North Packing and Provision
Company.
North Packing and Provision
Company.
North Packing and Provision
Company.
North Packing and Prov-ision
Company.
North Packing and Provision
Company.
North Packing and Provision
Company.
North Packing and Provision
Company.
North Packing and Provision-
Company.
North Packing and Provision
Company.
North Packing and Provision
Company.
North Packing and Provision
Company.
North Packing and Provision
Company.
North Packing and Provision
Company.
North Packing and Provision
Company.
No. 34.]
DIVISION OF FOOD AND DRUGS.
173
Requests for Extension of Time granted on Goods in Cold Storage from Dec. 1,
1919, to Dec. 1, i 5^') — Continued.
Article.
Weight
(Pounds).
Placed in
Storage.
Extension
granted to —
Name.
55,041
Mar.
3
1919
May
3
1920
53,604
Mar.
5
1919
May
5
1920
47,388
Mar.
6
1919
May
6,
1920
54,661
Mar.
6,
1919
May
6,
1920
55,475
Mar.
7,
1919
May
7,
1920
51,384
Mar.
8,
1919
May
8.
1920
22,981
Feb.
1,
1919
May
1,
1920
23,335
Feb.
4,
1919
May
4,
1920
25,133
Feb.
5,
1919
May
5,
1920
25,209
Feb.
6,
1919
May
c.
1920
25,704
Feb.
7,
1919
May
7,
1920
12,999
Feb.
8,
1919
May
8,
1920
21,891
Feb.
10,
1919
May
10.
1920
15,494
Feb.
12,
1919
May
12,
1920
13,933
Feb.
13,
1919
May
13,
1920
16,881
Feb.
14,
1919
May
14,
1920
14,8.30
Feb.
15,
1919
May
15,
1920
15,364
Feb.
19,
1919
May
19,
1920
19,959
Feb.
20,
1919
May
20,
1920
16,505
Feb.
21,
1919
May
21,
1920
14,645
Feb.
24,
1919
May
24,
1920
21,876
Feb.
25,
1919
May
25,
1920
8,803
Feb.
26,
1919
May
26,
1920
46,320
Jan.
18,
1919
Mar.
18,
1920
46,372
Jan.
18,
1919
Mar.
18,
1920
52,600
Jan.
20,
1919
Mar.
20,
1920
45,910
Jan.
21,
1919
Mar.
21,
1920
52,438
Jan.
21,
1919
Mar.
21,
1920
52,771
Jan.
21,
1919
Mar.
21,
1920
59,400
Jan.
21,
1919
Mar.
21,
1920
42,622
Jan.
22,
1919
Mar.
22,
1920
42,630
Jan.
23,
1919
Mar.
23,
1920
56,098
Jan.
23,
1919
Mar.
23,
i920
45,584
Jan.
24,
1919
Mar.
24,
1920
55,620
Jan.
24,
1919
Mar.
24,
1920
59,980
Jan.
24,
1919
Mar.
24,
1920
North Packing and Provision
Company.
North Packing and Provision
Company.
North Packing and Provision
Company.
North Packing and Provision
Company.
North Packing and Provision
Company.
North Packing and Provision
Company.
Springfield Provision Company.
Springfield Provision Company.
Springfield Provision Company.
Springfield Provision Company.
Springfield Provision Company.
Springfield Provision Company.
Springfield Provision Company.
Springfield Provision Company.
Springfield Provision Company.
Springfield Provision Company.
Springfield Provision Company.
Springfield Provision Company.
Springfield Provision Company.
Springfield Provision Company.
Springfield Provision Company.
Springfield Provision Company.
Springfield Provision Company.
Squire, John P., & Co.
Squire, John P., & Co.
Squire, John P., & Co.
Squire, John P., & Co.
Squire, John P., & Co.
Squire, John P., & Co.
Squire, John P., & Co.
Squire, John P., & Co.
Squire, John P., & Co.
Squire, John P., & Co.
Squire, John P., & Co.
Squire, John P., & Co.
Squire, John P., & Co.
174
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Requests for Extension of Time granted on Goods in Cold Storage from Dec. 1,
1919, to Dec. 1, iS^O — Continued.
Article.
Weight
(Pounds)
Placed in
Storage.
Extension
granted to —
Name.
Pork,
Pork,
Pork,
Pork,
Pork,
Pork,
Pork,
Pork,
Pork,
Pork,
Pork,
Pork,
Pork,
Pork,
Pork,
Pork,
Pork,
Pork,
Pork,
Pork,
Pork,
Pork,
Pork,
Pork,
Pork,
Pork,
Pork,
Pork,
Pork,
Pork,
Pork,
Pork,
Pork,
Pork,
Pork,
Pork,
48,186
54,722
55,453
61.900
45,150
47,088
51,605
52,062
53,103
54,865
55,210
40,060
47,329
48,720
53,573
38,880
49,909
51,910
53,608
58,610
45,840
45,889
52,739
52,912
48,787
53,236
53,579
45,337
47,000
52,638
54,604
58,165
43,184
65,423
52,452
55,160
Jan.
Jan.
Jan.
Jan.
Jan.
Jan.
Jan.
Jan.
Jan.
Jan.
Jan.
Jan.
Jan.
Jan.
Jan.
Feb.
Feb.
Feb.
Feb.
Feb.
Feb.
Feb.
Feb.
Feb.
Feb.
Feb.
Feb.
Feb.
Feb.
Feb.
Feb.
Feb.
Feb.
Feb.
Feb.
Feb.
25
, 1919
Mar.
25, 1920
25
, 1919
Mar.
25, 1920
27
, 1919
Mar.
27, 1920
28
1919
Mar.
28, 1920
29
1919
Mar.
29, 1920
29
, 1919
Mar.
29, 1920
29
1919
Mar.
29, 1920
29
1919
Mar.
29, 1920
29
1919
Mar.
29, 1920
30
, 1919
Mar.
30, 1920
30
, 1919
Mar.
30, 1920
31
1919
Mar.
31, 1920
31
1919
Mar.
31, 1920
31
1919
Mar.
31, 1920
31
1919
Mar.
31, 1920
1
1919
Apr.
1, 1920
1
1919
Apr.
1, 1920
1
1919
Apr.
1, 1920
1
1919
Apr.
1, 1920
1
1919
Apr.
1, 1920
3
1919
Apr.
1, 1920
3
1919
Apr.
3, 1920
3
1919
Apr.
3, 1920
3
1919
Apr.
3, 1920
4
1919
Apr.
4, 1920
4
1919
Apr.
4, 1920
4
1919
Apr.
4, 1920
6
1919
Apr.
6, 1920
6
1919
Apr.
6, 1920
6
1919
Apr.
6, 1920
6
1919
Apr.
6, 1920
6
1919
Apr.
6, 1920
7
1919
Apr.
7, 1920
7
1919
Apr.
7, 1920
8
1919
Apr.
8, 1920
10
1919
Apr.
10, 1920
Squire, John P., & Co.
Squire, John P., & Co.
Squire, John P., & Co.
Squire, John P., & Co.
Squire, John P., & Co.
Squire, John P., & Co.
Squire, John P., & Co.
Squire, John P., & Co.
Squire, John P., & Co.
Squire, John P., & Co.
Squire, John P., & Co.
Squire, John P., & Co.
Squire, John P., & Co.
Squire, John P., & Co.
Squire, John P., & Co.
Squire, John P., & Co.
Squire, John P., & Co.
Squire, John P., & Co.
Squire, John P., & Co.
Squire, John P., & Co.
Squire, John P., & Co.
Squire, John P., & Co.
Squire, John P., & Co.
Squire, John P., & Co.
Squire. John P., & Co.
Squire, John P., & Co.
Squire, John P., & Co.
Squire, John P., & Co.
Squire, John P., & Co.
Squire, John P., & Co.
Squire, John P., & Co.
Squire, John P., & Co.
Squire, John P., & Co.
Squire, John P., & Co.
Squire, John P., & Co.
Squire, John P., & Co.
No. 34.]
DIVISION OF FOOD AND DRUGS.
175
Requests for Extension of Time granted on Goods in Cold Storage from Dec. 1,
1919, to Dec. 1, i5^(9 — Continued.
Article.
Weight
(Pounds).
Placed in
Storage.
Extension
granted to —
Name.
Pork
40,470
Feb. 11, 1919
Apr. 11, 1920
Squire, John P., & Co.
Pork,
54,295
Feb. 11, 1919
Apr. 11, 1920
Squire, John P., & Co.
Pork,
58,800
Feb. 11, 1919
Apr. 11, 1920
Squire, John P., & Co.
Pork,
59,623
Feb. 11, 1919
Apr. 11, 1920
Squire, John P., & Co.
Pork,
49,500
Feb. 14, 1919
Apr. 14, 1920
Squire, John P., & Co.
Pork,
47,118
Feb. 15, 1919
Apr. 15, 1920
Squire, John P., & Co.
Pork,
48,824
Feb. 15, 191G
Apr. 15, 192C
Squire, John P., & Co.
Pork,
44,981
Feb. 17, 1919
Apr. 17, 192C
Squire, John P., & Co.
Pork,
51,579
Feb. 17, 1919
Apr. 17, 1920
Squire, John P., & Co.
Pork,
52,800
Feb. 17, 1919
Apr. 17, 1920
Squire, John P., & Co.
Pork,
37,556
Feb. 2J, 1919
Apr. 21, 1920
Squire, John P., & Co.
Pork,
52,382
Feb. 21, 1919
Apr. 21, 1920
Squire, John P., & Co.
Pork,
54,078
Feb. 21, 1919
Apr. 21, 1920
Squire, John P., & Co.
Pork,
45,270
Mar. 14, 1919
May 14, 1920
Squire, John P., & Co.
Pork,
41,608
Mar. 15, 1919
May 15, 1920
Squire, John P., & Co.
Pork,
46,410
Mar. 18, 1919
May 18, 1920
Squire, John P., & Co.
Pork,
51,050
Mar. 18, 1919
May 18, 1920
Squire, John P., & Co.
Pork,
42,812
Mar. 19, 1919
May 19, 1920
Squire, John P., & Co.
Pork,
47,310
Mar. 19, 1919
May 19, 1920
Squire, John P., & Co.
Pork,
48,085
Mar. 21, 1919
May 21, 1920
Squire, John P., & Co.
Pork,
48,970
Mar. 21, 1919
May 21, 1920
Squire, John P., & Co.
Pork,
55,639
Mar. 22, 1919
May 22, 1920
Squire, John P., & Co.
Pork,
45,340
Mar. 25, 1919
May 25, 1920
Squire, John P., & Co.
Pork,
46,959
Mar. 25, 1919
May 25, 1920
Squire, John P., & Co.
Pork,
50,400
Mar. 29, 1919
May 29, 1920
Squire, John P., & Co.
Pork,
51,600
Mar. 31, 1919
May 31, 1920
Squire, John P., & Co.
Pork,
51,170
Apr. 1, 1919
June 1, 1920
Squire, John P., & Co.
Pork,
52,345
Apr. 1, 1919
June 1, 1920
Squire, John P., & Co.
Pork,
52,510
Apr. 3, 1919
June 3, 1920
Squire, John P., & Co.
Pork.
54,015
Apr. 7, 1919
June 7, 1920
Squire, John P., & Co.
Pork,
30,350
Apr. 10, 1919
June 10. 1920
Squire, John P., & Co.
Pork,
33,170
Apr. 10, 1919
June 10, 1920
Squire, John P., & Co.
Bonita,
1,050
Oct. 8, 1919
Dec. 8, 1920
Tocco, Joseph.
Cod.
2,420
Nov. 24, 1919
Jan. 24, 1921
O'Brien, R., & Co.
Eels, sane
-
Aug. 5, 1919
Dec. 5, 1920
Busalacchi Brothers.
Eels, sane
455
Oct. 10, 1919
Dec. 10, 1920
Tocco, Joseph.
176
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Requests for Extension of Time granted on Goods in Cold Storage from Dec. J ,
1919, to Dec. 1, ^5:^0— Continued.
Article.
Weight
(Pounds).
Placed in
Storage.
Extension
granted to —
Name.
Flounders,
1,500
Aug. 10
1919
May 20
, 1920
Newburyport Fisheries Com-
Haddock,
1,330
Sept. 30
1919
Oct. 30
, 1920
pany.
Atlantic & Pacific Fish Com-
Haddock scrod
5,000
Aug. 15
1919
Dec. 31
1920
pany.
Whitman, Ward & Lee Com-
Herring, .
21,290
Apr. 10
1919
Oct. 9
1920
pany.
Atwood & Co.
Herring, .
28,700
Apr. 10
1919
Oct. 10
, 1920
Atwood & Co.
Herring, i
21,600
Jan. 9
1919
Apr. 1
1920
Bay State Fishing Company.
Herring, ^
4,300
Jan. 24
1919
Apr. 1
1920
Bay State Fishing Company.
Herring, *
9,000
Feb. 17
1919
May 1
1920
Bay State Fishing Company.
Herring, i
2,000
May 3
1918
Apr. 1
1920
Bay State Fishing Company.
Herring, i
1,800
June 10
1918
Apr. 1
1920
Bay State Fishing Company.
Herring, .
8,400
June 4
1919
Oct. 1
1920
Bay State Fishing Company.
Herring, .
5,425
Sept. 23
1919
Nov. 23
1920
Bay State Fishing Company.
Herring, .
3,700
Sept. 24
1919
Nov. 24
1920
Bay State Fishing Company.
Herring, .
6,8C0
Oct. 11
1919
Feb. 11
1921
Busalacchi Brothers.
Herring, .
2,600
Oct. 23
1919
Feb. 11
1921
Busalacchi Brothers.
Herring, .
3,200
Oct. 23
1919
Feb. 11
1921
Busalacchi Brothers.
Herring, .
2,500
Nov. 14
1919
Feb. 11
1921
Busalacchi Brothers.
Herring, .
1,140
Sept. 25
1919
Jan. 30
1921
Cefalu, Joseph.
Herring, .
],380
Sept. 30
1919
Jan. 30
1921
Cefalu, Joseph.
Herring, .
2,940
Oct. 16
1919
Jan. 30
1921
Cefalu, Joseph.
Herring, .
5,600
-
-
July 5
1920
Chatham Freezer Company.
Herring, •
1,800
Nov. 3
1919
Dec. 26
1920
Chatham Freezer Company.
Herring, '
37,600
Nov. 23
1919
Dec. 26
1920
Chatham Freezer Company.
Herring, >
24,300
Mar. 6
1919
May 6,
1920
Nagle, John, Company.
Herring, > .
40,000
Mar. 6
1919
May 6
1920
Nagle, John, Company.
Herring, .
4,000
Aug.,
1919
May 20
1920
Newburyport Fisheries Com-
Herring, .
3,000
Oct. 20
1919
Mar. 1
1921
pany.
Phillips, B. F., & Co.
Herring, .
925
Nov. 18
1919
Mar. 1
1921
Phillips, B. F., & Co.
Herring, .
770
Sept. 29
1919
Dec. 29
1920
Tocco, Joseph.
Herring, sardine,
1,750
Sept. 24
1919
Jan. 30
1921
Cefalu, Joseph.
Herring, sardine.
175
Sept. 30
1919
Jan. 30
1921
Cefalu, Joseph.
Herring, sardine.
560
Oct. 17
1919
Jan. 30
1921
Cefalu, Joseph.
Herring, sardine.
630
Oct. 24
1919
Jan. 30
1921
Cefalu, Joseph.
Herring, sardine,
245
Oct. 20
1919
Jan. 30
1921
Cefalu, Joseph.
Herring, sardine.
780
Oct. 29
1919
Jan. 30
1921
Cefalu, Joseph.
Herring, sardine.
2,200
Oct. 22
1919
Dec. 22
1920
Mantia, John, Sons.
1 Bait.
No. 34.]
DIVISION OF FOOD AND DRUGS.
177
Requests for Extension of Time granted on Goods in Cold Storage from Dec. 1,
1919, to Dec. 1, iP^O — Concluded.
Afticle.
Weight
(Pounds).
Placed in
Storage.
Extension
granted to —
Name.
Herring, sardine.
5,000
Nov. 25, 1919
Jan.
25, 1921
Russo & Sons.
Herring, sardine,
1,155
Oct. 2, 1919
Dec.
2, 1920
Tocco, Joseph.
Herring, sardine,
3,150
Oct. 31, 1919
Dec.
31, 1920
Tocco, Joseph.
Pollock, .
6,414
Dec. 9, 1919
Feb.
9, 1921
Dahlman, John A.
Salmon, .
400
Nov. 3, 1919
Feb.
3, 1921
Busalacchi Brothers.
Shark, .
640
July 15, 1919
Nov.
15, 1920
Globe Fish Company.
Skatefish,
1,750
Nov. 13, 1919
Jan.
13, 1921
Russo & Sons.
Skate wings, .
175
Aug. 13, 1919
Dec.
13, 1920
Globe Fish Company.
Skate wings, .
1,155
Oct. 28, 1919
Dec.
28, 1920
Tocco, Joseph.
Whiting, .
140
Oct. 4, 1919
Jan.
30, 1921
Cefalu, Joseph.
Whiting, .
7,500
Nov., 1919
Feb.
1, 1921
Consolidated Weir Company.
Whiting, .
42,500
Nov., 1919
Feb.
1, 1921
Consolidated Weir Company.
Whiting, .
1,500
Nov. 3, 1919
Feb.
3, 1921
Consolidated Weir Company.
Whiting, .
805
Aug. 13, 1919
Dec.
13, 1920
Globe Fish Company.
Whiting, .
630
Aug. 18, 1919
Dec.
18, 1920
Globe Fish Company.
Whiting, .
6,640
July 2, 1919
Dec.
31, 1920
Mantia, Salvatore.
Whiting, .
2,880
July 18, 1919
Dec.
31, 1920
Mantia, Salvatore.
Whiting, .
175
Sept. 4, 1919
Dec.
4, 1920
Tocco, Joseph.
Whiting, .
560
Sept. 11, 1919
Dec.
11, 1920
Tocco, Joseph.
Whiting, .
1,120
Sept. 12, 1919
Dec.
12, 1920
Tocco, Joseph.
Whiting, .
350
Sept. 25, 1919
Dec.
25, 1920
Tocco, Joseph.
Whiting, .
280
Oct. 3, 1919
Dec.
3, 1920
Tocco, Joseph.
Whiting, .
455
Oct. 10, 1919
Dec.
10, 1920
Tocco, Joseph.
Whiting, .
140
Oct. 25, 1919
Dec.
25, 1920
Tocco, Joseph.
Requests for Extension of Time not granted on Goods in Cold Storage from Dec.
1, 1919, to Dec. 1, 1920.
Article.
Eggs, canned.
Eggs, canned.
Eggs, canned.
Eggs, canned.
Egg whites.
C
Weight
(Pounds).
1,020
1,340
1,220
1,460
180
Placed in
Storage.
May 6, 1919
May 8, 1919
May 10, 1919
May 13, 1919
Mar. 4, 1919^
Name.
Goldsmith-Wall-Stockwell Company.
Goldsmith-Wall-Stockwell Company.
Goldsmith-Wall-Stockwell Company.
Goldsmith-Wall-Stockwell Company.
Rausch, Robert, & Son.
' Previously stored in the West.
178
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Requests for Extensio7i of Time not granted on Goods in Cold Storage from Dec.
1, 1919, to Dec. 1, iP^O — Concluded.
Abticle.
Weight
(Pounds).
Placed in
Storage.
Name.
Beef
4,689
Jan. 4, 1919
Boston Beef Company.
Beef, ....
8,402
Jan. 31, 1919
Boston Beef Company.
Beef rumps and rounds,
3,700
Jan. 24, 1919
Demary. A. C.
Ox joints.
810
Sept. 2, 1918
Wentworth Lunch Company.
Halibut,
3,750
Jan. 4, 1919
Boston Fish Pier Company.
Halibut,
4,431
Jan. 14, 1919
Boston Fish Pier Company.
Halibut,
375
Jan. 15, 1919
Boston Fish Pier Company.
Halibut,
Halibut,
5,018
5,094
Jan. 15, 1919
Jan. 17, 1919
Boston Fish Pier Company.
Boston Fish Pier Company.
Halibut,
7,620
Jan. 17, 1919
Boston Fish Pier Company.
Halibut,
55,011
Jan. 20, 1919
Boston Fish Pier Company.
Halibut,
5,122
Jan. 20, 1919
Boston Fish Pier Company.
Halibut,
5,220
Jan. 20, 1919
Boston Fish Pier Company.
Halibut,
7,118
Jan. 20, 1919
Boston Fish Pier Company.
Halibut,
4,099
Jan. 22, 1919
Boston Fish Pier Company.
Halibut,
7,620
Jan. 22, 1919
Boston Fish Pier Company.
Halibut.
1,074
Dec. 11, 1918
Fulham & Herbert.
Halibut,
5,165
Dec. 27, 1918
New England Fish Company.
Herring, .
2,200
Jan. 21, 1919
O'Brien, R., & Co.
Salmon, .
7,760
Jan. 15, 1919
Boston Fish Pier Company.
Shad,
10,598
Jan. 22, 1919
New England Fish Company.
Shad,
6,262
Jan. 25, 1919
New England Fish Company.
Shad,
12,616
Jan. 25. 1919
New England Fish Company.
Condensed milk, .
56 »
July 2, 1919
Hood, H. P.. & Sons.
Condensed milk, .
291
July 19. 1919
Hood. H. P.. & Sons.
2 Cans.
Bequests granted for Permission to remove Articles which had been in Cold Storage
longer than Ttcelve Months, from Dec. i, 1919, to Dec. 1, 1920.
Article.
Weight
(Pounds).
Placed in
Storage.
Name.
Butter
Butter
Beef
1,200
50
May 20, 1919
June 16, 1919
Lewis, Mears Company.
Lowney, The Walter M., Company.
Souza, John.
1
No. 34.]
DIVISION OF FOOD AND DRUGS.
179
Articles which had been in Cold Storage longer than Twelve Months, and on which
No Requests for Extension had been made, ordered removed, from Dec. 1,
1919, to Dec. 1, 1920.
Article.
Weight
(Pounds).
Placed in
Storage.
Name.
Eggs, canned.
. •
641
Pec. 27, 1918
Layton, John, Company.
Egg yolks, canned.
30
Apr. 18, 1919
Goldsmith-Wall-Stockwell Company.
Butter, .
-
July 3, 1919
Apollo Lunch.
Butter, .
5,200
Sept. 30, 1919
Armour & Co.
Butter, .
305
June 18, 1919
Dube Brothers.
Butter, .
1,575
July 10, 1919
Security Trust Company.
Oleomargarine,
1,505
Oct. 22. 1919
Cushman, H. G.
Oleomargarine,
506
May 19. 1919
Kellogg Products Inc.
Oleomargarine,
450
July 18, 1919
Kellogg Products Inc.
Oleomargarine,
720
Sept. 22, 1919
Kellogg Products Inc.
Oleomargarine,
380
Nov. 6, 1919
Kellogg Products Inc.
Chickens,
217
Dec. 27, 1919
Levin, A. P.
Chickens,
579
Oct. 21, 1919
Porter, C. H.
Fowl,
408
Dec. 27, 1918
Levin, A. P.
Poultry, .
-
Dec. 16, 1918
Brigham's Restaurant.
Poultry, .
-
Nov. 29, 1919
Cohen, Samuel.
Poultry, .
160
Feb. 1, 1919
Pratt, F. B., Company.
Poultry, .
-
Oct. 22, 1918
Shearer, C. T., Company.
Poultry, .
-
Feb. 12, 1919
Shearer, C. T., Company.
Poultry, .
-
Oct. 22, 1918
Warren Hotel.
Turkeys,
230
Dec. 23, 1918
Blackstone Supply Company.
Turkeys,
247
Dec. 27, 1918
Levin, A. P.
Turkeys,
230
Jan. 2, 1919
Robbing. Nathan, Company.
Rabbits,
360
Feb. 4, 1919
McCabe, M. J., Company.
Venison,
15
Nov. 14, 1918
Finnegan, R. E.
Game, m
scellaneou
s,
15
Feb. 8, 1919
Mixter, Dr. S. J.
Beef.
23,957
Nov. 7. 1919
Handy, H. L., Company.
Beef.
5,195
May 29. 1919
Libby & Libby Company.
Beef.
434
June 10, 1919
Libby & Libby Company.
Beef.
17,949
June 13, 1919
Libby & Libby Company.
Beef,
876
June 24, 1919
Libby & Libby Company.
Beef,
1,276
June 25, 1919
Libby & Libby Company.
Beef,
2,323
Dec. 11, 1918
Lipsky, Samuel.
Beef.
2,602
Dec. 18, 1919
Lipsky, Samuel.
Beef,
-
-
Shearer, C. T., Company.
_,
' Cans.
180
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Articles which had been in Cold Storage longer than Twelve Months, and on which
No Requests for Extension had been made, ordered removed, from Dec. 1,
1919, to Dec. 1, 1920 — Conthmed.
Article.
Weight
(Pounds).
Placed in
Storage.
Name.
Beef briskets, ....
5,739
May 20, 1919
Libby & Libby Company.
Beef briskets,
6,359
May 22, 1919
Libby & Libby Company.
Beef briskets,
7,025
May 23, 1919
Libby & Libby Company.
Beef briskets,
4,617
June 2, 1919
Libby & Libby Company.
Beef flanks, ' .
758
May 29, 1919
Libby & Libby Company.
Beef flanks, .
2,803
June 20, 1919
Libby & Libby Company.
Beef flanks, .
697
June 27, 1919
Libby & Libby Company.
Beef flanks, .
469
July 1, 1919
Libby & Libby Company.
Beef cheek meat, .
400
Jan. 21, 1919
Mindick, M.
Beef fores.
4,295
Sept. 17, 1919
Swift & Co.
Beef kidneys,
80
Apr. 26, 1919
Portsmouth Market.
Beef kidneys.
450
Apr. 26, 1919
Portsmouth Market.
Beef livers,
777
Dec. 30, 1918
Cohen, Nathan.
Beef rounds, .
6,461
June 6, 1919
Libby & Libby Company.
Beef rounds, .
1,538
Jan. 6, 1919
Lipsky, Samuel.
Beef rumps and rou
nds,
2,726
Apr. 24, 1919
Libby & Libby Company.
Beef stickers, .
2,565
Nov. 14, 1918
Lipsky, Samuel.
Beef stickers, .
2,948
Nov. 19, 1918
Lipsky, Samuel.
Calves' livers.
300
1918-1919
Royal Market Company.
Hogs' kidneys.
700
Mar. 14, 1919
Moore, Alexander.
Lamb,
716
Sept. 19, 1919
Goulakis, A.
Ox joints,
625
Sept. 2, 1918
Boylston Caf6.
Ox joints.
625
Sept. 2, 1918
Dorr, Arthur E., & Co., Inc.
Pork kidneys.
249
Sept. 18, 1919
Goulakis, A.
Sweetbreads, .
90
June 6, 1919
Batchelder & Snyder Company.
Veal kidneys,
118
Nov. 30, 1918
Standard Beef Company.
Eels, sand.
35
Oct. 15, 1919
Busalacchi, Tony, & Co.
Haddock,
500
July 3, 1919
Foilb, M.
Herring, .
400
Oct. 2, 1919
Busalacchi Brothers.
Herring, sardine.
175
Oct. 9, 1919
Globe Fish Company.
Herring, sardine.
175
Aug. 11, 1919
Mantia, S., & Co.
Lobster meat,
20
Apr. 22, 1919
Grilli, L
Mackerel,
1,750
Dec. 21, 1918
Globe Fish Company.
Mackerel,
140
Apr. 24, 1919
Hellenic Fish Market.
Mackerel,
2,650
June 11, 1919
Masheeco, M.
No. 34.]
DIVISION OF FOOD AND DRUGS.
181
Articles which had been in Cold Storage longer than Tioelve Months, and on which
No Requests for Extension had been made, ordered removed, from Dec. 1,
1919, to Dec. 1, i 9^0 — Concluded.
Article.
Weight
(Pounds\
Placed in
Storage.
Name.
Monkey fish,
280
Aug. 23, 1919
Mantia, S., & Co.
Salmon, .
200
July 5, 1919
Coleman Sons Company.
Shark, .
460
July 3. 1919
Globe Fish Company.
Shark, .
640
July 15, 1919
Globe Fish Company.
Shark, .
85
Oct. 11, 1919
Reynolds' Market.
Shark, .
192
Aug. 30, 1919
Russo & Sons.
Skates, .
-
July 23, 1919
Globe Fish Company.
Skates, .
-
July 17, 1919
Mantia, S., & Co.
Skate wings.
1,505
Oct. 22, 1919
Russo & Sons.
Whiting,
-
July 17, 1919
Corso & Cannizzo.
Whiting,
100
June 27, 1919
Globe Fish Company.
Whiting,
1,295
Aug. 11, 1919
Mantia, S., & Co.
Whiting,
3,710
Sept. 8, 1919
Mantia, S., & Co.
Whiting,
1,805
Sept. 12, 1919
Mantia, S., & Co.
182
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
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No. 34.]
DIVISION OF FOOD AND DRUGS.
183
Table No. 6. — List of Prosecutions.
For Sale of Milk not of Good Staridard Quality.
Name.
Address.
Court.
Date.
Result.
Baracos, Charles, .
Winthrop,
East Boston,
Aug. 17, 1920
Conviction.
Braun, Joseph,
Springfield,
Springfield,
Dec. 16, 1919
Conviction.
Caevallu, Joseph A.,
Fall River, .
Fall River,
Oct. 5, 1920
Conviction.
Caro, Samuel,
Springfield, .
Springfield,
Nov. 16. 1920
Conviction.
Cohen, Jacob,
Winthrop,
East Boston,
Aug. 9, 1920
Conviction.
Creamer, Oscar, .
Springfield, .
Springfield,
Nov. 24, 1920
Conviction.
Donovan, James, .
Salisbury,
Newburyport, .
Sept. 1, 1920
Conviction.
Economidy, Anthony, .
Springfield, .
Springfield,
Nov. 16, 1920
Conviction.
Gordon, James D.,
Salem,
Salem,
Aug. 6, 1920
Conviction.
Johnson, Charles, .
Hull, .
Hingham, .
Sept. 3, 1920
Conviction.
Karelis, Dennis, .
Hingham,
Hingham, .
Aug. 10, 1920
Conviction.
Karelis, Dennis, .
Hingham,
Hingham, .
Aug. 10, 1920
Conviction.
Koury, Maroun, .
Hull, .
Hingham, .
Sept. 3, 1920
Conviction.
Lampros, Samuel,
Springfield,
Springfield,
Nov. 16, 1920
Conviction.
Litchfield, Wm. F.,
Edgartown, .
Oak Bluffs,
Oct. 21, 1920
Conviction.
Mahamad, Kaya, .
Hingham,
Hingham, .
Aug. 10, 1920
Discharged.
McCarthy, Samuel J., •
Springfield, .
Springfield,
Dec. 16, 1919
Conviction.
Jilellar, Stephen, .
Springfield, .
Springfield,
Nov. 16, 1920
Conviction.
Norton, Clement, .
Edgartown, .
Oak Bluffs,
Oct. 21, 1920
Conviction.
Peterson, Robert, .
Hingham,
Hingham, .
Aug. 10, 1920
Conviction.
Sing, Mah, ....
Salem, .
Salem,
Aug. 6, 1920
Conviction.
Union News Co., .
Fall River, .
Fall River,
Mar. 30, 1920
Conviction.
Ying, Moy
Springfield,
Springfield,
Jan. 6, 1920
Conviction.
Young, Constantine,
Hingham,
Hingham, .
Aug. 10. 1920
Conviction.
For Sale of Milk from irhich a Portion of the Cream had been removed.
Buckley, Charles V.,
Graustein, Wm. A.,
Johnson, Bradford S.,
Kicopoulos, Nicholas,
Moregeau, William,
Nobut, Peter,
Monson, .
Cambridge,
Gardner,
Monson, .
Attleboro,
West Medway,
Palmer,
Waltham,
Gardner,
Palmer,
Attleboro,
Franklin,
Sept.
30,
1920
Jan.
7.
1920
Nov.
12,
1920
Sept.
30,
1920
July
23,
1920
Oct.
9,
1920
Conviction.'
Conviction.'
Conviction.
Conviction.'
Conviction.
Conviction.
' Continued to Dec. 30, 1920, for sentence.
2 Appealed
nol-prossed in Superior Court.
184
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
For Sale of Milk containing Added Water.
Name.
Address.
Court.
Date.
Result.
Almedia, Joseph, .
Arruda, Joseph J.,
Asadoorian, Hagop,
Asoian, Nishan,
Bacon, William H.,
Baker, D. Frank, .
Baker, Henry A., .
Barberian, Dan, .
Barbieri, Andrew, .
Bennett, Matthew J.,
Billings, Lawson H.,
Billings, Lewis E.,
Boissoneau, Alfred,
Bonnette, Theodore J.,
Bookless, Samuel, .
Bouchard, William,
Bury, Charles,
Cassidy, Frank,
Charonitch, Alexander,
Collins, John L., .
Corbin, John,
Correia, Manuel, .
Dumas, Joseph,
Fousica, Frank C,
Glass, Anton,
Goldstein, Samuel,
Gould, Leroy F., .
Grigolonok, John, .
Gurl, Joseph,
Haber, Andrew,
Hanscom, William,
Harrison, Rose,
Haskell, George C,
Houghton, Allan W.,
Huntley, Wm. H.,
Westport,
Fall River,
North Andover,
Andover,
Lexington,
Swansea,
Rockland,
Andover,
Great Barrington, .
Burlington,
Plympton,
Plympton,
Tiverton, R. I.,
Southbridge, .
Pittsfield,
Westport,
Taunton,
Med way,
Medway,
Woburn,
Millbury,
South Somerset,
Dudley, .
Fall River,
North Dartmouth,
Medway,
Sherborn,
Concord,
North Dartmouth,
South Hadley,
Bolton, .
Barnstable,
Orange, .
Amherst,
Marblehead,
Fall River,
Fall River,
Andover, .
Andover, .
Concord, .
Fall River,
Abington, .
LawTence, .
Great Barrington
Woburn,
Plymouth,
Plymouth,
Fall River,
Southbridge,
Pittsfield, .
Fall River,
Taunton, .
Franklin, .
Franklin, .
Woburn,
Worcester, .
Fall River,
Webster,
Fall River,
New Bedford,
Franklin, .
Framingham,
Concord, .
New Bedford,
Northampton,
Hudson,
Barnstable,
Orange,
Northampton,
Marblehead,
May 21, 1920
Oct. 5, 1920
Nov. 16, 1920
Nov. 16, 1920
Oct. 11, 1920
Aug. 31, 1920
Apr. 21, 1920
Apr. 12, 1920
Dec. 16, 1919
Nov. 8, 1920
May 11, 1920
May 11, 1920
Nov. 9, 1920
Apr. 23, 1920
Dec. 17, 1919
Aug. 10, 1920
June 10, 1920
Aug. 28, 1920
May 18, 1920
Nov. 5, 1920
June 28, 1920
Oct. 5, 1920
June 15, 1920
June 25, 1920
June 22, 1920
May 18, 1920
Oct. 30, 1920
Oct. 11, 1920
Aug. 11, 1920
June 2, 1920
Aug. 3, 1920
Sept. 24, 1920
June 24, 1920
June 2, 1920
Aug. 5, 1920
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Conviction. '
Dismissed.
Conviction.
Conviction. '
Conviction.
Conviction.
Conviction.
Conviction.'
Nol-prossed.2
Conviction.
Convection.
Conviction. '
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.!
Conviction.
Conviction.
Conviction.
Dismissed.
Conviction. '
Conviction.
Conviction.
Conviction.
Conviction. *
Conviction.
Conviction.
Conviction.
1 Appealed.
- Responsibility assumed by Fanny Tucker.
3 Case prosecuted in co-operation with Mr. H. E. Bowman, milk inspector, Somerville.
* Case prosecuted in co-operation with Mr. George T. Mecarta, milk inspector, Barnstable.
No. 34.]
DIVISION OF FOOD AND DRUGS.
185
For Sale of Milk containing Added Water — Continued.
Name.
Address.
Court.
Date.
Result.
Jackson, Wm. O.,
Jarman, David,
Jordan, Annie V.,
Joyce, James,
Karam, Sheehan,
• Katilin, Salome,
Koziel, John,
Larrabee, Harry A
Machado, John,
Mailloux, Lorenzo,
Maringo, Frank,
Marquis, Horace,
May, Charles P.,
Maynard, George E
Mello, Angelo,
Mello, Joseph Costa
Mello, Joseph C,
Mingos, Charles,
Palmer, William,
Palmer, William H
Perry, Frank S.,
Perry, Frank S.,
Perry, John, .
Proctor, Warren,
Reposa, Manuel,
Reynolds, Sr., Frank,
Rezendes, John,
Rich, John H.,
Sampson, Leon A
Silva, Alexander,
Silva, Paul,
Spaulding, James R.,
Steele, Joseph,
Stockton, James
Stone, John, .
Sullivan, John,
Sykes, Louis,
Hardwick,
Dracut, .
Pittsfield,
Salem,
Agawam,
West Medway,
Palmer, .
Nantucket,
Westport,
Berkley, .
Fall River,
Fall River,
Winchendon,
Marlborough,
Fairhaven,
Fall River,
North Westport,
Salem,
Pittsfield,
Pittsfield,
Attleboro,
Attleboro,
Dartmouth,
Lunenburg,
Somerset,
Lexington,
Somerset,
Truro,
Westborough,
Danvers,
Middleboroug
Salisbury,
Provincetown
Bellingham,
Sudbury,
Lexington,
Norwood,
h,
East Brookfield,
Lowell,
Pittsfield, .
Salem,
Springfield,
Franklin, .
Palmer,
Nantucket,
Fall River,
Taunton, .
Fall River,
Fall River,
Winchendon,
Marlborough,
New Bedford,
Fall River,
Fall River.
Salem,
Pittsfield, .
Pittsfield, .
Attleboro, .
Attleboro, .
New Bedford, .
Leominster,
Fall River,
Concord, .
Fall River,
Provincetown, .
Westborough, .
Salem,
Middleborough,
Newburyport,
Provincetown,
Franklin, .
Framingham,
Concord, .
Stoughton,
Feb. 5, 1920
Nov. 4, 1920
Dec. 17, 1919
Mar. 16, 1920
Dec. 1, 1919
Oct. 9, 1920
Oct. 27, 1920
Aug. 19, 1920
Aug. 10, 1920
Oct. 19, 1920
Apr. 21, 1920
Oct. 13, 1920
May 5, 1920
Oct. 23, 1920
Jan. 5, 1920
Feb. 19, 1920
Oct. 26, 1920
Aug. 6, 1920
Dec. 17, 1919
June 11, 1920
July 16. 1920
July 16, 1920
Sept. 21, 1920
Aug. 13, 1920
May 4, 1920
Aug. 6, 1920
Oct. 5, 1920
Sept. 8, 1920
June 30, 1920
Mar. 16, 1920
Nov. 13, 1920
Sept. 10, 1920
Sept. 15, 1920
Aug. 28, 1920
June 9, 1920
Aug. 6, 1920
Apr. 9, 1920
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Conviction. '
Conviction.'
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Conviction. '
Conviction.
Discharged.
Conviction.
Conviction.
1 Appealed.
186
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
For Sale of Milk containing
Added Water —
- Concluded.
Name.
Address.
Court.
Date.
Result.
Sykes, Louis,
Sykes, Louis,
Sykes, Louis,
Tatro, Joseph,
Tilden, Frank P., .
Tucker, Fanny,
Twitchell, Lillian I.,
Wiley, John H., .
Wolcoski, Russell, .
Yeziersky, Martin,
Norwood,
Norwood,
Norwood,
South Hadley,
North Scituate,
Southbridge, .
HolHston,
Mansfield,
South Billerica,
Agawam,
Stoughton,
Stoughton,
Stoughton,
Northampton, .
Hingham, .
Southbridge,
Framingham, .
Attleboro, .
Lowell,
Springfield,
Apr. 9, 1920
Apr. 9, 1920
Apr. 9, 1920
June 2, 1920
Nov. 30, 1920
Apr. 23, 1920
Oct. 16, 1920
June 4, 1920
Nov. 4, 1920
Dec. 2, 1919
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Discharged.
Conviction.
Conviction. »
Conviction.
For Sale of Cream helow Legal Standard.
Graustein, Wm. A.,
Graustein, Wm. A.,
Cambridge,
Cambridge,
Walt ham,
Waltham,
Jan. 7, 1920
Jan. 7, 1920
Discharged.
Conviction.'
Ferguson, Hugh R.,
For Sale of Adulterated Butter.
[Contained excess moisture.]
Hyannis,
Barnstable,
Aug. 12, 1920 ! Conviction.
For Sale of Adulterated Foods Other than Milk and Milk Products.
Clams.
[Contained added water.]
Anthony, George M., .
Chelsea, .
Chelsea,
May 17, 1920
Discharged.
Brown, Rufus S., .
Newburyport,
Newburyport, .
Sept. 10, 1920
Conviction. 2
Fowler, Wm. L., .
Salisbury,
Newburyport, .
Sept. 10, 1920
Conviction.
Pierce, Henry A., .
Boston, .
Boston,
May 23, 1920
Conviction.'
Smart, Phillip A.,
Lynn,
Lynn,
Oct. 14, 1920
Discharged.
Wilcox, William J..
Chelsea, .
Chelsea,
May 17, 1920
Discharged.
Olive Oil.
[Adulterated with foreign oil.]
Alexion, Markos, .
New Bedford,
New Bedford, . Mar. 5, 1920 1 Conviction.
1 Case prosecuted in co-operation with Mr. H. E. Bowman, milk inspector, Somerville. - Appealed.
\
No. 34.]
DIVISION OF FOOD AND DRUGS.
187
For Sale of Adulterated Foods Other than Milk and Milk Products — Continued.
Olive Oil — Concluded.
[Misbranded.]
Name.
Address.
Court.
Date.
Result.
Caresi, Guiseppi, .
Geas, Folios, ....
Leonardi, Santi, .
Boston, .
Fitchburg,
Lawrence,
Boston,
Fitchburg,
Boston,
Apr. 30, 1920
Mar. 23, 1920
Apr. 30, 1920
Conviction.
Conviction.
Conviction.
Sausage.
[Contained starch in excess of 2 per cent.]
Balkus, Andrew, .
Lynn,
Lynn,
Dec.
9, 1919
Conviction.
Beauchamp, Ovilla,
Holyoke,
Springfield,
Feb.
10, 1920
Conviction.
Briggs, John W., .
Methuen,
Lawrence, .
Mar.
25, 1920
Conviction.
Caton, Wm. E
Lowell, .
Lowell, .
Dec.
31, 1919
Conviction.
Cudahy Packing Company,
Boston, .
Boston,
Mar.
10, 1920
Conviction.
Cudahy Packing Company,
Boston, .
Boston,
Mar.
10, 1920
Conviction.
Cudahy Packing Company,
Boston, .
Boston,
Mar.
10, 1920
Conviction.
Eberwein, John, .
Pittsfield,
Pittsfield, .
Jan.
23, 1920
Conviction.
Furneaux, Henry J., .
Lawrence,
Lawrence, .
Jan.
30, 1920
Conviction.
Gavriluk, Alex,
Lawrence,
Lawrence, .
Jan.
21, 1920
Conviction.
Holt, John, ....
LawTence,
LawTence, .
Jan.
30, 1920
Discharged.
Holt, John, ....
Lawrence,
Lawrence, .
Jan.
30, 1920
Conviction.
Johnston, Robert W., .
Lowell, .
Lowell,
Jan.
22, 1920
Conviction.
Johnston, Robert W., .
Lowell, .
Lowell,
Jan.
22, 1920
Conviction.
Kirschner, Frank,
Haverhill,
Haverhill, .
Jan.
30, 1920
Conviction.
Mohawk Packing Company,
Boston, .
Boston,
Jaq.
16, 1920
Conviction.
Massachusetts Mohican Com-
Pittsfield,
Pittsfield, .
Jan.
23, 1920
Conviction.
pany.
National Packing Company,
Boston, .
Boston,
Mar.
11, 1920
Conviction.
National Packing Company,
Boston, .
Boston,
Mar.
11, 1920
Conviction.
Park Sausage and Provision
Company.
Park Sausage and Provision
Company.
Park Sausage and Provision
Company.
Sayisck, John,
Boston, .
Boston, .
Boston, .
Boston,
Boston,
Boston,
Feb.
Feb.
Feb.
4, 1920
4, 1920
4, 1920
Conviction.
Conviction.
Conviction.
Lawrence,
Lawrence, .
Jan.
30, 1920
Conviction.
Shedd, Harold H..
Haverhill,
Haverhill, .
Jan.
17, 1920
Conviction.
Thomas, Arthur, .
Waltham,
Waltham, .
Feb.
18, 1920
Conviction.
Wilner, Paul,
Haverhill,
Haverhill, .
Apr.
2, 1920
Conviction.!
Wisniowski, Frank,
New Bedford,
New Bedford, .
Jan.
20. 1920
Conviction.
1 Appealed.
188
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
For Sale of Adulterated Foods Other than Milk or Milk Products — Continued.
Sausage — Concluded.
[Contained coloring matter.]
Name.
Address.
Court.
Date.
Result.
Massachusetts Mohican Com-
pany.
Pittsfield,
Pittsfield, .
Jan. 23, 1920
Conviction.
Soft Drinks.
[Contained saccharine.]
Brazen, Joseph,
Lawrence,
LawTence, .
Oct.
1, 1920
Dismissed, i
Puzine, Jacob,
Lawrence,
Lawrence, .
Oct.
1, 1920
Conviction.
Yuz, John, ....
Lawrence,
Haverhill, .
Oct.
4, 1920
Conviction.
Thomas, Mishan,*
Thomas, Misrah,' .
Vinegar.
[Low in acid.
Lawrence,
Lawrence,
Lawrence,
Lawrence,
Nov. 19, 1920
Nov. 19, 1920
Conviction.
Conviction.'
Eggs.
[Decomposed; unfit for food
Cohen, Louis,
Economy Grocery
Company.
Flood, Nathan B.,
Flood, Nathan B.,
Roosov, Abraham,
Singer, Morris,
Stores
Boston, .
Maiden, .
North Adams,
North Adams,
Stoneham,
Boston, .
Boston,
Maiden,
Pittsfield,
Pittsfield,
Woburn,
Boston,
Jan.
14,
1920
Dec.
11,
1919
Jan.
23,
1920
Jan.
23,
1920
Dec.
19,
1919
Mar.
19,
1920
Conviction.
Conviction.
Conviction.
Conviction.
Conviction. *
Conviction.
False Advertising — Sale of Stale Eggs as Fresh Eggs.
Bay State Market Company,
New Bedford,
New Bedford, .
Jan. 20, 1920
Conviction.
Blay, Philip F
Waltham,
Waltham, .
Mar. 3, 1920
Conviction.
Janes, Charles W.,
Waltham,
Waltham, .
Feb. 18, 1920
Conviction.
New Bedford Public Market,
New Bedford,
New Bedford, .
Jan. 20, 1920
Conviction.
Newton Public Market,
Newton,
Newton, .
Nov. 1, 1920
Conviction.*
1 Left State before summons was served. Partner convicted.
* Case prosecuted in co-operation with the Lawrence Board of Health; analysis made by this De-
partment.
^ Continued for sentence.
* Appealed.
No. 34.]
DIVISION OF FOOD AND DRUGS.
189
For Sale of Adulterated Foods Other than Milk or Milk Products — Continued.
Eggs — Continued.
Mishrandcd.
Name.
Address.
Court.
Date.
Result.
Armour & Co
Boston, .
Boston,
Mar.
11, 1920
Conviction.'
Flood, Nathan B.,
North Adams,
Pittsfield, .
Dec.
30, 1919
Conviction.
Flood, Nathan B.,
North Adams,
Pittsfield, .
Jan.
23, 1920
Conviction.
Flood, Nathan B.,
North Adams,
Pittsfield, .
Jan.
23, 1920
Conviction.
Mills Tea and Butter Cor-
Pittsfield,
Pittsfield, .
Jan.
9, 1920
Conviction.
poration.
Rosen, Morris L., •
Boston, .
Boston,
Jan.
23, 1920
Conviction.'
Simpson Brothers Company,
Boston, .
Boston,
Jan.
23, 1920
Conviction.
Usave Stores, Inc.,
Waltham,
Waltham, .
Mar.
3, 1920
Conviction.
Walsh, Fred J., .
Lowell, .
Lowell,
Dec.
24, 1919
Conviction.
Young, Solomon N.,
Boston, .
Boston,
Jan.
14, 1920
Conviction.
Selling Cold-storage Eggs without marking the Container.
Alpert, Morris,
Angelo, Louis,
Barthel, Eugene E.
Berube, George,
Biband, J. Omer,
Bikis, James,
Blotner, Benjamin,
Borges, Joauum J.,
Brown, Charles N.,
Brown, Joseph,
Carr, Hugh, .
Chesses, Barney, .
Cohen, Louis,
Cohen, Max, .
Coutalonis, Thomas,
Curtis, William N.,
Danas, James,
David, Moses,
Desisto, Patrick, .
Direnski, Daniel, .
Donovan, Frank D.,
Duffy, James,
East Boston,
Lawrence,
Gardner,
Lawrence,
Amesbury,
Springfield,
Haverhill,
New Bedford,
Medford,
Boston, .
Medford,
Everett, .
Boston, .
Waltham,
Woburn,
Medford,
Lowell, .
East Boston,
Boston, .
Lowell, .
Lowell, .
Lowell, .
East Boston,
Lawrence, .
Gardner, .
Lawrence, .
Amesbury,
Springfield,
Haverhill, .
New Bedford, .
Maiden,
West Roxbury, .
Maiden,
Maiden,
Boston,
Waltham, .
Woburn,
Maiden,
Lowell,
East Boston,
Boston,
Lowell,
Lowell,
Lowell,
Feb. 6, 1920
Jan. 21, 1920
Nov. 26, 1920
Mar. 25, 1920
Jan. 12, 1920
Nov. 16, 1920
Jan. 17, 1920
Jan.. 20, 1920
Feb. 10, 1920
Jan. 27, 1920
Feb. 10, 1920
Feb. 17, 1920
Jan. 14, 1920
Mar. 8, 1920
Nov. 5, 1920
Feb. 10, 1920
Nov. 29, 1920
Feb. 17, 1920
Mar. 26, 1920
Nov. 29, 1920
Nov. 22, 1920
Nov. 22, 1920
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Appealed.
190
DEPARTIMENT OF PUBLIC HEALTH. [Pub. Doc.
For Sale of Adulterated Foods Other than Milk or Milk Products — Continued.
Eggs — Continued.
Selling Cold-storage Eggs without marking the Container — -Continued.
Name.
Address.
Court.
Date.
Result.
Eastwood, Albert, .
New Bedford,
New Bedford,
Jan. 20, 1920
Conviction.
Finkelstein, Morris,
West Roxbury,
West Roxbury, .
Feb. 3, 1920
Conviction.
Frentoz, Peter,
Springfield, .
Springfield,
Nov. 17, 1920
Con\'iction.
Garber, Harry,
Boston, .
Boston,
Jan. 14, 1920
Conviction.
Goldstein, Benjamin, .
West Roxbury,
West Roxbury, .
Feb. 3, 1920
Conviction.
Gordon, Milton,
Waltham,
Waltham, .
Feb. 18, 1920
Conviction.
Gotohean, John, .
Springfield, .
Springfield,
Nov. 16, 1920
Conviction.
Green, Samuel,
Jamaica Plain,
West Roxbury, .
Jan. 27, 1920
Conviction.
Guillet, J. Arthur,
New Bedford,
New Bedford, .
Jan. 20, 1920
Conviction.
Handy Company, H. L.,
Springfield, .
Pittsfield, .
Jan. 23, 1920
Conviction.
Harkins, Wm. A
Woburn, .
Woburn, .
Nov. 5, 1920
Conviction.
Harring. Herbert, .
East Boston, .
East Boston,
Feb. 6, 1920
Conviction.
Hoxie, Charles E.,
Brockton,
Brockton, .
Feb. 4, 1920
Conviction.
Jewell, Fred M
Amesbury,
Amesbury,
Jan. 12, 1920
Conviction.
Juk, Max, ....
Boston, .
Boston,
Mar. 26, 1920
Conviction.'
Kapner, Hyman, .
New Bedford,
New Bedford, .
Jan. 20, 1920
Conviction
Katz, Philip,
Chelsea, .
Chelsea,
Jan. 2, 1920
Conviction.
Kirshner, Nathan,
Boston, .
Boston,
Jan. 14, 1920
Conviction.
Kramer, Ernest, .
Jamaica Plain,
West Roxbury, .
Jan. 27, 1920
Conviction.
Manninen, Herman,
Gardner,
Gardner, .
Nov. 26. 1920
Conviction.
Melinski, Frank, .
Lawrence,
Lawrence, .
Jan. 21, 1920
Conviction.
Morris & Co.,
New Bedford,
New Bedford, .
Jan. 20, 1920
Conviction.
Nadler, Abraham,
Springfield,
Springfield,
Nov. 16, 1920
Conviction.
Newton Public Market,
Newton,
Newton, .
Nov. 1, 1920
Conviction. '
Nowak, Joseph,
Amesbury,
Amesbury,
Jan. 12, 1920
Conviction.
Perham, George L.,
Lowell, .
Lowell,
Nov. 29, 1920
Conviction.
Poulin, Joseph,
Amesbury,
Amesbury,
Jan. 12, 1920
Conviction.
Rayman, Harry, .
Medford,
Maiden,
Jan. 28, 1920
Conviction. '
Reid, Greenleaf W.,
Brockton,
Brockton, .
Feb. 4, 1920
Discharged.
Reid Company, G. W.,
Brockton,
Brockton, .
Mar. 1, 1920
Conviction. '
Renkert, George, .
Maiden, .
Maiden,
Feb. 24, 1920
Conviction.
Rosenberg, Abraham, .
Boston, .
Boston,
Jan. 14, 1920
Conviction.
Ruttenberg, Abraham, .
Newton, .
Newton,
Nov. 1, 1920
Conviction. ^
Sawink, Eliaa,
Pittsfield,
Pittsfield, .
Jan. 23, 1920
Conviction.
Scaltrito. John,
Boston, .
Boston,
Jan. 14, 1920
Conviction.
Appealed.
* Fined $25; sentence suspended.
No. 34.]
DIVISION OF FOOD AND DRUGS.
191
For Sale of Adulterated Foods Other than Milk and Milk Products — Concluded.
Eggs — Concluded.
Selling Cold-storage Eggs without marking the Container — Concluded.
Name.
Seaman, John H.,
Sevitch, Morris,
Silvia, Frank S., .
Simonello, Rocco, .
Smith, Abraham, .
Sorakes, Efine,
Specter, David,
Spellman, Louis, .
Stepnowski, Louis,
Terzepacz, Paul, .
Tillman, Samuel, .
Tobis, Angelo,
Whittemore, Ichabod,
Winer, Israel,
Zajac, Michael,
Address.
New Bedford,
New Bedford,
New Bedford,
Haverhill,
Everett, .
Springfield,
New Bedford,
New Bedford,
Pittsfield,
Pittsfield,
Springfield,
Springfield,
Lawrence,
Chelsea, .
New Bedford,
Court.
Date.
Result.
New Bedford, .
New Bedford, .
New Bedford, .
Haverhill, .
Maiden,
Springfield,
New Bedford, .
New Bedford, .
Pittsfield, .
Pittsfield, .
Springfield,
Springfield,
Lawrence, .
Chelsea,
New Bedford, .
Jan.
Jan.
Jan.
Jan.
Feb.
Nov.
Jan.
Jan.
Jan.
Jan.
Nov.
Nov.
Jan.
Jan.
Jan.
20, 1920
20, 1920
20, 1920
17, 1920
10, 1920
17, 1920
20, 1920
20, 1920
23, 1920
23, 1920
16, 1920
16, 1920
21, 1920
8. 1920
20, 1920
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Conviction.
Knight & Co., Inc.,
For Sale of Decomposed Food.
Delivering Decomposed Meat.
Boston, .
Charlestown,
Mar. 24, 1920
Conviction.
Raisins.
Kehayas, James C. (2 counts).
Boston, .
Boston,
July 6, 1920
Conviction.
Segal, Jacob N. (2 counts), .
Boston, .
Boston,
July 6, 1920
Conviction.
Zidros, John (2 counts).
Boston, .
Boston,
July 6, 1920
Conviction.
David, Moses,
Goldberg, Wolfe L.,
Sausage.
East Boston, .
Fall River, .
East Boston,
Fall River,
Feb. 17. 1920
Feb. 19, 1920
Conviction.
Conviction.
Perry, Frank S.,
Obstruction of an Inspector.
. Attleboro,
Attleboro, .
July 16, 1920
Conviction. '
I Appealed.
192
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
For Violation of the Laws relative to Cold Storage.
Returning to Cold-storage Articles of Food once removed therefrom for the
Purpose of Placing on the Market for Sale.
Name.
Address.
Court.
Date.
Result.
Gushing Beef Company,
Boston, .
Boston,
Sept. 27, 1920
Conviction.
Holding Articles of Food in Cold Storage for a Period Longer than Twelve
Months without the Consent of the Department of Public Health.
Batchelder & Snyder, .
Bay State Fishing Company
(10 counts).
Burns Company, Inc., John
(7 counts).
Cann's Sea Grill, Inc., .
Cefalu, Joseph,
Chatham Freezer Company
Ginter Company (2 counts)
Libby, Samuel (8 counts),
Libby, Samuel (8 counts),
McKeon, Wm. F. {2 counts)
Prevoir, Frank,
Rodman, Benjamin W.,
Security Trust Company,
Shattuck & Jones,
Story & Simmons Company
(2 counts).
Boston, .
South Boston
South Boston
Boston, .
Boston, .
Boston, .
South Boston
Boston, .
Boston, .
Watertown,
Boston, .
Boston, .
Lynn,
Boston, .
South Boston,
Boston,
Boston,
Boston,
Boston,
Boston,
Boston,
Boston,
Boston,
Boston,
Boston,
South Boston,
Boston,
Boston,
Boston,
Boston,
Jan.
Feb.
Feb.
Mar.
Mar.
Jan.
Feb.
Oct.
Oct.
Feb.
May
Jan.
Sept.
Feb.
Feb.
14,
1920
9,
1920
9,
1920
10,
1920
24,
1920
19,
1920
9,
1920
27,
1920
27,
1920
9,
1920
25,
1920
14,
1920
16,
1920
20,
1920
9,
1920
Nol-prossed.
Conviction.'
Conviction. •
Conviction. •
Conviction.
Conviction.*
Conviction.'
Conviction.
Conviction.
-2
Conviction.
Conviction.
Conviction.
Conviction.*
Conviction.'
Retaining Food in Cold Storage after it had been declared Unwholesome
BY THE Department of Public Health.
Brockton Public Market, Inc.,
Libby, Samuel,
Brockton,
Boston , .
Boston,
Boston,
Sept. 23, 1920
Oct. 27, 1920
Conviction.'
Conviction.
Removing Articles of Food from Storage without Inspection by the Depart-
ment OF Public Health after Such Food had been stored for More than
Twelve Calendar Months.
Bay State Fishing Company
(8 counts).
Burns Company, Inc., John
(4 counts).
McKeon, William F. (2
counts).
Story & Simmons Company
(2 counts).
South Boston,
South Boston,
Boston,
Boston,
Feb.
Feb.
9, 1920
9, 1920
Conviction.'
Conviction.'
Watertown,
Boston,
Feb.
9, 1920
-2
South Boston,
Boston,
Feb.
9, 1920
Conviction.'
' Defaulted ; charges taken to be true.
2 On file, without plea.
No. 34.]
DIVISION OF FOOD AND DRUGS.
193
For Violation of the Lmvs relative to Cold Storage — Concluded,
Retailing Cold-storage Goods without displaying a Sign marked "Cold Storage
Goods Sold Here."
Name.
Address.
Court.
Date.
Result.
Goldberg, Wolfe L.,
Fall River, .
Fall River,
Feb. 13, 1920
Conviction.
Green, Isaac,
Jamaica Plain,
West Roxbury, .
Jan. 27, 1920
Conviction.
Lipson, Morris,
Boston, .
Boston,
Jan. 14, 1920
Conviction.
Scaltrito, John,
Boston, .
Boston,
Jan. 14, 1920
Conviction.
Vartan, George M.,
Jamaica Plain,
West Roxbury, .
Jan. 27, 1920
Conviction,
Displaying Cold-storage Eggs without the Necessary Sign.
Gaouette, Napoleon J.,
New Bedford,
New Bedford, . Jan. 20, 1920
Conviction.
Representing Cold-storage Food as Fresh Food.
Bay State Market,
New Bedford,
New Bedford, . Jan. 20, 1920
Conviction.
Operating a Refrigerating Warehouse without a License issued by the De-
partment OF Public Health.
Whittemore, Ichabod,
Lawrence,
Lawrence, .
Jan. 21, 1920
Conviction.
For Violation of the Laws relative to Slaughtering.
Illegal Use of Stamp.
Pederson, Iner (2 counts),
Acton,
Concord,
Apr. 14, 1920 Conviction.
Slaughtering or authorizing Slaughtering in the Absence of Inspector,
Gold, Samuel,
Pittsfield,
Pittsfield, .
Feb. 2, 1920
Conviction.
Mclntire, Ralph W. (2 counts).
Fitchburg,
Fitchburg,
June 19, 1920
Conviction.'
Shenkman, Oscar,
New Marlborough, .
Great Barrington,
Aug. 25, 1920
Conviction.
Slomitsky, Max, .
Great Barrington, .
Great Barrington,
Aug. 18, 1920
Conviction.
Weaver, George,
West Acton, .
Concord, .
Apr. 14, 1920
Conviction.
Winkler, Conrad R., .
Adams, .
Adams,
May 5, 1920
Conviction,
Appealed.
194
DEPARTMENT OF PUBLIC HEALTH. [P. D. No. 34.
For Violation of the Laws relative to Slaicghtering — Concluded.
Selling, offering for Sale, or having in Possession with Intent to sell,
Unstamped Meat.
Name.
Address.
Court.
Date.
Result.
Brodsky, Barney, .
Fitchburg,
Fitchburg,
June 15, 1920
Conviction.
Corey, Frank R
Newport, R. I.,
Fall River,
Jan. 30, 1920
Conviction.
Dumaine, Wilfred,
Westport,
Fall River,
Aug. 3, 1920
Conviction.
Rutman, Jacob,
Fitchburg,
Fitchburg,
June 15, 1920
Conviction.
Shenkman, Oscar,
New Marlborough, .
Great Harrington,
Aug. 25, 1920
Conviction.
Winkler, Conrad R, .
Adams, .
Adams,
May 5, 1920
Conviction.
Selling or delivering Carcasses of an Animal which had come to its Death
Otherwise than by Slaughter while in a Healthy Condition.
Cunningham, Phillip, .
Boxborough, .
Concord, .
May 11, 1920
Conviction.
Slomitsky, Max, .
Great Harrington, .
Lee, .
Aug. 24, 1920
Conviction.
Stoskin, Morris,
Great Harrington, .
Lee, .
Aug. 24, 1920
Conviction.
Having Unwholesome Meat in his Possession with Intent to sell the Same.
Friedman, Samuel,
Mirman, Barney, .
Fitchburg,
Monterey,
Fitchburg,
Great Harrington,
June 15, 1920
Aug. 18, 1920
Conviction. '
Conviction.
Selling or offering for Sale Immature Veal.
Kirby, Perry,
Sousini, James,
East Chatham,
N. Y.
Pittsfield,
Pittsfield,
Pittsfield,
Feb. 13, 1920
June 4, 1920
Conviction.
Conviction.
As Inspector op Slaughtering violated the Rules and Regulations of the
Department of Public Health.
Farnum, Walter F.,
Lanesborough,
Pittsfield, .
Feb. 13, 1920
Conviction.
Fobes, Edwards.,
Acton, .
Concord, .
Apr. 14, 1920
Conviction.
Powers, Wm. P
Lee,
Lee, .
June 3, 1920
Conviction.
' Appealed.
Division of Communicable Diseases
Bernard^W. Carey, M.D., Director
[195]
Report of Division of Communicable Diseases.
The activities of the Division of Communicable Diseases have con-
tinued along the same general lines as in past years. Much time and
effort have been expended in making our morbidity reports more com-
plete, and it is believed some measure of success has been attained.
The co-operative arrangement with the Division of Registration in
Medicine made in the early part of the year has proved most beneficial
and far preferable to court action for violators of the law of reporting
those diseases declared dangerous to public health.
Critical analysis of our mortahty rates shows an appreciable decline
in most of the diseases over that for the year 1915 and for the median
year of the period 1906-1915. A glance at the rates for previous years
proves beyond question that a saving of life has resulted from our
efforts, and the economic gain to the State far exceeds the cost of this
work.
The following tabulation shows for the seven most prevalent diseases
not only our gains but also our losses, forcibly pointing out the need
for further work in whooping cough and measles: —
Disease.
Diphtheria
Scarlet fever,
Typhoid fever
Measles,
Epidemic cerebrospinal meningitis;
Whooping cough, ....
Tuberculosis
Median,
1906-1915.
20.1
7.8
11.8
6.7
4.3
7.6
132.7
1915.
19.4
4.9
6.7
4.0
3.4
7.6
113.2
1920.
15.4
5.5
2.4
9.0
3.3
14.0
97.2
The personnel of the Division has undergone many changes. Owing
to our inabihty to secure properly quaUfied persons for District Health
Officers it has appeared wise to redistrict the State into seven districts
rather than eight as formerly. It is yet too soon to form an opinion
as to whether or not this plan may be worked out advantageously and
without too great a burden upon the District Health Officers affected
by the change.
198 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
The following persons have resigned from the Department: —
Clark, Charles. Publicity agent in the Subdivision of Venereal Diseases. Serv-
ices terminated Sept. 15, 1920.
Keenan, James A., M.D. District Health Officer, Berkshire Health District.
Services terminated Feb. 10, 1920.
Lovell, Bertha C. Supervising investigator, Subdivision of Venereal Diseases.
Services terminated Sept. 30, 1920.
Osborn, Stanley H., M.D. Epidemiologist. Sen^ices terminated April 30, 1920.
Roberts, Bertrand E., M.D, District Health Officer, Connecticut Valley Health
District. Services terminated July 31, 1920.
Rogers, Emily M. Nursing assistant. Northeastern Health District. Services
terminated June 30, 1920.
The following appointments were made : —
Chace, Mrs. Sara W. Nursing assistant. Southeastern Health District. Ap-
pointed Sept. 7, 1920.
Henry, Jonathan E., M.D. Epidemiologist. Appointed June 1, 1920.
Miner, Harold E., M.D. District Health Officer, Connecticut Valley Health
District. Appointed Nov. 22, 1920.
Pfeiffer, Albert, M.D. Epidemiologist, Subdivision of Venereal Diseases. Ap-
pointed Jan. 1, 1920.
Routine inspections of hospitals and jails, lock-ups and houses of
correction were carried on as in previous years, with no marked change
noted in the conditions present.
Sixty-seven dispensaries, under the dispensary licensing law, sub-
mitted applications for licenses to the Department. In each instance
the dispensary submitting application was found to be operating for
public benefit, and the license was therefore granted.
The reported incidence of communicable diseases for the year 1920
has reached a total of 135,242, with the rather remarkable fact that
there has been no localized outbreak of alarming proportions at any
one time. Influenza, with 36.312 cases, measles, with 32,141 cases,
scarlet fever, with 10,260 cases, and whooping cough, with 9,994 cases,
have been of State-wide prevalence.
The reported incidence of measles and whooping cough is larger
than has ever been recorded in Massachusetts. It has been impossible
to determine accurately what factors are responsible for these increases.
Epidemiological investigation shows conclusively that increased effort
to limit the spread of these two conditions must be directed at the pre-
school age group because it is here that both morbidity and mortaUty
rates reach their peak.
The morbidity and mortality of whooping cough occurring as they
do in the years of early childhood should clearly place it in the fore-
No. 34.] DIVISION OF COMMUNICABLE DISEASES. 199
ground of our endeavors. The history' of so many needless exposures
with their dire result calls for special activity on our part. We must
overcome by persistent educational attacks the mistaken impression
that children are bound to have this or that disease and that they
"may as well have it and get over with it." If our people are insistent
in this belief, they should at least choose that period of life which
gives the least fatality and not that which gives the greatest.
In spite of the fact that many public health officials feel there is
nothing to be done about measles because of its extreme contagiousness
in the pre-eruptive stage, it is believed that persistent effort in the
beginning of an outbreak will do much to limit its spread and to effect
a diminution of cases. A school nurse, with a thermometer, sending
home from school children showing the slightest rise of temperature
and the careful instruction of mothers as to the isolation of the first
case and subsequent isolation of other children of her household show-
ing symptoms of illness of any sort will do much to limit the incidence
of this condition. Our experience during the past year in a few iso-
lated instances has definitely proved the efficacy of these precautions.
The reported incidence of diphtheria is still too high to warrant any
degree of satisfaction over its control. Much time, thought and energy
have been given to the control of this condition, and it is gratifying
to see an increase in the culturing for diagnosis and more attention
being paid to the carrier state. More and more is it evident that
endemic diphtheria will never be controlled by antitoxin and quaran-
tine measures alone. Our efforts must be extended to a search for all
possible contacts with a known case, their culturing, and with im-
mediate immunization by antitoxin of those showing positive cultures.
Schick tests, to determine the non-immune group of the community
with their subsequent immunization by the toxin-antitoxin mixture,
should be persistently applied. There are several indications that in
the near future the efforts of the Department and the local boards of
health to control diphtheria will bear fruit. As shown by our records,
physicians are utilizing the laboratory for diagnoses with increasing
frequency, which must of course result in the earlier diagnosis of
diphtheria and the earlier administration of the antitoxin. Demonstra-
tions by Dr. White, Director of the Division of Biologic Laboratories,
and the District Health Officers to physicians and local boards of
health of the method of performing the Schick test, together with the
reading of the findings, will make the future control of diphtheria more
satisfactory. There can be no doubt that diphtheria pi'evention and
control call for the widespread dissemination of the knowledge that all
agencies for its control are available to the people of the Commonwealth.
For the first time in the history of the Department the deaths from
200 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
typhoid fever are less than 100. This yearly decrease in the death rate
from typhoid fever is most gratifying and by its consistency points
out that intensive investigation of the individual case for sources of
infection, with proper preventive measures applied thereto, is the
proper and logical procedure for typhoid control. Massachusetts, be-
cause of its carefully guarded water supplies, its adequate sewage dis-
posal and the relatively large amount of pasteurization of its milk,
finds future control limited to a large extent to contact with individual
cases and the typhoid carrier. There can be no doubt that the immuni-
zation of our male group between the ages of twenty and forty who
served in the Army and Navy during the late war has had an appre-
ciable effect upon our rate. Prior to this year statistics have shown in
both morbidity and mortality an excess of males over females. This
year it is noted that conditions are reversed and that females are pre-
dominating in this age group. This is, of course, additional evidence
pointing out the wisdom of vaccinating our citizens against typhoid
and particularly of including our female population as well as the male.
It is recorded that 34 of our cases occurred in institutions among
patients where typhoid prevention may be so well carried out. It is
also regrettable that 10 cases were reported among nurses or attendants
in our hospitals where, because of the intimate association with typhoid
cases, infection is so likely to occur. There is need of reiterating our
warning of 1919 and to assist as far as we may in the immunization of
all inmates of institutions and of all who, because of their work, may
be unduly exposed.
We now have under supervision 55 typhoid carriers, of whom 7 were
discovered this year, — 4 through examinations made in the Bacteri-
ological Laboratory of this Department and 3 through local labora-
tories. Two of these carriers who presented positive faeces or urine
gave negative or atypical Widal reactions. This points out the neces-
sity of not placing too much reliance upon the Widal when other evi-
dence points to the possibility of an individual being responsible for a
given case or outbreak.
The reported incidence of lobar 'pneumonia does not present a true
picture of the actual incidence and it is questionable whether or not
we will ever be able to differentiate between broncho-pneumonia, in-
fluenza pneumonia and the secondary pneumonias with sufficient
accuracy from the reports to feel with any degree of certainty that
we have the correct index of the incidence of lobar pneumonia.
Searlct fever showed the same widespread distribution with undue
incidence as in measles and whooping cough. Investigation shows that
much of the infection was transmitted from the mild and often times
No. 34.] DIVISION OF COMMUNICABLE DISEASES. 201
unrecognized case. It was a frequent history that a given child was
taken out of a school peeling and that he had been in constant attend-
ance with the exception perhaps of one day, frequently being absent
from school the Friday before and appearing Monday with evidence
of a slight unaccounted-for rash. Until more thorough school inspec-
tion is available, conditions similar to this must go on and will cause
much waste of school time and money of our citizens.
The mortality rates of pulmonary tuberculosis have shown a gratify-
ing decrease for the year 1920. The reported incidence is approxi-
mately that of the preceding year. An increase in the reported
incidence is looked for, however, because of the special activities of the
local boards of health through their follow-up work with contacts and
the Department of Public Health with its consultation clinics. Never
before has there been such a concerted effort by all interested in the
control of tuberculosis towards early diagnosis through State, county
and municipal chnics with special attention paid by nutritional and
public health workers in the field of the school-age group. It appears
that it is in this group our future efforts must be actively centered,
and marked results may be expected if the present day theory of the
early infection of tuberculosis is tenable.
The public health aspect of tuberculosis of other forms is rapidly
receiving more attention in the minds of health officials. There is no
doubt that the forms of non-pulmonary tuberculosis which need
surgical attention should be placed in hospitals where competent sur-
geons and orthopedists are in attendance. With a death rate approxi-
mating 20 per 100,000 over a period of the last ten years other forms
of tuberculosis should receive the immediate and serious attention of
this Department.
A gradual decrease in the reporting of ophthalmia neonatorum is to
be seen, and the cities and towns now taking care of their own cases
have reached 42. There were but three instances where impaired
vision occurred. Of the total 1,638 cases, 1,205 were under fifteen
days, 307 between fifteen days and three months, and 126 were three
months and over. It is interesting to note that many of the cases
reported as ophthalmia neonatorum were in reality eyes red, swollen
and showing an unnatural discharge due to the use of silver nitrate
unneutralized by the addition of salt solution.
There have been 67 dog-bite cases reported during the year, an in-
crease over any preceding year. It is interesting to note that by far
the greatest majority of these cases are limited to the southeastern
section of the State. It is our belief that the time has come when
■efforts should be made to lessen the incidence of dog bites in Massa-
202 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
chusetts by at least restraining dogs on leashes while on the street and
by a systematic campaign against the stray or ownerless dog. Fifty-
two cases of dog bite received antirabic treatment.
Anterior yolioviyelitis is treated in another section of this report and
will receive only passing notice here. Our investigations have proved
nothing which was not shown by the investigations of the outbreak
of 1916. Multiple cases in a given household were extremely rare.
There was no change in the age incidence and no new light shown on
its mode of transmission. The only outstanding feature was the com-
parative freedom from infection in the western part of the State. A
triangle with its apex at Worcester and base drawn along the water-
front would include practically all of the incidence. This alone differs
from 1916 when the State, as a whole, was infected. Of what epi-
demiological significance this may be is unknown, but may possibly
be explained by the early infection of the eastern part of the State
and the colder weather preventing its advance westward.
The special work done in conjunction with the Harvard Infantile
Paralysis Commission was too hmited to allow any definite conclusions
to be drawn. It does appear, however, that lumbar puncture with the
bedside determination of cellular content is a practical procedure and
one which should become a part of our service to the physicians of the
State. Herein lies a golden opportunity for the differentiation of the
various meningeal conditions with the subsequent administration of
antimeningococcic serum in the event that it is indicated.
There was a decrease in the number of cases of anthrax reported
during the year. There were 17 cases, of which 7 were in Peabody, 3
in Lowell, and the rest scattered, with 1 each in Stoneham, Chelsea,
Lawrence, Hudson, Newton, Winchester and Worcester. The infection
was traced to hides in 11 cases, wool in 1 case and hair in 1 case.
Source of infection in 4 cases was unknown.
Mumps, with 5,962 cases reported, an increase of about 2,500 over
the preceding year, is worthy of comment. Here, as in the case of
the other frequently reported diseases, incidence has been scattered
throughout the State. The mortality was almost neghgible.
A lessened incidence of epidemic cerebrospinal meningitis for the year
was noted, 182 cases being reported. Three attempts were made to
detect possible carriers where the patient gave the history of recently
being admitted to this country. Over 100 nasopharyngeal cultures
were taken at the immigration station, all of which proved negative.
There was but one outbreak of septic sore throat reported during the
year which was milk-borne, and cultures taken from a milk handler
proved to be of the hemolytic type. There has been some question in
No. 34.] DIVISION OF COMMUNICABLE DISEASES. 203
the minds of physicians as to what exactly might constitute septic sore
throat and it has been repeatedly stated by the members of this De-
partment that in our opinion a septic sore throat is one which exhibits
a virulent hemolytic streptococcus. It is believed that if all public
health officials accept this definition our reports of septic sore throat
will be diminished in number and a more complete picture of the true
incidence will be obtained.
There were 37 cases of dysentery which, with the exception of 9 cases
which occurred in August at the Medfield State Hospital, were in
various sections of the State. The question has been raised whether
institutional dysentery may not properly be of paratyphoid origin,
rather than due to other causes. The attention of the Department and
local boards of health should be directed to the possibility of dysentery
being imported into this country through immigration, and careful
investigation of the individual case should be carried out.
There were 29 cases of smallpox reported during the year, with two
distinct outbreaks, — one in May in Boston with 8 cases and 1 in
Braintree connected with this outbreak, and one in December in
Methuen wath 14 cases reported during the month, 9 of Avhich were
in one family. The source of infection in these outbreaks as well as in
the other cases was outside of Massachusetts. The majority Avere
directly traceable to the mild outbreak that occurred in Canada.
There were 25 cases of tetanus reported during the year. This does
not represent the total number of cases, however, of tetanus occurring
in the State because of the fact that 21 deaths have been recorded.
Pellagra was reported in 16 instances, 9 cases of which were found
in State institutions.
There were 3 cases of actinomycosis and 3 cases of leprosy reported.
REPORT OF THE STATE DISTRICT HEALTH OFFICERS.
The duties enjoined upon the State District Health Officers are
numerous and varied. They are the field agents of the Department
and are the representatives of the Commissioner of Public Health in
their respective districts. They are in frequent contact with boards of
health, local health officers and workers, advising with them regarding
the many problems incident to daily routine health administration;
they are constantly in touch with the occurrence of cases of disease
dangerous to the public health as reported each day to local boards of
health, alert to inquire into or be of assistance in any instance where
such diseases are found to be newly occurring or showing increasing
prevalence.
204 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
In this connection they are often called upon to aid in establishing a
diagnosis in doubtful cases, e.g., in distinguishing between chicken pox
and smallpox, in deciding whether a given case is scarlet fever, or in
determining the nature of the trouble in a suspected case of infantile
paralysis.
The State District Health Officers annually inspect all jails, houses
of correction, station houses, lock-ups, places of detention, all hospitals
and dispensaries, public or private, as required by law.
In addition they are subject to the performance of any special work
assigned by the Department; such tasks include unusual investiga-
tions in the field, e.g., an inquiry into the circumstances of maternal
mortality, studies relating to infant mortality rates, surveys in given
communities to determine the extent and prevalence of tuberculosis,
promoting the formation of a voluntary health district with the em-
ployment of a full-time health officer; under this is included also
service on committees for various purposes, — the preparation of sug-
gested minimum rules for the control of communicable diseases, to con-
sider new possibilities of educational work, etc.
Nursing Assistants.
The work of the nursing assistants is concerned to a considerable
extent with tuberculosis, — visiting the tuberculosis dispensaries and
individual cases in communities where there is no nursing service, and
in attempting to raise the standard of tuberculosis work, and in co-
ordinating such work on the part of the public and various private
agencies.
They are also called upon to assist in other phases of the work of
the Department, especially in connection with educational measures as
carried out through lectures and health exhibits, and in investigating
the occurrence of cases of communicable disease.
Educational Work.
Though the consideration of the educational work of the Depart-
ment will be found in the report of the Division of Hygiene, a brief
statement of the share of the District Health Officers and nursing
assistants in such work is properly included here.
During the year 199 lectures were given in 88 cities and towns
before audiences aggregating approximately 14,000. The subjects dis-
cussed had to do with various phases of health work, — the preven-
tion of disease, the promotion of health, the need for trained health
Avorkers, etc.
No. 34.] DIVISION OF C0:M]MUNICABLE DISEASES. 205
Many talks were sought or arranged to aid in the sohition of some
particular problem or to assist in the creation of a public opinion
which should eventually bring about appropriations for specific pur-
poses, such as the employment of a public health or school nurse, the
estabHshment of a dental clinic, etc.
Reahzing from experience that most graduate nurses, though ex-
cellently qualified through their training for their professional duties,
lacked adequate knowledge of public health and pubHc health work, a
course of eight lectures on health administration and work was pre-
pared by the District Health Officers and other members of the De-
partment. Through the co-operation of the Association of Training
School Superintendents this course was given in some 20 or more
hospitals before groups aggregating about 700 nurses in training.
Much interest was manifested. This work will be repeated the en-
suing year under the management of the Division of Hygiene.
In this connection it may be emphasized that much, if not most of
the work of the District Health Officers and nursing assistants is dis-
tinctly, though indirectly, educational. For in the field there is con-
stant opportunity for the quiet and unobtrusive spreading of health
knowledge and propaganda. In retrospect it is clearly manifest that
such continued effort has represented no small part in bringing about
in this Commonwealth the increased interest of the present day in all
matters pertaining to health.
Diseases dangerous to the Public Health.
The unusual prevalence of some of the communicable diseases,
notably scarlet fever and diphtheria, has been due, in great degree, as
determined by field experience, to contact infection, favored by a
quarantine too short or poorly observed, and to "missed" or mild, un-
recognized cases. Cases of nasal diphtheria were frequent, and in
many instances served as a source of infection. It was also observed
that in many instances the earUer cases in a household received no
medical attention until a later case showed more pronounced or alarm-
ing symptoms. It was noted further, also, that many times second and
multiple cases occurred in the same household at intervals which indi-
cate that household immunization was not carried out.
Details regarding the communicable disease work will be found in
the report of the epidemiologist.
206
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
District Changes.
During the year, following the passage of legislation, the number of
State District Health Officers was reduced from 8 to 7. This necessi-
tated a corresponding change in district boundaries.
To District No. 2 have been added Ashland, Framingham, Holliston,
Hopkinton, Marlborough, Natick and Sherborn.
Ashby, Aver, Groton, Hudson, Pepperell, Shirley and Townsend
have been added to District No. 4.
The towns in Worcester County formerly in Districts Nos. 5 and 6
have been consolidated into the "Worcester County District," known
as District No. 5.
There have been added to District No. 7 the towns of New Salem,
Orange and Warwick.
A list of the districts as now constituted, together with the names
of the District Health Officers and nursing assistants, follows: —
Health Districts and State District Health Officials.
Acushnet.
Attleboro.
Barnstable.
Berkle3^
Bourne.
Brewster.
Carver.
Chatham.
Chilmark.
Dartmouth.
Dennis.
Dighton.
Duxbury.
Eastham.
Edgartown.
Fairhaven.
Fall River.
Falmouth.
The Southeastern District — No. 1.
Freetown.
Gay Head.
Gosnold.
Harwich.
Kingston.
Lakeville.
Mansfield.
Marion.
Mashpee.
Mattapoisett.
Middleborough.
Nantucket.
New Bedford.
Norton.
Oak Bluffs.
Orleans.
Plvmouth.
Plympton.
Provincetown.
Raynham.
Rehoboth.
Rochester.
Sandwich.
Seekonk.
Somerset.
Swansea.
Taunton.
Tisburj'.
Truro.
Wareham.
Wellfleet.
West Tisbury.
Westport.
Yarmouth — 52.
Dr. Charles W. Milliken, 411 Book Store Building, New Bedford, State Dis-
trict Health Officer.
Mrs. Sara W. Chace, Nursing Assistant.
:N'o. 34.] DIVISION OF COMMUNICABLE DISEASES.
207
Abington.
Ashland.
Avon.
Bellinghani.
Boston.
Bra in tree.
Bridgewater.
Brockton.
Brookline.
Cambridge.
Canton.
Cohasset.
Dedham.
Dover.
East Bridgewater.
Easton.
Foxborough.
Framingbam.
Franklin.
The Eastern District — No. 2.
Halifax.
Hanover.
Hanson.
Hingham.
Holbrook.
Holliston.
Hopkinton.
Hull.
Marlborough.
Marshfield.
Medfield.
Medway.
Millis.
Milton.
Natick.
Needham.
Newton.
Norfolk.
North Attleborough.
Norwell.
Norwood.
Pembroke.
Plain\alle.
QUINCY.
Randolph .
Rockland.
Scituate.
Sharon.
Sherborn.
Stoughton,
Walpole.
Wellesley.
West Bridgewater.
Westwood.
Weymouth .
Whitman.
Wrentham — 56.
Dr. George T. O'Donnell, 546 State House, Boston, State District Health
Officer.
Miss Cecilia A. Lemner, N^lrsing Assistant.
The Northeaster!! District — No. 3.
Amesburj'.
Ljmnfield.
Revere.
Be\^rly.
Malden.
Rockport.
Boxford.
Manchester.
Rowley.
Chelsea.
Marblehead.
Salem.
Dan vers.
Melrose.
Salisbury.
Essex.
Merrimac.
Saugus.
Everett.
Middleton.
Stoneham.
Geo^geto^vn.
Nahant.
Swampscott.
Gloucester.
Newbur}^
Topsfield.
Groveland.
Newburyport.
Wakefield.
Hamilton.
North Reading.
Wenham.
Ha\i;rhill,
Peabody,
West Newbury.
Ipswich.
Reading.
Winthrop — 40
Lynn.
Dr. Lyman A. Jones, Willey House, Swampscott, State District Health Officer.
Miss M. Gertrude Martin, Nursing Assistant.
208
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
The North Midland District — No. 4-
Acton.
Dunstable.
Somerville.
Andover.
Groton.
Stow.
Arlington.
Hudson.
Sudbury.
Ash by.
LA-WKENCE.
Tewksbury.
Ayer.
Lexington.
Townsend.
Bedford.
Lincoln.
Tjmgsborough.
Belmont.
Littleton.
Waltham.
Billerica.
LOAVELL.
Watertow-n.
Boxborough.
Maynard.
Way land.
Burlington.
Medford.
Westford.
Carlisle.
Methuen.
Weston.
Chelmsford.
North Andover.
Wilmington.
Concord.
Pepperell.
Winchester.
Dracut.
Shirley.
WOBURN — 42
Dr. Charles E. Simpson, 100 Hotyrood Avenue, Lowell, State District Health
Officer.
Miss Mildred F. Ashley, Niirsing Assistaiit.
The Worcester County District —
No. 5.
Ashburnham .
Hopedale.
Royalston.
Athol.
Hubbard ston.
Rutland.
Auburn.
Lancaster.
Shrewsburj'.
Barre.
Leicester.
Southborough.
Berlin.
Leominster.
Southbridge.
Blackstone.
Lunenburg.
Spencer.
Bolton.
Mendon.
Sterling.
Boylston.
Milford.
Sturbridge.
Brookfield.
Millburk'.
Sutton.
Charlton.
Millville.
Templeton.
Clinton.
New Braintree.
Upton.
Dana.
Northborough.
Uxbridge.
Douglas.
Northbridge.
Warren.
Dudley.
North Brookfield.
Webster.
East Brookfield.
Oakham.
West Boylston.
FiTCHBURG.
Oxford.
AVest Brookfield.
Gardner.
Paxton.
Westborough.
Grafton.
Petersham.
Westminster.
Hard wick.
Phillipston.
Winchendon.
Har\'ard.
Princeton.
Worcester — 60
Holden.
Dr. Francis A. Finnegan, 614 Park Building, Worcester, State District Health
Officer.
Mrs. Anna Hartnett, Nursing Assistant.
Miss Katherine B. O'Connor, Nursing Assistant.
No. 34.] DIVISION OF COMMUNICABLE DISEASES.
209
The
Agawam .
Amherst.
Belchertown.
Blandford .
Brim field.
Chesterfield.
Chicopee.
Conway.
Deerfield.
Easthampton.
East Longmeadow
Enfield.
Goshen.
Granby.
Granville.
Greenwich.
Connecticut Valley District
Hadley.
Hampden.
Hatfield.
Holland.
HOLYOKE.
Huntington.
Leverett.
Longmeadow.
Ludlow.
Monson.
Montgomery.
Northampton.
Palmer.
Pelham.
Prescott.
Russell.
No. 6.
Shutesbury.
Southampton .
South Hadley.
►Southwick.
Springfield.
Sunderland.
Tolland.
Wales.
Ware.
West Springfield.
Westfield.
Westhampton.
Whately.
Wilbraham.
Williamsburg — 47.
Dr. H.VROLD E. Miner, 289 Main Street, Springfield, State District Health
Officer.
Miss Mary E. Ayer, Nursing Assistant.
Adams.
Alford.
Ash field.
Becket.
Bernardston.
Buckland.
Charlemont.
Cheshire.
Chester.
Clarksburg.
Colrain.
Cummington.
Dal ton.
Egremont.
Erving.
Florida.
Gill.
Great Barrington.
Greenfield.
The Berkshire District — No
Hancock.
Hawley.
Heath.
Hinsdale.
Lanesborough .
Lee.
Lenox.
Leyden.
Middlefield.
Monroe.
Montague.
Monterey.
Mount Washington.
New Ashford.
New Marlborough.
New Salem.
North Adams.
Northfield.
Orange.
Otis.
Peru.
PiTTSFIELD.
Plain field.
Richmond.
Rowe.
Sandisfield.
Savoy.
Sheffield.
Shelburne.
Stockbridge.
Tyringham.
Warwick.
Washington.
Wendell.
West Stockbridge.
Williamstown,
Windsor.
Worthington — 57.
Dr. Oscar A. Dudley, Box 1036, Pittsfield, State District Health Officer.
Miss Katharine M. Turner, Nursing Assistant.
210
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Work of Engineering Division.
Work coming under this head has consisted largely in taking samples
of water from springs and wells, and submitting a report of the sur-
roundings, at the request of the Division of Sanitary Engineering,
more especially at points distant from the State House, where the
doing of the work resulted in a substantial saving of time and expense.
BEPORT OF THE WORK OF THE BACTERIOLOGICAL
LABORATORY.
During the year ended Nov. 30, 1920, the Bacteriological Laboratory
iias examined 28,637 specimens. Table 1 shows the number and kinds
of examinations. A comparison is made between the years 1915 and
1920.
Table 1.
Diphtheria,
Tuberculosis, .
Widal test.
Typhoid culture,
Gonorrhea,
Malaria, .
Miscellaneous,
C
1920.
18,046
4,341
1,533
908
2,775
82
9521
28,637
I Including 545 pneumococcus type determinations; 34 diphtheria virulence tests; 49 animal inocula-
tions for tubercle bacilli; 78 paratyphoid A and B; 15 anthrax (animal tests).
Table 2 shows the results of examinations:
Table 2.
Diphtheria (primary).
Diphtheria (release), .
Tuberculosis,
•Typhoid fever (Widal test),
Typhoid fever (culture test),
Gonorrhea, ....
Malaria, ....
Miscellaneous,
Total
Positive.
Negative.
*AtJT)ical.
1,477
1,770
1,013
363
51
292
1
10,418
4,381
3,328
1,087
857
2,483
81
83
Total.
11,895
6,151
4,341
1,533
908
2,775
82
952
28,637
Diphtheria.
The culturing of school children in infected schools has been carried
.on throughout the year to a limited extent, 5,053 cultures being
examined. Twenty-four carriers were found among this number. This
No. 34.1 DIVISION OF COMMUNICABLE DISEASES.
211
work might be increased without overburdening the laboratory.
Careful investigation of the carriers would add greatly to the value of
the work.
Typhoid Fever.
Although the number of Widal tests made was less than usual,
examinations of specimens of fajces and urine for typhoid bacilli were
greatly increased, totaling 908. Four carriers were discovered. None
of these handled food for sale but were apparently responsible for cases
in their households.
Pneumococcus Type Determination.
There were 545 specimens of sputum examined for pneumococcus
type. The results follow: —
Type I, .
Type II, .
Type III.
Group IV,
Per Cent.
11.4
16.0
20.9
51.7
No pneumococci, 195.
Many of the specimens received were saliva rather than sputum,
which probably accounts for the high percentage of Group IV pneumo-
cocci.
REPORT OF THE SUBDIVISION OF VENEREAL DISEASES.
The campaign for the control of venereal diseases has made steady
progress during the past year.
Statistics.
It does not appear wise to draw any statistical deductions from re-
ports of cases filed since venereal diseases have been reported. Avail-
able figures do not appear to support extravagant claims made by
some investigators.
The number of cases reported and consequently the reported rate
per 100,000 population are decHning. The rate per 100,000 for the
212 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
year July 1, 1918, to June 30, 1919, was 463; from July 1, 1919, to
June 30, 1920, was 316; the yearly rate from July 1, 1920, based on
four months' reports, is 283. These figures include only infectious
cases, and even for infectious cases are probably distinctly incomplete.
From Jan. 1, 1920, to Dec. 31, 1920, 10,212 cases were reported from
184 cities and towns having a combined population of 3,791,726, thus
leaving 170 towns with a combined population of 271,216 from which
there were no reports. Granted that a uniform rate of infection ob-
tains throughout the State, and this is a safe assumption, these re-
porting towns should have returned 730 cases. If all physicians in
some towns fail to make proper returns, it is fair to assume that some
physicians in every city and town are lax in observing certain legal
requirements.
Even allowing for incomplete returns, these figures appear to indi-
cate a lessened rate of infection, and this assumption is supported by
statements of physicians in different sections of the State.
Examinations of prisoners confined in Massachusetts penal institu-
tions do not reveal the rate of venereal infections among the prison
population indicated in statistics published by observers elsewhere. It
is hoped that more accurate figures may be available next year.
t
Clinics.
The work of the State-approved clinics has increased in numbers of
patients treated, and has also improved in other respects not demon-
strable by figures: the number of patients has increased; quarterly
conferences of clinic directors and clinicians have tended to standardize
methods of treatment and procedure in the several clinics; all clinics
are apparently providing adequate clinical facilities for their several
areas; and changes in hours and personnel have been necessary in
some instances to meet the demand for increased service.
In July the clinic at the Salem Hospital was formally approved; in
November a chnic organized and equipped by the board of health of
Haverhill was approved. In North Adams a civic committee, repre-
senting professional, social, mercantile and manufacturing interests, is
considering the advisability of establishing and equipping a clinic in
that city; a method of procedure has been outlined to the committee.
The climes at Lynn and Brockton have been reorganized, apparently
with benefit to both clinics.
It is difficult to establish any standard as to the amount of work
which should be accomplished in any cHnic, and equally difficult justly
to compare one clinic with another. Attendance at clinics in this State
No. 34.] DIVISION OF COMMUNICABLE DISEASES.
213
will be influenced apparently by customs and ideals obtaining in the
city under consideration, by the character of the population, whether
the people have been educated to seek treatment at out-patient de-
partments, and by the fees demanded by physicians for private treat-
ment. A clinic which apparently may treat few patients in propor-
tion to the population may be rendering to that community valuable
service.
Consultation clinics conducted by neurologists for examination of
known and suspected cases of neurosyphilis will probably be a reality
within a few months. It is intended to refer patients from the State-
approved clinics to these consultation clinics, and also to provide like
service for the private cases of physicians.
The following figures cover work of the clinics from Dec. 1, 1919,
to Dec. 1, 1920: —
Total New
Patients.
Monthly
Average of
Total
Patients.
Total Treat-!
ments given.
Attleboro,
32
13.0
306
Boston City,
498
358.0
11,427
Boston Dispensary
2,421
2,382.9
60,395
Massachusetts General
2,498
1,706.0
39,350
Massachusetts Homoeopathic,
347
285.9
6,881
Brockton
98
29.7
906
Fall River
102
80.5
3,914
Fitchburg
45
11.0
471
Haverhill,'
4
-
13
Holyoke, - . . .
31
-
100
LawTence,
118
76.4
1.583
Lowell,
260
106.4
2,737
Lynn
126
82.5
2,728
New Bedford
316
208.2
3,043
Pittsfield
17
5.6
250
Salem
69
25.6
700
Springfield,
356
171.8
3,032
Worcester,
122
126.6
2,690
7,460
-
140,526
I Clinic opened Nov. 1, 1920.
2 Clinic opened April, 1920.
214 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Social Service.
Careful studies of the social service needs of the State were made,
and a plan for providing such service outlined. Illness necessitated
the postponement of these plans.
Through co-operation with the department of penal institutions a
follow-up service for reaching families of infected prisoners has been
inaugurated. This has not been in operation a sufficient length of time
to warrant any statement. A prisoner paroled before the expiration of
his sentence must, if infected, present himself regularly at a State
clinic for treatment; this condition is written in the parole.
Lapsed Cases.
From Dec. tL, 1919, to Dec. 1, 1920, 1,342 cases were reported by
name because they failed to return for treatment, or because other
reasons indicated that summary action was advisable. These cases
were in turn reported to local boards of health for investigation and
necessary action. The majority of these cases were returned for treat-
ment. In a few instances local boards of health reported that aid from
police officials was necessary, but in no instance was court action re-
quired.
Early in January a new procedure was adopted in reporting lapsed
cases to local health authorities to insure routine reporting of those
cases only which are actively infectious. In cases of syphilis when
three months have elapsed between the date of the numbered report
and the report by name, and when four months have elapsed in cases
of gonorrhea, a letter is addressed to the attending physician request-
ing further information. This insures the possibility of giving accurate
information to the local health authority.
Arsphenamine.
The number of ampoules of arsphenamine distributed during this
year is greater than during 1919. Reports received indicate that the
arsphenamine manufactured and distributed by the State compares
favorably in its action with commercial products, in fact fewer reactions
follow its use. Inquiries indicate that there is a growing demand for
the neo-arsphenamine product, and it appears that this should be
given careful consideration.
A report issued some months past credited Massachusetts with the
use of more arsphenamine per patient than any other State in the
Union. If the figures given were correct, it indicates that physicians
in this State are conscientiously treating their syphilitic patients.
No. 34.] DIVISION OF COMMUNICABLE DISEASES. 215
Advertising.
The posting of signs advertising locations and hours of cHnics has
been continued during the year. About 13,000 signs have been posted.
Educational.
As the campaign for the control of venereal disease progresses, it
becomes increasingly evident that education in its broadest sense offers
the most effective weapon. The educational feature to be successful
must have the active sympathy and hearty co-operation of practically
every individual. Since this is, for the present at least, an impossi-
bility, plans have been devised for interesting organizations and indi-
viduals engaged in various phases of welfare work.
The study group feature outlined and perfected in the early fall of
last year has been the medium through which women interested in
various social activities and organizations engaged in welfare work for
young women have received instruction in the problem of venereal
disease control. It is hoped that through these study groups whole-
some information may be given to those who may not have other
opportunities of securing like instruction.
As opportunity has presented, conferences have been held In various
cities to discuss local conditions affecting prevalence of venereal disease,
and to outline possible procedure for control of the same. These
conferences have been attended by health officers, city executives,
court officers, nurses, teachers, physicians, social workers, and repre-
sentatives of social and welfare organizations. At each conference the
State program has been carefully outlined, the chnics being especially
emphasized. These conferences have served to give a clearer under-
standing of the venereal disease campaign, and to establish more
cordial relations between official and nonofficial agencies and the State
clinics.
Industrial.
No great effort has been exerted to launch any comprehensive
program through industrial companies. In answer to requests, em-
ployers of labor have been interviewed and apprised of measures insti-
tuted to control venereal disease. These men expressed sympathy
with the program, but thought that active efforts on their part might
be misinterpreted by employees.
216 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Meeting of Clinic Directors.
Conferences or meetings of directors and clinicians of the State-
approved venereal disease clinics have been held quarterly in January,
April, July and October. These meetings have been called to consider
and discuss matters of interest relating to clinic management and to
care and treatment of patients infected with a venereal disease.
The meetings were as follows : —
January — Neurosyphilis. A clinic was conducted at the Boston Psychopathic
Hospital by Dr. H. C. Solomon.
Papers: Dr. Henry J. Perry, Dr. J. Homer Wright, Dr. W. H. Watters, Dr.
Townsend W. Thorndike and Hermaim C. Lythgoe.
April — Gonorrhea in the Male. Dr. Edward J. Keyes, Jr., New York,
Papers: Hermann C. Lythgoe and Dr. H. C. Solomon.
July — Gonorrhea in the Female. Dr. A. K. Paine and Dr. William P. Graves.
Paper: Dr. William A. Hinton.
October — Congenital Syphilis.
Papers: Dr. W. H. Watters, Dr. C. Morton Smith and Dr. M. C. Smith.
These meetings have been interesting and instructive, and apparently
have stimulated the clinicians to exercise their best endeavors toward
creating a healthy atmosphere in their several clinics.
Police Departments.
Through co-operation with an agent of the United States Interde-
partmental Social Hygiene Board, the animated diagrammatic film
"Health and Disease" has been presented to many police departments
of the State, and apparently has produced a deep impression. Many
police departments have voluntarily promised to restrain incorrigible
patients, and promised assistance in locating and restraining vicious
sources of infection.
Inspection of Jails and Houses of Correction.
Between April 21 and July 20 every jail and house of correction in
the State was visited for the purpose of ascertaining the methods of
examining prisoners to determine the presence or absence of venereal
infection and modes of treating the same.
Eighteen institutions were visited. The combined population was
1,902 men and 274 women, a total of 2,176, all of whom, with the
exception of a few who had just been admitted, had been examined.
No. 34.] DIVISION OF COMMUNICABLE DISEASES. 217
The State institutions (Charlestown State Prison, Bridgewater,
Concord Reformatory and Sherborn Reformatory) and four of the
county jails (Deer Island, East Cambridge, Worcester and Springfield)
appear to be well equipped for treating venereal diseases.
Sources of Infection.
Investigations of reported sources of infection during the past year,
and facts ascertained therefrom, have proved the wisdom of having
such investigations made by workers directly connected with the De-
partment. Some reports appeared to be maliciously made, and others
were apparently prompted by jealousy. All persons consulted received
the investigator courteously. Many were examined and given treat-
ment when necessary.
Courts.
Personal interviews with courts and court officials, started in Sep-
tember, 1919, were finished late in August, 1920. During this period
judges and probation officers of all courts of the State — superior,
poHce and district — were interviewed. The State program for control
of venereal diseases was carefully explained, court procedure in cases
of actual and suspected sex offences was ascertained, methods of se-
curing examinations in different courts were compared, and uniform
procedure in cases suitable for probation was adopted. Thus without
any standard legaHzed process it has been possible to secure thorough
co-operation of courts and court officials, a uniform mode of action
which promises all that could be secured were the exact procedure
legally defined.
Keeping Fit Campaign.
A conference to outline a campaign for Massachusetts was held in
the State House December 5. The following organizations were repre-
sented: Y. M. C. A., Parent-Teacher Association, Massachusetts
CathoHc Order of Foresters, State Grange, Salvation Army, Farm
Bureau, Red Cross, Knights of Columbus, local health officers. The
purposes of the campaign were outlined, the "Keeping Fit" posters
were displayed, and the "Keeping Fit" pamphlet for young men was
distributed. It was carefully explained that posters or stereopticon
slides, or both, would be supplied free by the Massachusetts Depart-
ment of Public Health to any organization, mercantile or manufactur-
ing company, or to any individual who wished to assist in the cam-
paign and who would make arrangements to have them displayed;
218
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
that a balopticon for projecting the stereopticon slides would be loaned
if necessary; that speakers could be supplied; that supplies of the
"Keeping Fit" pamphlet would be provided.
Organizations represented at this conference rendered valuable assist-
ance during the campaign. Local conferences were held in several
cities for the purpose of outlining campaigns for these communities,
and in each instance appeared to give the result sought.
Under date of January 26 a letter was addressed to the masters of
private schools for boys in the State, asking permission to explain by
personal interview the "Keeping Fit" campaign, and, with the per-
mission of the masters, to provide a poster exhibit.
All the private schools (18 in number) for boys of fifteen years and
over requested a loan of posters and a supply of pamphlets. Some re-
quested posters for permanent use, and in answer to these requests a
set of posters was presented to the school.
All the colleges of the State used the posters either in the gymnasium
or as a part of the course in physical culture.
By special request, a set of posters was loaned to a college for
women, who expressed great satisfaction with the presentation.
Exhibits were also loaned and pamphlets were supplied to Y. M.
C. A., Y. M. H. A., Salvation Army, messenger companies, telegraph
companies, News Boys' Union, stores, offices, and to several individuals
interested in or having approach to boys. Many sets are in use at
present and requests on file indicate that the demand will continue for
many months.
The expense of the campaign was approximately as follows: —
Forty sets of posters,
Pamphlets,
Salaries,
Traveling,
Express,
$330 00
64 00
7S0 00
200 00
10 00
$1,384 00
The results were as follows:
Total showings of posters and slides, 192
Total attendance (conservative estimate) , 58,507
Pamphlets distributed, 27,383
Cost of reaching one boy, ^ 023
No. 34.] DIVISION OF COMMUNICABLE DISEASES.
219
Summary, Dec. 1, 1910, to Dec. 1, 1920
Reported by number: —
Gonorrhea,
Syphilis,
Total,
Reported by name (lapsed cases).
Ampoules of arsphenamine distributed
Wassermann examinations, .
Smear examinations, ^
Pamphlets distributed, .
Lectures,
State-approved clinics, .
New cases admitted to clinics.
Average monthly attendance at clinics.
Total treatments given,
7,330
3,180
10,510
1,342
27,106
36,910
2,798
53,027
72
18
7,460
5,670.1
140,526
PENIKESE HOSPITAL.
The leper hospital at Penikese was transferred from the Department
of Public Welfare to the Department of Public Health Dec. 1, 1919,
and was then placed in the Division of Communicable Diseases for
administrative purposes.
The maximum number of patients treated at Penikese for the year
was 17, two of whom were ex-soldiers and cared for under contract
with the United States War Risk Insurance Bureau after enabling
legislation had been secured. There were 3 deaths during the year and
1 patient deported.
The total appropriation granted for the year was $34,820 and $35,-
692.67 was expended, a deficit of $872.67 resulting. This deficit was
occasioned by the increased cost of food supplies and freight charges,
together with labor difficulties. Never before has the institution had
such a difficult time to procure and to keep help, and an unusual
number of trips to Boston has been necessitated.
The allotment and expenditure of the appropriation were as fol-
lows : —
1 Refers only to smear examinations made in State laboratory. Each clinic examines smears also.
220
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Allotment,
1920.
Expended,
1920.
Personal services
Travel, transportation and office expenses.
Food
Clothing,
Furnishings and household supplies.
Medical and general care,
Heat, light and power, .
Farm
Grounds,
Repairs, ordinary, ....
/ $1,156
\ 5,500
! S136
\ 600
/ $408
1. 1,800
$13,400 00
900 00
6,656 00
736 00
1,200 00
2,208 00
4,000 00
4,000 00
50 00
1,670 00
$34,820 00
$13,742 12
1,887 88
6,173 32
723 12
1,354 84
2,076 44
4,358 47
3,857 21
54 52
1,464 75
$35,692 67
Two of the inmates showed such exceptional improvement under
the Chaulmaugra oil treatment that it was thought that it might be
possible to parole them with safety to the public. A board of exam-
iners was appointed by the Commissioner to pass upon their condition
and to advise the Department as to the feasibility of allowing them to
return to community life.
This board consisted of Dr. M. Victor Safford, Dr. Victor G. Heiser,
Dr. Townsend Thorndike and Dr. D. Crosby Greene.
Bacteriological examination of smears obtained from scar in the
nose showed the presence of leprse bacilli, and the blood of both
patients proved to be faintly positive in the Wassermann test. The
board recommended, therefore, their return to the hospital for further
treatment.
The inventory submitted is as follows: —
Land and buildings (1919 estimate), $106,201 83
Personal, 33,515 18
Total, $139,717 01
The Federal government through the United States Public Health
Service has taken definite steps to establish a national leprosarium at
Carville, La. The patients now at Penikese will be transferred to this
new hospital early in the year. This disposition should prove bene-
ficial both to the patients and to the State.
No. 34.] DIVISION OF COMMUNICABLE DISEASES. 221
The splendid service of the superintendent and the older employees
who have so faithfully performed their arduous duties warrants special
mention. The State has indeed been fortunate in such service and the
lot of these unfortunate people made lighter by the thoughtful ad-
ministration of Dr. Parker and Mrs. Parker.
REPORT OF EPIDEMIOLOGIST.
Epidemiological Significance of Age Distribution in Certain
Communicable Diseases.
In 1918 tabulations of all reported cases of communicable disease
by age (and by sex) was begun. At once certain important facts, long
known to close students of these diseases, became available for use by
boards of health and health officers in their propaganda and campaigns
to limit the morbidity and mortality from these diseases.
Complete tabulations of death returns by ages are not available for
about eighteen months after the end of the year in which they occur.
This comes about because, though the Secretary of State's office is will-
ing to and does furnish very promptly each month a total of deaths
from each communicable disease, which is approximately correct, it is
not willing to sacrifice accuracy in its final tabulations and undertakes
many time-consuming verifications which prevent an earlier publication
of the complete tabulations of death returns.
At first, therefore, age distributions of deaths and of cases had each
to be studied in separate years.
No fair fatality rates by ages could be arrived at, since the cases
and deaths for the same year could not be compared. Therefore, it
was not until 1920 that we were able to present complete tables on
morbidity, mortality and fatality by ages for the same groups of cases.
The tables presented, then, are for 1918 and not 1920, since we are
now just getting our completed and corrected death tabulations for
that year.
Such tables bring out striking and valuable facts as to variations of
morbidity, mortality and fatality at different ages. Also, they are
valuable standards for epidemiological investigation in that much
variation from the State average of incidence by ages would likely be
a valuable clue in a particular outbreak.
990
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Table 1. — Measles in Massachusetts, 1918, Cases and Deaths by Ages.
•
Morbidity.
Mortality and Fatality.
Age Groups (Years).
1 -i^
fi fe =3
73 ?
-W CO Q,
0 o3 hi)
C 1- 03
M <- 2
o o o
S C3.Q 3
o-^ -
O <s
Pi
j: ■
3 C3
||
o ca
^«
^ Q) S)
Pi
III
Ph
1
2
3
4
5
6
7
8
9
10
Under 1
736
2.5
789
2.7
-
140
26.4
-
17.8
1. .
1,758
6.0
1,928
6.6
2.7
210
39.4
26.4
10.9
2.
2,277
7.8
2,513
8.6
9.3
69
13.0
65.8
2.7
3.
2,337
8.0
2,571
8.8
17.9
36
6.8
78.8
1.4
4,
2,553
8.7
2,804
9.6
26.7
20
3.8
85.6
.7
5.
2,731
9.3
3,009
10.3
36.3
\
89.4
6,
3,501
12.0
3,827
13.1
46.6
7,
2,579
8.9
2,834
9.7
59.7
i 24
4.5'
.2
8,
1,718
5.9
1,899
6.5
69.4
9.
• •
1,135
3.9
1,256
4.3
75.9
10 to 14, inclusive,
2,314
7.9'
2,542
8.71
80.2
5
.9
93.9
.2
15 to 19, inclusive,
935
3.2
1,023
3.5
88.9
4
.7
94.8
.4
20 to 24, inclusive.
816
2.8
906
3.1
92.4
95.5
25 to 34, inclusive.
847
2.9
935
3.2
95.5
35 to 44, inclusive,
236
.8
263
.9
98.7
i 24
4.5
.1
45 to 54, inclusive.
62
.2
87
.3
99.6
55 and over.
18
.1
29
.1
99.9
Unknown,
2,662
9.1
-
-
-
-
-
-
-
1
^otalE
»
29,215
100.0
29,215
100.0
100.0
532
100.0
100.0
1.82
1 This figure for five years. To obtain annual average divide by 5.
2 It is noted that the fatality rates for 1918 of 1.8 per cent for measles and 9.4 per cent for whooping
cough are higher than the median endemic indexes for the period 1911-19 (Table 8), which were 1.3 and
7.6 per cent, respectively. This is thought, in a measure at least, to have been due to influenza. Also,
scarcity of physicians in 1918 in many localities probably resulted in poorer reporting than has ordinarily
been the case. Furthermore, the classification of deaths from primary and secondary causes given on
death certificates has been done since 1916 according to the United States census publication, "Index of
Joint Causes of Death." This is now being done by many of the States and is an improvement in that
it makes the statistics of the various States more comparable. It is probable that under this system
some deaths are credited to measles and whooping cough that formerly would have been credited to
causes that were really secondary.
No. 34.] DIVISION OF COMMUNICABLE DISEASES.
223
Table
2. — W
hooping Cough in
Massachusetts
1918,
Cases
and Deaths hy Ages.
Morbidity.
Mortality and Fatality.
Age Groups (Years).
'-' »
Xi -^ -t^
B fc «
B aw
US
*^ to
c !: S
m tH S
S|'S§
CQ 0)1
O
las
— .-o
03 0)
O C3
^&
PU
>.T3
is .
Ill
1
2
3
4
5
6
7
8
9
10
Under 1,
772
9.9
831
10.7
-
332
45.6
-
40.0
1,
804
10.4
854
11.0
10.7
212
29.1
45.6
24.8
2.
868
11.2
940
12.1
21.7
73
10.0
74.7
7.8
3.
908
11.7
978
12.6
33.8
41
5.6
84.7
4.2
4,
810
10.4
870
11.2
46.4
32
4.4
90.3
3.7
5.
815
10.5
877
11.3
57.6
94.7
6.
775
10.0
839
10.8
68.9
7.
520
6.7
559
7.2
79.7
34
4.71
1.2
8.
297
3.8
318
4.1
86.9
9,
204
2.6
225
2.9
91.0
10 to 14, inclusive,
266
3.41
287
3.7»
93.9
1
.1
99.4
.3
15 to 19, inclusive,
39
.5
47
.6
97.6
-
-
99.5
-
20 to 24, inclusive.
27
.4
31
.4
98.2
25 to 34, inclusive.
52
.7
54
.7
98.6
•
35 to 44, inclusive.
19
.2
23
.3
99.3
4
.5
2.9
45 to 54, inclusive.
16
.2
16
.2
99.6
55 and over,
16
.2
16
.2
99.8
Unknown,
557
7.2
-
-
-
-
-
-
-
T
otals
■
7,765
100.0
7,765
100.0
100.0
729
100.0
100.0
9.42
1 This figure for five years. To obtain annual average divide by 5. 2 See similar note under measles.
From these tables we find that —
1. Approximately 34 per cent of the whooping cough and IS per
cent of the measles were in children under 3.
2. Eighty-five per cent of the deaths from whooping cough and
79 per cent of those from measles were in children under 3 years.
3. The apparent fatality rates for the group under 3 were 23^ per
cent for whooping cough and 8 per cent for measles.
4. For each thousand reported cases of measles there were 18 deaths,
and 14 of these were under 3.
5. In the same year each thousand cases of whooping cough repre-
sented 92 deaths, and 77 of these were under 3.
6. Even though there was about four times as much measles,
224
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
whooping cough mortaUty leads with 729 deaths, compared with 532
for measles. This is a total of 1,261 deaths from both diseases and
1,036 of these were less than 3 years old.
7. Measuring success by a reduction in deaths from these diseases
it is at once apparent that the results depend very largely on how
successfully we prevent measles and whooping cough in children under
3, among whom 80 to 85 per cent of the deaths from the two diseases
occurred.
8. Propaganda and methods of control should be more specifically
directed at this age group.
9. In these years when so many children die of measles and whoop-
ing cough or their complications, the most careful medical attention
and nursing are needed to prevent dangerous complications.
Table 3. — Diphtheria in Massachusetts, 1918, Cases and Deaths by Ages.
Morbidity.
MORTAXITT AND FaTALITT.
Age Groups (Years).
1 -M
S a> «
.^ -f^ -M
fl fc «
■z
■:3 s
Ota
-if 3 a
12;
m (1)1
o-gg
all
S a*
0 H
S cSCQ
Pt(
B 0 +j
— 13
0 =3
CJ3
0 *^ .
Si So
■« to*;
>.'0
<i 0
<
1
2
3
4
5
6
7
8
9
10
Under 1
195
2.8
215
3.1
-
50
8.2
-
23.2
1, .
281
4.1
311
4.5
3.1
77
12.7
8.2
24.7
2,
450
6.5
498
7.2
7.6
77
12.7
20.9
15.5
3,
540
7.8
602
8.7
14.8
84
13.8
33.6
14.0
4,
530
7.7
588
8.5
23.5
53
8.7
47.4
9.0
5.
502
7.2
554
8.0
32.0
56.1
6.
509
7.3
568
8.2
40.0
7.
447
6.5
498
7.2
48.2
178
29.3
7.7
8.
372
5.4
415
6.0
55.4
9,
257
3.7
284
4.1
61.4
10 to 14, inclusive,
850
12.31
935
13.5'
65.5
43
7.1'
85.4
4.6
15 to 19, inclusive,
347
5.0
381
5.5
79.0
10
1.6
92.5
2.6
20 to 24, inclusive,
399
5.8
443
6.4
84.5
94.1
25 to 34, inclusive.
330
4.8
367
5.3
90.9
35 to 44, inclusive,
146
2.1
173
2.5
96.2
i 36
5.9
2.4
45 to 54, inclusive,
65
.9
69
1.0
98.7
55 and over,
22
.3
21
.3
99.7
Unknown,
680
9.8
-
-
-
-
-
-
-
T
otals
.
6,922
100 .0
6,922
100.0
100.0
608
100.0
100.0
8.8
1 This figure for five years. To obtain annual average divide by 5.
No. 34.] DIVISION OF COMMUNICABLE DISEASES.
225
Table 4. — Scarlet Fever
in Massachusetts, 1918, Cases an
d Deaths by Ages.
Morbidity.
Mortality and Fatality.
Age Groups (Years).
1 .^
q o *j
-^ CO
O d ■
® ^
CM
" >- 2
Oo o
Ph
C3-C
1 on
n o ♦i
3 art
..J *^
O 03
Q -^ •
^ en hn
aj ■♦J r-
Ill
1
2
3
4
5
6
7
8
9
10
Under 1,
31
.7
31
.7
-
2
2.6
-
6.4
1.
89
2.0
99
2.2
.7
12
15.4
2.6
12.1
2.
230
5.1
247
5.5
2.9
8
10.3
18.0
3.2
3.
291
6.5
314
7.0
8.4
5
6.4
28.3
1.5
4.
350
7.8
382
8.5
15.4
16
20.5
34.7
4.2
5,
384
8.6
418
9.3
23.9
55.2
6.
395
8.8
427
9.5
33.2
7,
327
7.3
355
7.9
42.7
17
21.81
1.0
8,
261
5.8
283
6.3
50.6
9,
249
5.5
269
6.0
56.9
J
10 to 14, inclusive,
736
16.41
799
17.81
62.9
3
3.8
77.0
.4
15 to 19, inclusive,
296
6.6
323
7.2
80.7
4
5.1
80.8
1.2
20 to 24, inclusive.
191
4.3
207
4.6
87.9
85.9
25 to 34, inclusive.
230
5.1
251
5.6
92.5
35 to 44, inclusive.
61
1.3
67
1.5
98.1
1 ^^
14.1
2.0
45 to 54, inclusive.
13
.3
13
.3
99.6
55 and over.
5
.1
5
.1
99.9
Unknown,
351
7.8
-
-
-
-
-
-
-
T
otals
-
4,490
100.0
4,490
100.0
100.0
78
100.0
100.0
1.7
1 This figure for five years. To obtain annual average divide by 5.
Comparing the above two tables with Tables 1 and 2 we find that —
1. Whereas 85 per cent of the total cases of measles were under 12
and of whooping cough under 8, for diphtheria and scarlet fever this
percentage occurred under 20 and 18, respectively.
2. Eighty-five per cent of the deaths from measles were in cases
under 4 and from whooping cough under 3, whereas from diphtheria
and scarlet fever this amount of mortality has not occurred until the
ages of 10 and 20, respectively.
3. In other words, in both deaths and cases diphtheria and scarlet
fever extended over a wider range of ages.
4. Nevertheless, the highest mortality and fatality, as in measles
and whooping cough, came in the early years of life.
226
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Table 5. — Pulmonary Tuberculosis in Massachusetts, 1918, Cases and Deaths
by Ages.
Morbidity.
Mortality and Fatality.
Age Groups (Years).
Number of Re-
ported Cases at
Stated Age.
Per Cent of Total
Reported Cases
at Each Age.
Number of Cases
at Each Age after
redistributing the
Unknown.
Per Cent of Cases
at Each Age
based on Col-
umn 4.
Per Cent of Cases
at less than
Stated Age.
Number of Re-
ported Deaths
at Stated Age.
Per Cent of Total
Deaths at Stated
Age.
Per Cent of Total
Deaths at less
than Stated Age.
Apparent Fatality
Rates at Stated
Age.
1
2
3
4
5
6
7
8
9
10
Under 1, .
[ 54
1.0
-
-
1, . . .
44
.9
1.0
-
2, . . .
[ 172
2.2
204
2.6
-
^ 14
.3
1.9
66.2
3, . . .
19
.4
2.2
-
4, . . .
I 4
.1
2.6
-
5 to 9, inclusive,
188
2.4
219
2.8
2.6
34
.7
2.7
15.5
10 to 14, inclusive,
209
2.7
251
3.2
5.4
80
1.5
3.4
31.9
15 to 19, inclusive.
485
6.2
572
7.3
8.6
366
7.1
4.9
64.0
20 to 29, inclusive,
1,979
25.2
2,342
29.9
15.9
1,431
27.6
12.0
61.1
30 to 39, inclusive.
1,596
20.4
1,888
24.1
45.8
1,280
24.7
39.6
67.8
40 to 49, inclusive.
1,047
13.4
1,237
15.8
69.9
895
17.3
64.3
72.3
50 to 59, inclusive.
597
7.6
705
9.0
85.7
559
10.8
81.6
79.3
60 to 69, inclusive.
249
3.2
298
3.8
94.7
275
5.3
92.4
92.3
70 and over,
103
1.3
117
1.5
98.5
121
2.3
97.7
103.4
Unknown,
1,208
15.4
-
-
-
1
-
-
-
Totals,
7,833
100.0
7,833
100.0
100.0
5,177
100.0
100.0
66.1
No. 34.] DIVISION OF COMMUNICABLE DISEASES.
227
Table 6. — Tuberculosis, Other Forms, in Massachusetts, 1918, Cases and Deaths
by Ages.
Morbidity.
Mortality and Fatality.
Age Groups (Years).
Number of Re-
ported Cases at
Stated Age.
Per Cent of Total
Reported Cases
at Each Age.
Number of Cases
at Each Age after
redistributing the
Unknown.
Per Cent of Cases
at Each Age
based on Col-
umn 4.
Per Cent of Cases
at less than
Stated Age.
Number of Re-
ported Deaths
at Stated Age.
Per Cent of Total
Deaths at Stated
Age.
Per Cent of Total
Deaths at less
than Stated Age.
Apparent Fatality
Rates at Stated
Age.i
1
2
3
4
5
6
7
8
9
10
Under 1, .
57
7.6
63
8.4
-
98
12.4
-
155.5
1, . . .
66
8.8
73
9.7
8.4
100
12.6
12.4
137.0
2, . . .
36
4.8
39
5.3
18.1
52
6.6
25.0
133.3
3, . . .
33
4.4
36
4.8
23.4
54
6.8
31.6
150.0
4. . . .
40
5.4
44
5.9
28.2
29
3.7
38.4
65.9
5 to 9, inclusive,
97
13.0
106
14.2
34.1
71
9.0
42.1
67.0
10 to 14, inclusive.
41
5.5
45
6.0
48.3
34
4.3
51.1
75.5
15 to 19, inclusive.
49
6.6
54
7.2
54.3
39
4.9
55.4
72.2
20 to 29, inclusive,
111
14.9
122
16.3
61.5
36
10.9
60.3
70.5
30 to 39, inclusive,
72
9.6
78
10.5
77.8
78
9.8
71.2
100.0
40 to 49, inclusive.
52
7.0
57
7.6
88.3
65
8.2
81.0
114.0
50 to 59, inclusive.
15
2.0
16
2.2
95.9
47
5.9
89.2
293.7
60 to 69, inclusive,
10
1.3
11
1.5
98.1
23
2.9
95.1
209.1
70 and over,
3
.4
3
.4
99.6
16
2.0
98.0
533.3
Unknown,
65
8.7
-
-
-
-
-
-
Totals,
747
100.0
747
100.0
100.0
792
100.0
100.0
106.0
1 Indicates poor reporting.
These tables show that —
1. Pulmonary tuberculosis is a disease of adult life, 54 per cent of
the cases and 52 per cent of the deaths in 1918 being in the group
20-39, inclusive.
2. Pulmonary tuberculosis is not particularly a disease of childhood,
only 8.6 per cent of the cases and 7.1 per cent of the deaths being
under 15.
3. Tuberculosis, other than pulmonary, is a disease of childhood,
54 per cent of the cases and 55 per cent of the deaths being under 15.
The fatality rate for tuberculosis, other than pulmonary, indicates
bad reporting. H.owever, there is no reason to believe that the unre-
ported cases are distributed by ages differently from those reported.
k
228
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Sex Distribution of Communicable Diseases,
Table 7 is included so that Health Officers and others interested in
the investigation of epidemics may have data upon which to base
tables for normal incidence of these diseases by sex. Given a standard
sex distribution, any marked variation therefrom would probably be
of epidemiological significance.
It is noted that in 1919 more females than males had diphtheria
after twenty years of age and that for all ages more males than fe-
males suffered from pulmonary tuberculosis. Figures for 1918 show
the same in both cases. The total number of cases of pulmonary
tuberculosis for 1918 was 7,833, and of these cases 4,565 were males,
3,167 females and 101 of unknown sex. Also, in adult life in 1918,
more cases of diphtheria occurred in females than in males.
Table 7.-
-Cas
es of
Certaii
I Con
imun
icable 1
Jisea.
ies, 1
919, by
bex
and /
ige.
Whooping Cough.
Measles.
Diphtheria.
Pulmonary
Tuberculosis.
Age Groups
(Years).
Male.
Fe-
male.
Un-
known.
Male.
Fe-
male.
Un-
known.
Male.
Fe-
male.
Un-
known.
Male.
Fe-
male.
Un-
known.
1
2
3
4
5
6
7
8
9
10
11
12
13
Under 1, .
278
263
8
172
144
15
87
53
5
1, . . .
264
252
9
315
298
20
161
106
-
2. .
251
300
15
374
343
28
251
203
4
82
59
1
3,
315
313
12
417
404
32
289
284
5
4.
279
250
8
445
442
26
305
295
4
5,
298
297
9
551
520
30
364
300
8
6,
327
309
4
682
652
22
317
335
2
7,
216
234
4
506
509
17
290
303
3
1 **
107
-
8.
112
134
3
337
340
11
244
269
-
9,
. 76
64
3
201
165
7
198
223
1
,
10 to 14, inclusive,
100
103
1
318
338
6
531
609
5
109
161.
3
15tol9, inclusive,
10
10
-
80
97
3
142
169
2
211
286
4
20 to 24, inclusive,
15
12
-
55
68
1
74
178
-
388
479
2
25 to 34, inclusive,
8
19
-
37
72
2
103
231
3
883
745
10
35 to 44, inclusive,
3
10
-
22
22
-
48
109
1
721
483
1
45 to 54, inclusive
2
4
-
8
8
-
25
37
-
527
224
4
55 and over,
6
6
-
1
5
-
11
26
-
371
176
4
Unknown,
165
166
180
326
239
252
342
333
41
447
378
27
1
,
"otals.
2,725
2,746
256
4,847
4,666
472
3,782
4,063
84
3,823
3,098
56
No. 34.] DIVISION OF COMMUNICABLE DISEASES.
229
Outbreaks or Communicable Diseases in 1920.
Communicable diseases reached sufficient proportions to call
for
special investigation and special report to the central office by the
District Health Officers in over fifty instances. Besides this, watch
was kept on those diseases that were generally and widely prevalent.
1. Anterior Poliomyelitis.
Beginning about the middle of July and lasting until December an
outbreak of this disease, totaling about 700 cases, took place in eastern
and northeastern Massachusetts. Locations and dates of onsets of the
first 23 reported cases were as follows: —
June 30,
Manchester
July
2,
Dedham.
July
9,
Rutland.
July
9,
Boston.
July
11,
Lawrence.
July
13,
Boston.
July
14,
Boston.
July
14,
Lawrence.
July
16,
Boston.
July
20,
Maiden.
July
20,
Boston.
July
21,
Boston.
July
22,
Boston.
July
22,
Chelsea.
July
23,
Boston.
July
25,
Boston (two).
July
26,
Somerville.
July
27,
Boston.
July
30,
Boston.
July
24,
1 Medfield.
July
24,
* East Weymouth
August 4,
1 Scituate.
By the end of July, twelve foci of infection existed. One focus had
furnished 12 of the first 23 cases and the other eleven foci furnished
1 case each. Whether the disease had smouldered in the largest focus
before cases were reported and had spread from unrecognized cases in
this focus, or had originated from one of the smaller foci, is a question.
The outbreak confined itself to eastern and northeastern Massachu-
setts and spread slowly from the metropolitan cities into the north-
eastern cities and towns. The incidence by months, as compared with
1916, was as follows: —
1920.
1916.
To July 1
16
30
July
16
106
August
93
252
September,
273
623
October,
190
701
November
77
179
December
31
36
Totals
69§
1,927
1 Date of report ; date of onset not available.
230 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
A weekly record of reports showed an incidence very closely follow-
ing the seasonal distribution in 1916. The peak for reported cases was
reached in both years in the week of October 2.
Dr. Lyon and Dr. Hassman, who were supplied from the staff of the
Harvard Infantile Paralysis Commission to do early diagnostic con-
sultation work, saw 57 cases (Dr. Lyon, 49; Dr. Hassman, 8). Diag-
nosis was based on study of the cell content of spinal fluid as well as
clinical symptoms. The cases seen were classified as follows: —
Cases.
Punctures.
Late paralytic 8 None
Early paralytic 15 8
Preparalytic, 10 10
Not poliomyelitis, ........... 22 8
Not diagnosed, ........... 2 2
The early cases were those that when seen either showed very slight
paralysis that had escaped the attention of the physician or were cases
that had developed some paralysis in the interim since they were last
seen. The total number of cases seen was so small that it will be
possible to draw inferences and not conclusions from the study. Of
the 10 cases diagnosed before there was any paralysis at all, 8 have
been reported on and 3 were found to have subsequently developed
paralysis.
2. Influenza.
(a) Chronology. — The arrival of the 1920 epidemic was noted on
January 20, when 64 cases were reported to the Department, whereas
the total for the previous week was only 58 cases. For comparison,
on January 27, 482 cases were reported, and on February 2, 1,076
cases. Because of the allied character of the diseases, lobar pneu-
monia (the only form of pneumonia reportable in Massachusetts)
statistics also are given.
Following the practice of 1918, educational measures were at once
instituted by means of moving pictures, slides, newspapers and lectures
to warn the public, but what effect was thereby produced on the
progress of the disease it is impossible to say.
Cases were first reported in and around Boston, and rapidly in-
creased, the height of the epidemic being reached sixteen days later
on February 4, 5 and 6. Although the peak as shown by case reports
was on February 9, 10 and 11, this false peak was caused by the
delay in mails due to the heavy snowstorm of February 5, 6 and 7,
and does not represent the true peak of the disease.
No. 34.] DIVISION OF COMMUNICABLE DISEASES.
231
The epidemic ran a ten-week course, — shorter than the 1918-19
epidemic of six to seven months, — and was similar to that experi-
enced elsewhere in the country. January 20 to March 31, inclusive,
was the correct duration.
Lobar pneumonia cases showed an immediate increase with influ-
enza cases, and paralleled the curve of that disease.
(b) Age Distribution. — The age distribution of the influenza cases
of the 1920 epidemic was similar to that of the previous one, the larger
number of cases being in the age groups of 0 to 4 and 25 to 34 years.
The 5 to 14 year age group suffered the least.
Case Incidence at Different Ages.
Ages (Years).
Per Cent of
Total Cases.
Ages (Years).
Per Cent of
Total Cases.
Oto 4
5 to 14
15 to 24
25 to 34
10.0
12.0
19.4
27.9
35 to 44
45 to 54,
55 to 64
65 and over,
14.7
9.4
3.7
2.9
(c) Sexes. — As in previous epidemics the incidence in males ex-
ceeded that in females, the figures being 51 and 49 per cent, respec-
tively. The age groups of the sexes showed that up to twenty-five
years there were more cases among females, but after that age the
majority of the cases were males. The mortality statistics are not yet
complete for the age groupings.
(d) Vir%dence. — In 1918-19 the fatality rate was 7.6 per cent,
whereas this year there is a rate of 4.68 per cent, judging from death
statistics. There is a great source of error in the fatality rate of in-
fluenza because of the many mild cases that are not reported, which
would tend to lower the fatality rate considerably.
{e) Imviunitij. — The fact that the morbidity rate was much less
in 1920 than 1918-19 suggests that there may be a definite immunity
conferred by the disease or a great decrease in the virulence of the
causative organism. Possibly both of these factors played a part.
(/) Morbidity, Mortality and Fatality. — From Oct. 1, 1918, to April
30, 1919, inclusive, there were 184,419 cases of influenza reported and
13,419 deaths, giving a fatality rate of 7.3 per cent. In September,
1918, there were 2,939 deaths, making a total of 16,358 deaths in
Massachusetts during the epidemic from Sept. 1, 1918, to April 30, 1919.
In the present epidemic there were 35,633 cases from Jan. 1, 1920,
to March 31, 1920, and incomplete records give 1,660 deaths, making
a fatality rate of 4.65 per cent.
232
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Obviously, the fatality rates for both epidemics are much too high
because of the non-reporting of the milder cases of influenza. A rate
of 3 to 5 per cent for 1918 and of less than 1 per cent for 1920 would,
perhaps, be nearer the true fatality rates of these two epidemics.
/AfflUE'NZA m MA3JACmJErTJ'
3r WEEKLY rOTALJ-JSl^a
20,000
idpoo
^ 16^000
§ 12p00
^ iOfiOO
S ^,000
^ 4',000
^ ^.000
20,000
idfiOO c^
i&jOOO ^
i4fioo ^
i2fioo g
10,000 ^
djOOO ^
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4,000 ^4
3 iO Jr ^4 JI 7 !4 2/ £d e £} £0 2r 3
JANUARV FEBRUASy MARCH A
PMIlTMOmA (103AR)
Br WEEKLK rOTAU-iS2a
i
I
7oo
6O0
Soo
400
Joo
Boo
loo
o
700
600 S
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400 ^
300 ^
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\
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^
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^ 10 17 24 JI 7 14 ^/ £3 C /3 £0 ^r J
S
3. Measles.
A State-wide epidemic prevailed during the first seven months of
1920. For the entire year 32,141 cases were reported, the largest num-
ber ever known. Seventeen separate outbreaks were investigated,
which were found to have been due to school, family and neighbor-
hood contact before quarantine was instituted. Large numbers of
No. 34.] DIVISION OF COMMUNICABLE DISEASES. 233
missed mild cases and late diagnoses made control particularly diffi-
cult. The disease became so prevalent that all individual outbreaks
could not be investigated and resort had to be had to general advice.
4. Whooping Cough.
The beginning of the year saw also a widespread and well-developed
outbreak of this disease throughout the State. It, too, with about
10,000 reported cases, exceeded all past records of incidence.
Health officials should acquaint themselves accurately with the
years of greatest mortality and fatality (Tables 1 and 2) for both
whooping cough and measles; and should preach unceasingly to par-
ents the duty of deferring as long as possible the evil day when their
children may contract these diseases.
5. Diphtheria.
In 1920 there were about 7,500 reported cases, an incidence little
different from previous years.
Twenty-four outbreaks that occurred were investigated. Of these,
six, or 25 per cent, were second outbreaks in the same towns. This is
food for thought.
In one instance a case in the first outbreak that had been released
from quarantine by culture became a carrier and caused the second
outbreak. Might not released cases of diphtheria be cultured several
times at definite intervals after release from quarantine, as a routine
measure, to discover whether they have become intermittent carriers?
This would protect both the immediate family and the public. The
rule might at least apply to school children. Might not health officials
on the occurrence of undue incidence of diphtheria at once, as a rou-
tine, re-culture all cases that have occurred within the past six months,
especially the ones at all likely to be associated with the current cases?
In one instance the second outbreak came because a milker with
diphtheria, excluded from a dairy farm on the advice of the State
Department, had been allowed to return without release cultures.
In the four other instances the lax quarantines practiced, the undis-
covered mild cases, the practice of releasing from quarantine without
cultures in some instances were still found to prevail.
6. Scarlet Fever.
There were sixteen outbreaks that required investigation by the
District Health Officers. With about 10,000 cases reported, the inci-
dence exceeded any since 1914. The total deaths also exceeded those
of any year since 1914.
234
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
7. Septic Sore Throat.
But one real outbreak of this disease occurred. It was milk-borne
and involved 43 cases on the same route. In searching for the cause
of this outbreak several cows were found to be suffering from garget.
Cultures were taken from the udders and from the milk of these cows
and also from the throats of all the milk handlers. The returns from
these first cultures showed streptococci from the garget in the cows
but none from the milk handlers. The streptococci isolated from the
cows were non-hemolytic, whereas all organisms that had been iso-
lated from the cases were distinctly of the hemolytic type. A second
trip was made to that town and all the milkers recultured, and in one
milker's throat was found a hemolytic streptococcus. It is believed
that he and not the cows caused the outbreak.
8. Typhoid Fever.
The 1920 record for typhoid excels the remarkable record made in
1919. The following outbreaks occurred:
Place.
Num-
ber of
Cases.
Time.
History.
Chelsea, . .
18
July
Milk-borne epidemic. Unpasteurized supply.
A one-dairy route. No outside help. Carrier
not found after a number of examinations.
Taunton, .
8
July and August,
In State hospital for insane. Thought to have
been due to a supposed carrier, who absconded
when it began to appear that she was the
cause of the cases. Suspected carrier, an
attendant.
Warner, N. H.,
9
August,
Vacationists, mostly teachers, at a summer
boarding house returned to Massachusetts
and developed typhoid shortly afterwards in
Boston, Worcester, Waltham, Somerville and
Stoneham. The secretary of the New Hamp-
shire Board of Health reports that the out-
break involved cases from Rhode Island and
New Hampshire also, and was probably due
to a mild case of typhoid in the kitchen help.
Ipswich, .
33
September,
Milk; three milk handlers involved. One sus-
pected of being carrier. Suspicion not yet
confirmed.
Fall River,
34
September,
Polluted well in one of the large mills.
Northampton,
15
Dec, 1917, to Feb.,
1920.
Two attendants who left the hospital about
Jan. 1, 1920, suspected of being carriers. One
had typhoid history. Suspicions were not
confirmed.
New Bedford, .
29
August and Septem-
ber.
No cause could be found.
No. 34.] DIVISION OF COMMUNICABLE DISEASES.
235
In -four of the six outbreaks tabulated, carriers were suspected but
not proved. This is illustrative of the difficulty and large amount of
work often necessary to detect carriers and of the disappointments
frequently in store for us. However, as the amount of typhoid in
Massachusetts has year by year grown less, our efforts can now be
more intensive. Purthermore, we now begin such investigations with
the knowledge that it will likely require great numbers of cultures to
detect the carrier, especially if he be of the intermittent type.
Progress made in Past Five-year Period.
Tables 8 to 17 have been prepared for purposes of comparison with
past years. Included in each table, except Table 13, are median rates
for the nine-year period 1911-19, inclusive, and underneath these
figures come the 1920 figures which are readily compared with them.
Table 8. — Case, Death and Fatality Rates for Measles and Whooping Cough,
1911-20, inclusive.
Year.
1911, .
1912, .
1913, .
1914, .
1915, .
1916, .
1917, .
1918, .
1919, .
Popula-
tion
based on
State and
Federal
Censuses
3,445,416
3,510,795
3,576,174
3,641,553
3,706,931
3,739,364
3,771,797
3,804,231
3,836,664
Measles
1
Cases.
Cases
per
100,000.
Deaths.
Deaths
per
100,000.
Fa-
tality
Rates.
3
4
5
6
7
16,094
467.1
158
4.6
1.0
22,423
638.7
286
8.2
1.3
29,192
816.3
315
8.8
1.1
12,264
336.8
149
4.1
1.2
22,881
617.2
149
4.0
.6
25,460
680.9
392
10.5
1.5
23,880
633.1
371
9.8
1.6
29,215
768.0
532
14.0
1.8
9,985
260.2
183
4.8
1.8
Whooping CouqhI*
Cases.
Cases
per
100,000.
8
3,911
2,112
3,325
3,316
7,182
6,447
3,877
7,765
5,727
Deaths.
9
113.5
88.6
93.0
91.1
193.7
172.5
102.8
204.1
149.3
10
292
225
239
225
283
346
243
729
319
Deaths
per
100,000.
11
8.5
6.4
6.7
6.2
7.6
9.2
6.4
19.2
8.3
Fa-
tality
Rates.
12
7,5
7.2
7.2
6.8
3.9
5.4
6.3
9.4
5.6
Median Rates.
1911-19, .
-
23,880
633.1
286
8.2
1.3
3,911
113.5
283
7.6
6.8
1920, .
3,869,098
32,141
830.7
347
9.0
1.1
9,994
258.3
542
14.0
5.4
I Made reportable in 1893.
2 Made reportable in 1907.
Both measles and whooping cough show greater mortality rates in
the five-year period 1916-20 than in the period 1911-15. See
236
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Tables 13a and h, which are based on Tables 8 to 17. As has been
said before, most of this increase for measles and whooping cough is
due to change in classification of deaths which occurred in 1916 (see
the note under Table 1). This is very definitely proved in Table 136
which is the same as Table 13a, except that it is based on the United
States Census Mortality Reports for all years except 1920. The differ-
ence between State and Federal figures comes through different methods
of classifying primary and secondary causes of deaths. The same
death certificates were used by both, the United States census data
being taken from transcripts of original certificates. About 1916 or
1917 the State figures began to be based on classification according to
the United States census publication, "Index of Joint Causes of
Death." Since that time the figures from the two sources have more
nearly approximated and are now practically uniform for these two
diseases.
Table 9. — Case, Death and Fatality Rates for Diphtheria and Scarlet Fever,
1911-20, inclusive.
Popula-
tion
based on
State and
Federal
Censuses.
Diphtheria, i
Scarlet Fever, i
Year.
Cases.
Cases
per
100,000.
Deaths.
Deaths
per
100,000.
Fa-
tality
Rates.
Cases.
Cases
per
100,000.
Deaths.
Deaths
per
100,000.
Fa-
tality
Rates.
1
2
3
4
5
6
7
8
9
10
11
12
1911, .
3,445,416
6,998
203.1
563
16.3
8.1
6,173
179.1
184
5.3
3.0
1912. .
3,510,795
5,433
154.8
473
13.5
8.7
5,633
160.4
118
3.4
2.1
1913, .
3,576,174
6,741
188.5
628
17.6
9.3
8,062
225.4
293
8.2
3.6
1914, .
3,641,553
8,080
221.9
652
17.9
8.1
11,057
303.7
246
6.8
2.2
1915, .
3,706,931
9,282
250.4
721
19.4
7.8
8,613
232.3
182
4.9
2.1
1916, .
3,739,364
7.282
194.7
629
16.8
8.6
6,271
167.7
127
3.4
2.0
1917. .
3,771,797
10,322
273.7
838
22.2
8.1
5,953
157.8
120
3.2
2.0
1918, .
3,804,231
6,922
181.9
608
15.9
8.8
4,490
118.0
78
2.0
1.7
1919, .
3,836,664
7,929
206.6
591
15.4
7.5
8,018
209.0
130
3.4
1.6
Median Rates.
1911-19. .
-
6,998
203.1
629
16.8
8.1
6,173
179.1
130
3.4
2.1
1920. .
r
3,869,098
7,513
194.2
595
15.4
7.9
10,260
265.2
215
5.5
2.1
=3
I Made reportable in 1884.
Diphtheria shows a mortality rate of 17.0 for the period 1911-15
and of 17.1 for the period 1916-20 (see Table 13a). This is par-
No. 34.] DIVISION OF COMMUNICABLE DISEASES.
237
ticularly discouraging in view of the increased efforts that have been
put forth by the State Department through educational matter and
through the District Health Officers. However, if we consider Table
136, based mainly on Federal figures the showing is better, viz., 17.3
for 1911-15 and 16.9 for 1916-20.
The epidemiologist comes into close touch with outbreaks of disease,
and reference is again made to the 1920 outbreak of diphtheria.
Scarlet fever has decidedly decreased in mortality in the last five
years.
Table 10. — Case, Death and Fatality Rates for Cerebrospinal Meningitis and
Anterior Poliomyelitis, 1911-1920, inclusive.
Popula-
Cerebrospinal Meningitis, i
Anterior Poliomtelitis
2
tion
based on
State and
Federal
Censuses.
Ye.^r.
Cases.
Cases
per
100,000.
Deaths.
Deaths
per
100,000.
Fa-
tality-
Rates.
Cases.
Cases
per
100,000.
Deaths.
Deaths
per
100,000.
Fa-
tality
Rates.
1
2
3
4
S
6
7
8
9
10
H
12
1911,.
3,445,416
150
4.4
143
4.1
95.4
232
6.7
36
1.0
15.5
1912, .
3,510,795
202
5.8
138
3.9
68.4
169
4.8
76
2.2
45.0
1913, .
3,576.174
180
5.0
147
4.1
81.7
361
10.1
69
1.9
19.1
1914, .
3,641,553
181
5.0
156
4.3
86.3
151
4.1
45
1.2
29.8
1915, .
3,706,931
145
3.9
125
3.4
86.3
135
3.6
32
.9
23.7
1916, .
3,739,364
150
4.0
136
3.6
90.5
1,927
51.5
452
12.1
23.4
1917, .
3,771,797
196
5.2
168
4.4
85.7
174
4.6
51
1.3
29.3
1918. .
3,804,231
378
9.9
231
6.1
61.1
99
2.6
37
1.0
37.4
1919, .
3,836,664
253
6.6
181
4.7
71.5
66
1.7
17
.4
25.8
Median Rates.
1911-1919, .
1920, .
3.869,098
181
182
5.0
4.7
147
129
4.1
3.3
86.3
70.8
174
696
4.6
18.0
45
140
1.2
3.6
25.8
20.1
I Made reportable in 1893.
2 Made reportable in 1909.
Both infantile paralysis and cerebrospinal meningitis showed in-
creased mortality in the last five-year period. In infantile paralysis
work our lack of knowledge of the mode of spread hinders us.
In the case of cerebrospinal meningitis there are several considera-
tions. The disease is often rapidly fatal. A death report is frequently
the first information that a local board has. Many deaths are so re-
ported which may be due to other things, as tuberculous meningitis.
Spinal punctures are often not made. Our statistics on this disease are
not, therefore, of the best.
i
238
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Table 11. — Case, Death and Fatality Rates for All Forms of Tuberculosis,
1911-1920, inclusive.
Popula-
Pulmonary. 1
Other Forms, i
tion
based on
State and
Federal
Censuses.
Year.
Cases.
Cases
per
100.000.
Deaths.
Deaths
per
100,000.
Fa-
tality
Rates.
Cases.
Cases
per
100,000.
Deaths.
Deaths
per
100,000.
Fa-
tality
Rates.
1
2
3
4
5
6
7
8
9
10
11
12
1911, .
3,445,416
7,031
204.1
4,418
128.2
62.8
-1
_i
_i
_i
-1
1912, .
3,510,795
7,519
214.2
4,212
119.9
56.0
447
13.6
855
24.4
179.2
1913, .
3,576,174
7,424
207.6
4,180
116.9
56.4
412
11.5
869
24.6
210.9
1914. .
3,641,553
7,144
196.2
4,171
114.5
58.3
570
15.7
890
24,4
156.1
1915, .
3,706,931
8,046
217.0
4,194
113.2
52.2
822
22.2
853
23.0
103.9
1916, .
3,739,364
7,878
210.7
4,467
119.4
56.5
657
17.6
955
25.6
145.5
1917, .
3,771,797
8,365
221.8
4,651
123.3
55.5
776
20.6
758
20.1
97.6
1918, .
3,804,231
7,833
205.9
5,177
136.1
66.1
747
19.6
792
20.8
106.0
1919, .
3,836,664
6,977
181.8
4,200
109.5
60.2
782
20.4
694
18.1
88.7
Median Rates.
1911-1919,
1920, .
C
3,869,098
7,424
6,696
207.6
173.1
4,467
3,743
119.4
96.7
56.5
55.8
747
800
19.6
20.7
855
639
24.4
16.5
145.5
79.9
1 All forms of tuberculosis were made reportable in 1907, but reporting of other forms than pulmonary
was very incomplete before 1912.
Table 13a shows some decrease in the mortaHty from all forms of
tuberculosis. The decrease for the pulmonary form was from a rate
of 118.4 for 1911-1915 to 117.5 for 1916-1920. Federal figures (Table
136) are more favorable, being 116.9 and 115.8, respectively.
Table 11 shows a decidedly decreased mortality for 1919 and 1920,
the figures being 109.5 and 96.7, respectively.
No. 34.] DIVISION OF COMMUNICABLE DISEASES. 239
Table 12. — Case, Death and Fatality Rates for Typhoid Fever, ^ 1911-1920,
inclusive.
Year.
Population
based on
State and
Federal
Censuses.
Cases.
Cases
per
100,000.
Deaths.
Deaths
per
100,000.
Fatality
Rates.
1911.
1912,
1913,
1914,
1915,
1916,
1917,
1918,
1919,
3,445,416
3,510,795
3,576,174
3,641,553
3,706,931
3,739,364
3,771,797
3,804,231
3,836,664
3
2,238
2,088
2,398
2,333
2,204
1,515
1,546
1,067
940
4
64.9
59.5
67.0
64.1
59.5
40.5
41.0
28.0
24.5
5
302
269
280
268
246
172
178
160
103
7.7
7.8
7.4
6.6
4.6
4.7
4.2
2.7
7
13 5
12.9
11.7
11.5
11.2
11.3
11.5
15.0
10.9
Median Rates.
1911-1919
-
2,088
59.5
246
6.6
11.5
1920
3,869,098
935
24.2
96
2.5
10.3
1 Made reportable in 1893.
Steady progress has been made in typhoid fever work. The mortal-
ity has been reduced from 7.6 for the period 1911-1915 to 3.7 for
1916-1920. In 1919 and 1920 the remarkable low records of 2.7 and
2.5 deaths per 100,000 were made.
Being a disease involving a small number of cases as compared with
such diseases as measles, whooping cough, diphtheria and scarlet fever,
it has been possible for the Department to do intensive work on ty-
phoid. For many j'ears all cases on milk farms and nearly all other
cases have been personally investigated by the District Health Officers.
The main factor in the decrease, perhaps, has been the increasing im-
provement in sanitation and water supplies of towns and cities.
240
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
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No. 34.] DIVISION OF COMMUNICABLE DISEASES. 241
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242
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Table 14. — Case, Death and Fatality Rates for Lobar Pneumonia and Influenza,
1918-1920, inclusive.
Popula-
lation
based on
State and
Federal
Censuses.
LoBAH Pneumonia. 1
Influenza. 2
Year.
Cases.
Cases
per
100,000.
Deaths.
Deaths
per
100,000.
Fa-
tality
Rates.
Cases.
Cases
per
100,000.
Deaths.
Deaths
per
100,000.
Fa-
tality
Rates.
1
2
3
4
5
6
7
8
9
10
11
12
1918,
3,804,231
13,374
351.5
10,339
271.7
77.5
145,262
3,818.4
13,783
362.3
9.5
1919,
3,836,664
4,585
119.5
2,508
05,5
54.7.
40,417
1,053.4
3,052
79.5
7.5
1920,
3,869,098
5,558
143.6
2,781
71.9
50.0
36,312
938.5
1,700
43.9
4.7
I Made reportable in 1917.
2 Made reportable in 1918.
Table 15. — Case, Death and Fatality Rates for Go7iorrhea and Syphilis, 1918-
1920
, inclusive.
Popula-
Gonorrhea. 1
Syphilis. 1
tion
based on
State and
Federal
Censuses.
1
Year.
Cases.
Cases
per
100,000.
Deaths.
Deaths
per
100,000.
Fa-
tality
Rates.
Cases.
Cases
per
100,000.
Deaths.
Deaths
per
100,000.
Fa-
tality
Rates.
1
2
1
3
4
5
6
7
8
9
10
11
12
1918, .
3,804,231
7,681
201.9
6
2
.08
3,284
86.3
280
7.4
8.5
1919, .
3,836,664
9,435
245.9
8
2
.08
4,127
107.5
281
7.3
6.8
1920, .
3,869,098
7,225
186.7
4
.1
.05
2,987
77.2
225
5.8.
7.5
I Made reportable in 1918.
No.
34.]
DIVISION OF COMMUNICABLE DISEASES.
243
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DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
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No. 34.] DIVISION OF COMMUNICABLE DISEASES. 245
Cases axd Deaths from Diseases Daxgerous to the Public-
Health, 1920.
Index to Line Numbers in the Table of Cases and Deaths from Diseases
Dangerous to the Public Health, 1920.
Abington,
,
114
Charlemont, .
291
Gardner,
45
Acton, .
197
Charlton,
189
Gay Head, .
. 359
Acushnet,
161
Chatham,
225
Georgetown, .
. 199
Adams,
62
Chelmsford, .
119
Gill,
. 289
Agawam,
115
Chblse.^,
19
Gloucester,
. 36
Alford, .
355
Cheshire,
239
Goshen,
. 348
Amesbury,
97
Chester,
262
Gosnold,
. 361
Amherst,
112
Chesterfield, .
317
Grafton,
. 100
Andover,
82
Chicopee,
31
Granby,
. 296
Arlington,
44
Chilniark,
349
Granville,
. 302
Ashburnhani,
206
Clarksburg, .
284
Great Barrington,
. 93
Ashby, .
290
Clinton,
63
Greenfield,
55
Ashfield,
283
Cohasset,
163
Greenwich,
. 335
Ashland,
191
Colrain,
211
Groton,
. 183
Athol, .
70
Concord,
98
Groveland,
. 184
Attleboro,
41
Conway,
273
Auburn,
136
Cummington,
310
Hadley,
. 152
Avon, .
193
Halifax,
. 306
Ayer,
175
Dalton,
Dana, .
137
311
Hamilton,
Hampden,
Hancock,
. 205
. 308
. 319
Barastable, . .120
Danvers,
64
Hanover,
. 164
Barre, .
139
Dartmouth, .
107
Hanson,
. 228
Beeket.
287
Dedham,
65
Hardwick,
. 145
Bedford,
244
Deerfield,
154
Harvard,
. 276
Belchertown,
201
Dennis,
231
Harwich,
. 194
Bellingham.
195
Dighton,
174
Hatfield,
. 1.53
Belmont ,
72
Douglas,
196
H.WERHILL, .
. IS
Berkley,
288
Dover, .
274
Hawley,
Heath, .
. 332
Berlin, .
301
Dracut ,
129
. 334
Bernardston,
299
Dudley,
131
Hingharn,
. 116
Beverly,
34
Dunstable,
347
Hinsrlfile
25.5
Billerica,
142
Duxbury,
198
Holbrook,
. 162
Blackstone,
143
Holden,
. 167
Blandford,
324
East Bridgewater, .
1.38 ,
Holland,
. 360
Bolton,
304
East Longmeadow,
192
HoUiston,
. 169
Boston-,
3
Eastham,
318
HOLYOKE,
17
Bourne,
168
Easthampton,
68
Hopedale,
. 159
Boxborough,
343
Easton,
126
Hopkinton, .
. 185
Boxford,
307
Edgartown, .
259
Hubbardston,
. 281
Boylston,
. 297
Egremont,
316
Hudson,
. 102
Braintree,
73
Enfield,
305
Hull, .
. 187
Brewster,
. 292
Erving,
275
Huntington, .
. 257
Bridge water.
69
Essex, .
227
Brimfield,
. 285
Everett,
26
Ipswich,
. 101
Brockton,
. 16
Brookfield,
. 213
Fairhaven,
. 92
Kingston,
. 176
Brookline,
. 28
F.\i.L River,
7
Buckland,
. 240
Falmouth,
. 128
Lakevillc,
. 220
Burlington, . . . 295
FiTCHBURG, .
. 27
Lancaster,
. 178
Florida,
. 328
Lanesborough,
. 270
Cambridge, ... 9
Foxbnrough, .
. 146
L.\.WREXCE, .
. 15
Canton, . . .103
Framingham,
. 43
Lee,
. 127
Carlisle. . . .333
Franklin,
. 94
Leicester,
. 150
Carver,
. 226
Freetown,
. 219
Lenox, .
. 149
246
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Leominster,
. 47
Northboroug
h, . . 216
Shutesburj^
. 346
Leverett,
. 300
Northbridge,
. 77
Somerset,
. 140
Lexington,
. 109
Northfield,
. 210
Somerville, .
. 14
Leyden,
. 338
Norton,
. 180
South Hadley,
. 118
Lincoln,
. 251
Nor well.
. 229
Southampton,
. 282
Littleton,
. 272
Norwood,
. 58
Southborough,
. 202
Longmeadow,
. 215
Southbridge, .
51
Lowell,
. 11
Oak Bluffs,
. 245
Southwick,
. 230
Ludlow,
. 90
Oakham,
. 325
Spencer,
. 124
Lunenburg, .
. 223
Orange,
. 117
Springfield,
8
Lynx, .
. 12
Orleans,
. 267
Sterling,
. 2.52
Lynnfield,
. 261
Otis,
. 337
Stockbridge,
. 217
Oxford,
. 148
Stoneham,
. 85
Malden,
. 20
Stoughton,
. 89
Manchester, .
Mansfield, .
iVIarblehead, .
. 156
. 106
. 86
Palmer,
Paxton,
. 74
. 323
Stow, .
Sturbridge,
Sudbury,
. 278
. 266
. 264
Marion,
. 243
Peabody,
Pelham,
39
. 322
Sunderland,
. 242
Marlborough,
. 50
Sutton,
182
Marshfield, .
Mashpee,
. 232
. 356
Pembroke,
Pepperell,
Peru, .
Petersham,
Phillips ton,
Pittsfield,
Plainfield,
Plain\'ille,
Plymouth,
Plympton,
Prescott,
Princeton,
Provincetown
. 260
. 166
. 362
. 309
. 339
. 23
. 341
. 253
. 59
. 314
. 351
. 303
. 135
Swampscott,
Swansea,
. S3
. 157
IVIattapoisett,
IMaynard,
Medfield,
Medford,
Medway,
Melrose,
Mendon,
Merriinac,
Methuen,
Middleborough,
Middlefield, .
. 248
. 96
. 141
. 29
. 165
. 46
. 286
. 208
. 49
. 80
. 350
Taunton,
Templeton,
Tewksbury,
Tisbury,
Tolland,
Topsfield,
Townsend,
Truro, .
TyngsborougV
Tyringham,
1,
. 30
. 132
. 99
. 250
. 358
. 277
. 218
. 312
280
. 353
Middleton, .
. 246
Milford,
. 56
Quincy,
. 22
Millbury,
. 113
Upton 207
Millis, .
. 247
Randolph,
. 122
Uxbridge, . . .123
Millville,
. 204
Raynham,
. 214
Milton,
. 79
Reading,
. 87
Wakefield, ... 57
Monroe,
. 340
Rehoboth,
. 188
Wales, .
345
IMonson,
. 121
Revere,
. 33
Walpole,
111
Montague,
. 81
Richmond,
. 327
W.^LTHAM,
32
Monterey,
. 344
Rochester,
. 271
Ware, .
76
Montgomery,
. 357
Rockland,
. 95
Wareham,
108
Mount Washington
. 364
Rockport,
. 130
Warren,
133
Rowe, .
. 336
Warwick,
326
Nahant,
. 235
Rowley,
. 236
Washington,
352
Nantucket, .
. 151
Royalston,
. 293
Watertown, .
42
Natick,
. 67
Russell,
. 268
Wayland,
221
Needham,
. 84
Rutland,
. 203
Webster,
60
New Ashford,
. 363
Wcllesley,
91
New Bedford,
. 10
Salem,
. 25
Wellfleet,
298
New Braintree,
. 330
Salisbury,
. 224
Wendell,
354
New Marlborough,
. 294
Sandisfield, .
. 320
Wenham,
279
New Salem, .
. 315
Sandwich,
. 263
West Boylstor
',
258
Newbury,
. 233
Saugus,
. 66
West Bridgewator,
155
Newburyport,
. 52
Savoy, .
. 321
West Brookfield,
269
Newton,
. 24
Scituate,
. 170
West Newbury,
238
Norfolk,
. 237
Seekonk,
. 158
West Springfield, .
61
North Adams,
. 38
Sharon,
. 179
West Stockbridge, .
265
North Andover,
. 105
Sheffield,
. 212
West Tisbury,
329
North Attleborough
78
Shelburne,
. 249
West borough.
104
North Brookfield, .
. 173
Sherborn,
. 209
Westfibld, .
40
North Reading,
. 241
Shirley,
. 190
Westford,
171
Northampton,
. 37
Shrewsbury, .
. 144
Westhampton,
331
No. 34.] DIVISION OF COMMUNICABLE
Westminster,
222
Weston,
181
Westport,
147
West wood.
234
Weymouth, .
54
Whately,
256
Whitman,
88
Wilbrahani, .
Williamsburg,
Williamstown,
Wilmington, .
Winchendon,
Winchester, .
Windsor,
177
200
134
172
110
71
342
DISEASES.
247
Winthrop,
. 53
WOBURX,
. 48
Worcester, .
5
Worthington,
. 313
Wrentham, .
. 160
Yarmouth,
. 254
24S
DEPARTINIEXT OF PUBLIC HEALTH. [Pub. Doc.
Cases and Deaths from Diseases Dangerovs
63A
19A
9
61A
19B
10
Popu-
lation
An-
terior
Polio-
Chicken
Diph-
Ep.
Cere-
bro-
Ger-
man
In-
esti-
mated
as of
Pox.
theria.
.spinal
Mea-
fluenza.
Cities axd Towns grouped
mye-
litis.
Menin-
sles.
IN- Order of Population.
gitis.
July 1,
o
1920.
w
cn
m
n
CO
cc
+3
a
en
c3
.a
cS
i
5*
c
C3
0
C3
0
C!
«
C5
a
C3
0
M
QJ
3
a
fi
0
p
0
Q
0
Q
0
p
0
P
1
Massachusetts, ....
4,062,942
696
140
5355
11
7513
595
182
129
484
-
36312
1700
2
Cities over 500,000.
3
Boston,
823,413
191
48
1052
-
1773
140
36
33
107
-
8417
473
4
Cities over 150,000.
5
Worcester
180,103
5
-
154
1
240
14
4 1 3
16
-
1602
83
6
Cities, 100,000-150,000.
696.382
77
21
1050
2
im
144
54 39
65
-
5949
254
7
Fall River
1.30,515
4
_
82
1
284
40
8 10
7
-
623
33
8
New Bedford,
123,022
_
_
77
-
210
32
13 7
2
-
758
38
9
Springfield,
117,601
4
2
186
-
141
17
6
6
25
-
560
60
10
Cambridge,
112,973
29
7
568
1
228
6
6
4
22
-
1776
39
11
Lowell,
109,7.33
14
6
72
-
266
21
11
7
-
-
1236
36
12
Lynn,
102,538
26
6
65
—
315
28
10
5
9
—
996
48
13
Cities, 50,000-100,000.
487,077
88
18
367
4
960
91
17
8
63
-
4609
177
14
Somerville, . . . .
96,874
19
5
61
—
121
22
2
1
10
-
1068
30
15
Lawrence, .
94,806
12
2
65
1
145
22
6
2
2
-
354
28
16
Brockton, .
67.902
12
1
73
1
109
7
3
2
3
-
149
19
17
Holyoke. .
64,030
_
_
15
1
45
6
-
-
4
-
136
7
18
Haverhill, .
55,007
25
9
67
-
247
10
3
1
37
-
1390
43
19
Chelsea,
54,858
11
_
54
1
117
4
-
2
6
-
459
23
20
Maiden,
53,600
9
1
32
—
176
20
3
~
1
—
1053
27
21
Cities and Towns, 25,000-
50,000.
513,i53
123
14
831
-
1190
75
23
14
49
-
3789
205
22
Quincy
49,039'
12
_
70
-
169
4
6
1
2
-
251
21
23
Pittsfield, .
47,404
5
-
80
-
28
-
3
2
5
-
465
28
24
Newton,
46,556
15
2
185
-
96
6
1
-
8
-
396
14
25
Salem,
43,502
7
-
68
-
188
12
5
5
2
-
67
14
26
Everett,
42,129
8
1
94
-
167
10
-
-
3
-
405
8
27
Fitchburg,
41,562
5
2
36
-
52
5
-
-
3
-
321
12
28
Brookline, .
39,427
9
-
126
-
36
1
1
-
7
-
227
14
29
Med ford, .
38,174
13
1
25
-
60
1
-
-
2
-
223
15
30
Taunton, .
38,141
5
3
5
-
51
4
2
2
2
-
227
22
31
Chicopee, .
35,071
_
-
4
-
137
M
3
1
10
-
27
21
32
Waltham, .
32,571
28
3
117
-
89
11
1
2
4
-
914
17
33
Revere,
32,427
9
1
-
-
102
5
2
-
-
-
94
8
34
Beverly,
27,449
7
1
21
—
15
1
1
1
1
~
172
11
35
Cities and Towns, 10,000-
25,000.
610.1 S3
103
18
861
-
936
62
28
13
80
-
4947
236
30
Gloucester, . . . .
24,561
4
1
10
-
76
8
-
1
-
-
75
8
37
Northampton,
23,971
2
-
14
-
62
6
-
-
7
-
129
5
38
North Adams,
22,051
-
-
9
-
23
2
2
1
-
-
282
15
39
Peabody, .
21,651
3
-
17
-
42
3
2
1
4
-
191
9
40
VVestfield, .
20,875
-
-
43
-
30
3
1
-
-
-
158
4
41
Attleboro, .
20,839
-
-
8
-
41
2
2
2
3
-
215
11
42
Watertown,
20.307
1
-
114
-
33
1
2
1
2
-
119
5
43
Frainingham,
18,892
8
"
36
6
1
2
_
"
181
10
No. 34.] DIVISION OF COMMUNICABLE DISEASES. 249
to the Public Health, 1920.
92
Ix)bar
Pneu-
monia.
O
Measles.
3
o
5558 2781 32141
1518
661
344 173
lOSJfi 41i
210
79
231
247
175
142
54
28
72
78
6450
la;
iio6
507
420
1138
914
961 1360
83 117
664 326
153i 69
1081 61
82! 57
17i 46
156 43
86; 21
52; 29
i
I
633\ 362
52
58
S8{
"'I
62
69
471
331
35
6
31
796
8
28
24
31
35
13
3:;
19
30
34
44
28
33
20
18
29
49
16
28
15
18
380
17
11
11
16
17
5
11
13
19C
Mumps,
347 5962 6
66
4385
688
651
697
454
1007
432
460
5m
154
449
2001
360
414
549
623
302
106
77
355
14
11-2
18
23
11
14
44
2
n
5439
108
129
178
79
39
167
306
215
u
1280
425
945
13
7
156
595
24
79
407
89
30
59
149
47
33
1032
4
10
276
67
136
31
241
62
23
1
48
110
756
38A
Oph-
thalmia
Neona-
torum.
Scarlet
Fever.
C3
1638
476
202
524
140
174
74
44
79
13
197
28
14
53
12
21
58
11
11
4
2
4
5
6
13
2
1
95
28-29
Tuber-
culosis,
Pulmo-
nary.
O
10260
1874
976
1984
138
308
458
287
227
566
995
207
244
118
108
84
104
130
1070
165
56
143
103
80
18
81
112
92
58
63
51
48
1566
95
35
7
64
16
71
57
63
215 6696
70
22
40
4
2
22
4
2
17
3743 800 639 935
2005
328
130',
215
334
185
208
199
166
762
142
179
94
73
109
9'
68
669
66
89
43
50
64
62
40
45
30-35
Tuber-
culosis,
Other
Forms.
Ty-
phoid
Fever.
816
169
626
108
127
81
133
237
33
197
31
48
21
27
85! 44
92 26
64
104
38
66
54
33
30
368
26
38
20
40
25
49
18
20
86 60
36: 34
40! 18
23 11
25
879
33
74
135
39
131
18
30
22
12
35
14
67
11
7
5
6
8
6
4
4
4
10
8
1
85
21
36 45! 1
30
31
30 1
33 31
27t 7
29! 9
119
21
118
50
16
18
27
19
m
16
55
13
8
14
28
111
146
Whoop-
ing
Cough.
38C
Gonor-
rhea.
O
96 9994 542 7225
11
31
2551
127
1790
94
70
413
884
193
136
1238
213
347
340
38
99
56
145
1192
122
19
357
97
131
13
131
24
43
35
195
25
1497
30
54
1
6
121
2
85
171
155
11
103
14
13
18
24
22
12
74
61
37
Syphi-
lis.
03
o
o
1
4 2987 225
3042
366
146:
209
182
403
195
302
176
651
139
69
78
185
66
2,
613
43
62
30
56
41
67
24
21
125
16
30
79
19
49i
9
16
46
22
13
20
26
9
1183
246
67
56
245
57
130
69
244
25
95
44
15
43
12
10
213
17
13
5
27
8
27
12
3
56
6
12
12
15
304
10
11
7
20
9
15
3
4
67
20
15
32
18
12
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
250
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Cases and Deaths from Diseases Dangerous
o
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
Cities and Towns grouped
IN Order of Population.
44
Arlington, .
45
Gardner, .
46
Melrose,
47
Leominster,
48
Woburn,
49
Methuen, .
50
Marlborough,
51
Southbridge,
52
Newburyport,
53
Winthrop, .
54
Weymouth,
55
Greenfield,
56
Milford, .
57
Wakefield, .
58
Norwood, .
59
Plymouth,
60
Webster,
61
West Springfield
62
Adams,
63
Clinton,
64
Danvers, .
65
Dedham, .
66
Saugus,
67
Natick,
68
Easthampton,
69
Bridgewater,
70
Athol,
71
Winchester,
72
Belmont, .
73
Braintree, .
74
Palmer,
100
101
102
103
Towns, 5,000-10,000.
Ware,
Northbridge,
North Attleborough,
Milton,
Middleborough,
Montague, .
Andover, .
Swampscott,
Needham, .
Stoneham,
Marblehead,
Reading, .
Whitman, .
Stoughton,
Ludlow,
Wellesley, .
Fair haven.
Great Barrington,
Franklin,
Rockland,
Maynard,
Amesbury,
Concord
99 I Tewksbury,
Grafton,
Ipswich,
Hudson,
Canton,
Popu-
lation
esti-
mated
as of
July 1,
1920.
63A
An-
terior
Polio-
mye-
litis.
Q
19A
Chicken
Pox.
Diph-
theria.
61A
Ep.
Cere-
bro-
spinal
Menin-
gitis.
IS
19B
Ger-
man
Jlea-
sles.
10
In-
fluenza.
O
18,744
18,121
18,093
17,714
17,556
16,673
15,948
15,905
15,686
15,493
15,089
14,904
14,340
14,214
14,065
13,744
13,664
13,542
13,416
13,312
13,017
12,876
12,497
12,426
11,220
11,146
11,080
10,729
10,727
10,672
10,363
3Jt2,018
9,922
9,718
9,569
9,303
9,064
9,029
8,682
8,533
8,120
7,905
7,887
7,832
7,759
7,675
7,610
7,507
7,480
7,356
7,273
7,225
7,166
7,137
6.952
6,843
6,797
6,788
6,774
6,483
54
H
38
15
20
36
43
17
8
6
9
38
7
91
12
10
14
8
22
2
10
15
4
18
4
2
7
13
25
70
41
5
SOS
1
5
27
25
15
40
1
11
6
6
44
19
1
9
3
31
10
4
3
1
18
33
7
39
20
18
59
14
5
21
18
27
54
9
33
5
21
19
7
13
16
16
23
11
4
54
5
2
19
23
12
16
564
6
2
13
4
8
25
18
4
11
7
15
27
2
32
3
43
11
72
7
14
26
18
6
4
4
7
3
46 //
1
11
64
272
68
98
251
181
152
25
60
183
210
114
231
23
27
80
78
88
56
119
112
80
52
265
82
50
23
91
397
101
28
S969
22
96
1
155
31
65
122
42
230
178
14
63
55
11
133
10
39
5
10
9
302
281
3
15
o
13
11
11
8
10
2
6
4
9
8
3
9
3
2
2
3
7
6
5
5
4
4
6
5
2
3
3
2
4
2
7
105
1
5
5
4
8
2
8
2
1
4
1
2
3
6
2
3
1
3
4
No. 34.] DIVISION OF COMINIUNICABLE DISEASES. 251
to the Pxihlic Health, 1920 — Continued.
92
6
: 19C 38A
1 1 1
7
28-29 30-35
]
8
38 C
37
Lobar
Pneu-
monia.
Measles.
Mumps.
Oph-
thalmia
Neona-
torum.
Scarlet
Fever.
Tuber-
culosis,
Pulmo-
nary.
Tuber-
culosis,
Other
Forms.
Ty-
phoid
Fever.
Whoop-
ing
Cough.
Gonor-
rhea.
Syphi-
lis.
Cfi
00
1
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1
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109
36
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8
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44
23
16
121
2
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-
34
-
58
23
8
8
4
-
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-
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-
4
1
45
17
9
364
2
20
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7
5
5
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-
40
1
12
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33
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5
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41
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78
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54
11
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96
11
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60
3
20
-
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56
11
6
134
3
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1
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-
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57
39
11
46
_
6
_
-
-
27
-
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1
6
-
57
5
18
-
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-
58
5
7
211
7
1
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-
-
24
-
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6
3
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17
1
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59
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1
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48
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14
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1
30
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1
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10
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27
2
8
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-
65
7
6
17
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59
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1
28
1
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66
22
14
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67
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3
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3
19
10
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-
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68
15
11
254
2
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57
-
15
17
1
1
2
-
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9
-
58
-
69
6
4
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17
5
14
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70
13
5
109
_
63
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21
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5
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1
5
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71
18
6
352
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49
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8
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1
16
38
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75
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10
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73
9
10
107
-
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4
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2
—
22
3
5
-
13
~
74
267
ZSl
3028
22
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1
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9
344
214
51
55
101
7
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25
273
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//
75
1
6
9
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1
2
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76
8
6
59
1
18
-
1
-
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-
17
9
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5
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80
3
4
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17
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15
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1
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10
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42
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1
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1
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33
2
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1
4
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10
_
_
_
_
4
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1
1
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3
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1
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—
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—
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3
22
8
1
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3
~
2
"
4
103
252
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Cases and Deaths from Diseases Dangerous
63A
19A
9
61A 19B
1(
»
Popu-
lation
An-
terior
Polio-
Chicken
Diph-
Ep.
Cere- Ger-
bro- 1 man
In-
esti-
Pox.
theria.
spinal Mea-
fluenza.
Cities and Towns grouped
mated
mye-
litis.
Menin-
sles.
IN Order of Population.
as of
July 1,
gitis.
o
12;
1920.
(n
en
aa
VI
CO
n
rrt
J3
oa
j:
oi
-a
CO
A
M
GO
43
s
®
.4^
02
i
■♦J
2?
%
.«->
S
ca
li
03
<s>
53
s
03
&
C3
S.
03
O
'^
O
D
o
Q
o
Q
o
Q
U
Q
O
Q
104
Westborough, ....
6,425
1
10
_
8
_
_
_
_
_
144
3
105
North Andover,
6,399
1
1
5
-
11
1
-
-
3
-
29
1
106
Mansfield, .
6,386
1
-
115
-
15
1
-
-
3
-
26
-
107
Dartmouth,
6,320
-
-
2
-
7
3
-
-
-
-
49
3
108
Wareham, .
6,296
-
-
-
-
-
-
-
-
-
13
2
109
Lexington,
6,184
2
1
11
-
4
-
-
-
2
-
196
-
no
VVinchendon,
6,148
1
-
5
-
2
-
-
-
-
-
87
3
111
VValpole, .
6,115
1
-
4
-
2
-
-
-
-
-
44
1
112
Amherst, '
6,022
1
-
10
-
6
-
-
-
17
-
80
3
113
Millbury,
5,873
-
-
5
1
5
9
-
-
-
-
36
-
114
Abington,
5,844
1
-
5
-
9
2
-
-
-
-
2
1
115
Agawam,
5,654
-
-
-
-
4
-
-
-
-
-
-
2
116
Hingham,
5,576
1
_
1
-
3
-
-
-
2
-
46
1
117
Orange,
5,478
_
-
1
-
6
1
-
-
-
-
3
1
118
South Hadley, .
5,476
-
-
-
-
5
-
-
-
2
-
91
3
119
Chelmsford,
5,360
—
_
_
-
7
-
-
-
-
-
50
-
120
Barnstable,
5,328
2
_
22
-
2
-
-
-
1
-
44
3
121
Monson,
5,259
_
1
12
-
7
-
-
-
-
-
30
1
122
Randolph,
5,187
_
_
-
-
-
1
-
-
-
-
-
-
123
Uxbridge, .
5,181
1
-
2
-
53
3
-
-
-
-
24
2
124
Spencer
5,118
-
-
3
-
16
4
1
1
—
—
67
3
125
Towns, 2,500-5,000.
188,563
../rf
4
361
S
S35
9
4
5
58
-
11 SZ
7o
126
Ea.ston
4,986
_
_
16
_
9
1
_
_
-
_
80
4
127
Lee, .
4,858
_
_
3
-
13
-
-
-
-
-
9
4
128
Falmouth,
4.724
_
_
2
-
-
2
2
-
-
77
1
129
Dracut,
4,606
-
-
4
-
4
-
-
-
-
-
33
1
130
Rockport, .
4,502
-
-
2
-
8
-
-
-
-
-
84
2
131
Dudley, .
4,483
1
1
9
-
2
-
-
-
-
-
11
3
132
Templeton,
4,420
_
_
1
6
-
-
-
-
-
69
4
133
Warren,
4,351
-
-
-
-
1
-
-
-
17
-
101
2
134
Williamstown, .
4,267
_
_
-
_
36
-
-
-
-
-
3
2
135
Provincetown, .
4,218
-
-
18
-
3
1
-
-
-
-
22
-
136
Auburn,
4,177
_
_
3
_
9
-
-
-
-
-
30
2
137
Dalton,
4,160
_
_
1
-
1
-
-
-
-
-
14
3
138
East Bridgewatcr,
4,028
—
_
_
_
-
_
_
-
-
-
5
2
139
Barre,
•
4,017
—
_
-
_
1
-
-
-
2
-
41
3
140
Somerset, .
3,981
_
_
-
_
13
-
-
-
-
-
35
1
141
Medfield, .
3,836
2
-
-
-
-
-
-
-
-
-
4
-
142
Billerica,
3,720
_
_
1
-
11
1
-
-
-
-
-
-
143
Blackstone,
3,705
_
_
1
_
5
-
-
-
-
-
3
1
144
Shrewsbury,
3,679
-
-
-
1
-
-
-
-
-
-
24
1
145
Hardwick,
3,669
-
-
3
-
20
3
-
-
2
-
31
-
146
Foxborough,
3,641
_
_
8
-
13
-
-
-
-
-
80
4
147
VVestport, .
3,610
-
-
2
-
2
-
-
-
-
-
4
1
148
Oxford,
3,600
-
-
19
-
4
-
-
1
-
-
40
-
149
Lenox,
3,430
-
-
2
-
1
-
-
1
-
-
28
1
150
Leicester, .
3,411
-
-
2
-
1
-
-
-
-
-
-
1
151
Nantucket,
3,380
_
1
-
_
-
-
-
1
-
-
49
1
152
Hadley, .
3,359
-
-
2
-
2
-
-
-
-
-
4
-
153
Hatfield, .
3,302
-
-
1
-
1
-
-
-
13
-
-
-
154
Deerfield, .
3,291
_
-
5
_
1
-
-
-
1
-
7
-
155
West Bridgewater,
3,272
-
-
-
-
2
-
-
-
-
-
-
1
156
Manchester,
3,227
4
-
1
-
2
-
-
-
-
-
47
1
157
Swansea, .
3,162
_
-
-
-
3
-
-
-
-
-
11
-
158
Seekonk, .
3,153
-
-
-
-
-
-
-
-
-
-
-
1
159
Hopedale, .
3,140
-
-
3
-
1
-
-
-
-
-
-
-
160
Wrenthani,
3,112
-
-
2
-
3
-
-
-
-
-
6
-
161
Acushnet, .
3,111
-
-
1
-
1
-
-
-
-
-
6
3
162
Holbrook, .
3,084
1
1
-
-
9
-
-
-
-
-
5
1
163
Cohasset, . . ■
3,024
~
~
9
—
—
—
~
"
"
14
No. 34.] DIVISION OF COMMUNICABLE DISEASES.
253
to the Public Health, 1920
Continued.
92
6
19C 38A i
1
7
28-29
30-35
]
8
38C
37
I-obar
Pneu-
monia.
Measles.
Mumps.
Oph-
thalmia
Neona-
torum .
Scarlet
Fever.
Tuber-
culosis,
Pulmo-
nary.
Tuber-
culosis,
Other
Forms.
Ty-
phoid
Fever.
Whoop-
ing
Cough.
Gonor-
rhea.
Syphi-
lis.
n
" 1
«
cc
to
M
CO
OQ
m
«
to
d
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n
J3
c3
1
J3
i
J3
e8
i
J3
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i
OS
S 1
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C3
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o
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C3
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o
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O
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o
p
o
Q
o \
0
o
Q
o
Q
O
P
o
P
O
P
2
20
22
45
-!l9
19
17
9
1
10
_
_
_
13 -
20
4
104
6
6
73
- 1 6
-
_
_
23
2
7
5
3
2
-
-
38
-
1
-
-
-
105
6
1
126
- 2
_
1
_
14
_
7
7
-
-
1
-
78
1
10
-
5
-
106
3
4
28
1
4
_
1
-
19
-
8
2
-
2
6
2
1
-
-
-
-
-
107
5
5
62
_
_
_
1
_
6
1
4
4
1
1
2
-
8
2
3
-
2
-
108
5
3
119
1
21
_
_
_
15
-
5
8
-
-
-
-
37
1
4
-
-
-
109
7
4
107
-
26
-
_
-
71
-
5
4
-
1
-
-
27
-
-
-
1
-
no
3
1
10
_
5
-
3
_
13
_
5
5
2
1
-
-
22
-
6
-
1
-
111
11
2
45
-
6
-
1
-
10
-
3
-
-
-
4
-
64
2
1
-
-
-
112
6
4
3
-
22
-
1
-
19
-
4
1
-
-
1
-
-
-
3
-
1
-
113
2
4
51
_
13
1
_
-
35
-
4
2
-
1
1
-
13
1
1
-
-
-
114
_
4
-
_
-
-
_
-
7
-
4
3
-
1
3
-
-
1
-
-
-
115
6
4
37
-
2
-
_
-
25
-
4
2
-
-
3
1
24
-
2
-
1
-
116
4
-
-
-
-
_
-
1
-
12
6
1
2
5
-
-
-
1
-
-
-
117
1
2
29
1
_
_
_
_
14
_
3
3
-
-
-
-
17
2
1
-
2
-
118
3
49
_
3
-
1
-
18
-
2
2
-
1
1
-
-
-
-
-
~
-
119
8
6
77
-
5
-
_
-
11
-
3
3
1
-
1
-
28
-
9
-
-
120
3
3
15
_
36
-
—
-
5
-
6
9
-
1
-
-
2
1
-
-
10
-
121
1
3
-
-
-
-
-
7
-
2
2
-
-
-
-
-
-
1
-
1
-
122
2
5
105
1
_
-
1
_
9
1
10
4
3
2
-
-
-
-
6
-
-
-
123
1
5
2
-
15
—
-
-
5
-
6
1
1
1
—
-
—
~
2
~
~
~
124
1^3
no
me
17
i79
-
17
-
JtOd
6
209
156
15
19
2S
0
396
18
103
-
33
IS
125
1
3
85
_
2
—
1
_
13
1
6
4
1
2
_
_
4
-
2
-
1
-
126
_
89
-
-
-
_
-
31
-
6
3
_
2
-
-
1
-
1
-
-
127
_
2
110
3
3
_
_
-
-
-
13
-
-
-
-
-
-
6
-
1
-
128
_
3
6
_
1
-
_
_
4
1
3
1
1
-
_
-
-
-
1
-
-
-
129
_
1
31
-
-
-
_
-
16
-
5
2
-
-
3
-
9
1
1
-
1
-
130
9
16
_
_
_
_
-
1
_
10
2
2
2
-
2
1
-
-
-
-
131
1
1
1
-
-
-
1
-
11
-
1
2
-
-
-
-
-
-
2
-
-
-
132
7
2
9
1
6
-
1
-
1
-
4
1
-
2
-
-
-
-
4
-
-
-
133
_
2
_
-
-
-
-
_
_
2
3
-
1
1
1
1
1
-
-
-
-
134
1
2
3
-
-
-
-
-
1
_
4
1
1
-
1
1
10
-
7
-
1
-
135
1
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
1.36
1
4
32
_
-
-
-
-
6
_
-
5
-
_
-
-
-
-
-
-
-
-
137
1
4
22
-
-
-
-
-
3
-
3
5
-
-
1
-
-
-
2
-
2
-
138
2
150
2
2
-
-
-
6
_
1
3
-
1
-
-
2
-
-
-
-
-
139
10
3
-
1
-
-
1
-
5
-
7
4
1
-
-
-
1
-
-
-
-
-
140
2
8
39
_
12
_
2
-
1
_
25
28
-
2
-
-
19
-
-
-
-
4
141
1
5
71
-
1
-
-
-
8
-
3
6
-
-
1
-
9
2
1
-
-
-
142
7
_
2
_
_
_
-
—
_
4
2
-
-
-
-
-
-
-
-
-
-
143
2
1
7
-
1
-
_
-
4
-
2
1
-
-
-
-
-
-
1
-
-
-
144
—
65
1
10
_
_
_
10
2
1
2
-
-
-
-
1
-
-
-
-
-
145
11
7
9
-
2
-
1
-
23
_
12
9
4
1
7
-
63
-
10
-
11
3
146
1
-
20
-
-
-
-
-
3
-
1
2
-
-
-
-
-
-
-
-
1
-
147
1
2
1
-
17
-
-
-
13
_
1
1
_
1
1
-
1
2
-
-
-
-
148
4
2
1
-
10
-
-
-
6
-
2
2
1
1
1
-
1
-
3
-
-
-
149
3
3
_
-
_
_
_
_
12
1
1
1
-
_
1
-
-
-
-
-
-
-
150
5
2
-
-
-
-
-
6
-
-
2
-
-
-
-
3
-
-
-
-
-
151
_
-
3
_
2
_
_
_
4
_
1
-
-
-
_
-
6
-
-
-
-
-
152
5
3
18
-
13
-
-
-
S
-
3
-
-
-
-
-
28
1
-
-
-
-
153
1
2
54
-
8
-
-
-
14
1
-
2
-
-
-
-
12
3
-
-
-
-
154
1
-
1
-
-
-
-
-
-
1
2
-
-
-
-
-
-
-
-
-
-
155
_
_
12
_
1
_
_
_
12
_
6
1
_
-
_
-
20
1
4
-
1
1
156
4
2
1
-
-
-
_
-
3
-
2
3
-
-
-
-
-
-
1
-
-
-
157
1
_
_
_
_
_
_
_
_
2
3
_
_
_
-
1
-
-
-
-
-
158
_
-
14
1
3
-
_
-
9
-
1
-
_
-
-
-
-
-
2
-
1
-
159
14
6
50
1
1
_
_
_
24
_
4
4
_
1
_
-
34
3
1
-
1
-
160
_
-
17
2
4
_
1
-
6
-
5
2
-
-
-
-
-
-
-
-
-
-
161
-
1
7
-
2
-
-
-
1
-
5
3
-
-
-
-
-
-
5
-
-
-
162
1
—
1
—
9
—
—
—
3
—
1
—
1
—
~
-*
6
~
7
•"
1
~
163
254
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Cases and Deaths from Diseases Dangerous
63A
19A
1
J
61A
19B
J
10
An-
Ep.
Popu-
lation
terior
Polio-
Chicken
Diph-
Cere-
bro-
Ger-
man
In-
esti-
Pox.
theria.
spinal
Mea-
fiuenza.
Cities and Towns grouped
IN Order of Population.
mated
as of
July 1,
1920.
mye-
litis.
Menin-
gitis.
sles.
6
CO
CQ
QO
02
«
02
c
CO
OO
J3
03
i
C3
i
CO
9}
cc
5
oj
Si
C)
c3
S
o
u
V
Qi
>J
o
Q
o
Q
u
Q
o
0
o
Q
o
o
164
Hanover
3,020
1
_
_
24
1
165
Medway, .
3,002
-
-
-
—
4
_
1
_
_
_
1
166
Pepperell, .
2,958
_
_
—
_
_
_
_
_
_
2
167
Holden, .
2,895
_
_
3
—
_
_
_
_
1
_
141
1
168
Bourne,
2,880
1
1
3
_
_
_
_
_
21
2
169
Holliston, .
2,867
3
5
_
3
_
_
_
„
_
30
170
Scituate,
2,849
1
_
1
_
1
_
_
_
^
_
171
Westford, .
2,833
_
_
42
_
10
_
_
_
_
_
64
3
172
Wilmington,
2,820
2
_
2
_
1
_
_
_
_
_
3
173
North Brookfield,
2,812
_
_
_
1
_
_
_
_
_
20
1
174
Dighton, .
2,775
-
-
-
-
_
_
_
_
_
5
3
175
Ayer, .
2,759
1
-
41
1
6
_
_
_
_
_
43
1
176
Kingston, .
2,721
_
_
_
_
1
_
_
1
_
18
2
177
Wilbraham,
2,719
_
—
_
_
_
_
_
_
6
178
Lancaster, .
2,710
_
_
_
_
7
_
_
_
1
_
90
1
179
Sharon,
2,634
1
_
4
_
2
_
_
_
_
70
180
Norton,
2,632
_
_
_
_
1
_
1
_
_
_
2
181
Weston,
2,587
_
_
4
_
6
_
_
_
_
54
1
182
Sutton,
2,569
_
_
5
_
1
_
_
_
_
_
76
183
Groton,
2,520
2
_
25
_
2
_
_
_
_
_
28
1
184
Groveiand,
2,507
1
_
5
_
2
1
_
_
_
_
54
1
185
Hopkinton,
2,500
1
-
-
-
1
-
-
-
-
7
2
186
Towns under 2,500.
206,109
23
6
S51
1
155
12
3
2
$
-
S288
88
187
Hull,
2,483
3
1
7
_
6
_
_
„
_
32
2
188
Rehoboth,
2,465
_
„
_
_
_
_
23
2
189
Charlton, .
2,401
_
_
2
^
3
_
_
_
_
_
1
190
Shirley,
2,366
2,343
_
_
_
2
^
_
_
_
_
1
_
191
Ashland,
_
_
10
_
4
_
_
_
_
_
13
2
192
East Longmeadow,
2,340
_
_
_
1
_
_
„
_
_
2
1
193
Avon,
2,320
-
_
5
_
2
_
_
_
_
_
2
194
Harwich, .
2,246
_
_
3
_
7
_
_
_
_
_
19
1
195
Bellingham,
2,219
_
_
_
1
_
1
_
—
—
1
1
196
Douglas,
2,206
_
_
4
_
2
_
_
_
_
3
2
197
Acton,
2,167
_
_
2
_
1
_
_
_
_
__
26
198
Duxbury, .
2,165
_
_
2
_
_
_
_
_
_
3
199
Georgetown,
2,162
1
_
_
_
_
_
_
_
_
_
30
1
200
Williamsburg, .
2,103
_
_
_
5
_
„
_
„
_
11
1
201
Belchertown,
2,072
_
_
_
_
2
__
_
_
_
_
202
Southborough, .
2,059
5
1
_
_
_
_
_
_
_
3
1
203
Rutland, .
2,052
1
_
_
_
_
,„
_
_
_
204
Millville, .
2,036
_
_
_
_
_
_
_
_
_
_
_
205
Hamilton, .
2,014
_
-.
2
_
_
_
1
_
_
_
24
2
206
Ashburnham,
2,007
1
_
_
_
_
_
_
_
_
116
207
Upton,
2,000
_
_
_
_
_
_
_
_
_
_
208
Merrimac, .
1,997
_
_
10
_
7
1
_
_
_
_
41
_
209
Sherborn, .
1,977
_
_
2
_
2
^
_
_
^
_
210
Northfield,
1,928
•
_
_
_
_
_
_
_
__
2
211
Colrain,
1,922
_
_
12
_
2
_
_
_
_
_
1
3
212
Sheffield, .
1,909
_
—
_
_
2
_
_
1
_
_
17
213
Brookfield,
1,908
_
_
23
_
„
_
_
—
192
3
214
Raynham,
1,898
_
_
1
_
_
_
_
_
_
_
2
215
Longmeadow, .
1,886
1
_
8
_
1
_
_
_
_
_
15
1
216
Northborough, .
1,885
_
_
3
_
2
_
_
_
_
_
9
217
Stockbridge,
1,869
_
_
2
_
_
_
_
-,
_
_
21
_
218
Townsend,
1,864
-
-
_
_
_
_
_
_
_
_
61
1
219
Freetown, .
1,861
_
_
_
_
1
1
_
_
_
_
10
220
Lakeville, .
1,855
_
_
_
_
2
„
_
_
_
18
_
221
Wayland, .
1,851
_
_
_
—
3
1
_
_
_
_
11
1
222
Westminster,
1,844
_
_
_
—
_
—
_
_
25
1
223
Lunenburg,
1,834
—
—
3
—
—
—
-
—
-
-
24
No. 34.] DIVISION OF COMMUNICABLE DISEASES. 255
to the Public Health, 1920 — Continued.
92
6
}
19C
38A
7
28-29
30-35
1
8
38C
37
Lobar
Pneu-
monia.
Measles.
Mumps.
Oph-
thalmia
Neona-
torum.
Scarlet
Fever.
Tuber-
culosis,
Pulmo-
nary.
Tuber-
culosis,
Other
Forms.
Ty-
phoid
Fever.
Whoop-
ing
Cough.
Gonor-
rhea.
Syphi-
lis.
IK
6
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—
—
"
223
256
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Cases and Deaths from Diseases Dangerous
Cities and Towns grouped
IN Order of Population.
Popu-
lation
esti-
mated
as of
July 1,
1920.
63A
An-
terior
Polio-
mye-
litis.
19A
Chicken
Pox.
C3
Diph-
theria.
C3
o
61A
Ep.
Cere-
bro-
spinal
Menin-
gitis.
19B
Ger-
man
Mea-
sles.
10
In-
fluenza.
Salisbury, .
Chatham, .
Carver,
Essex,
Hanson,
Norwell,
Southwick,
Dennis,
Marshfield,
Newbury, .
Westwood,
Nahant,
Rowley,
Norfolk,
West Newbury,
Cheshire, .
Buckland, .
North Reading,
Sunderland,
Marion,
Bedford,
Oak Bluffs,
Middleton,
Millis,
Mattapoisett,
Shelburne,
Tisburj',
Lincoln,
Sterling,
Plainville, .
Yarmouth,
Hinsdale, .
Whately, .
Huntington,
West Boylston,
Edgartown,
Pembroke,
Lynnfield, .
Chester,
Sandwich, .
Sudbury, .
West Stockbridge
Sturbridge,
Orleans,
Ru.ssell,
West Brookfield
Laiiesborough,
Rochester,
Littleton, .
Conway,
Dover,
Erving,
Harvard, .
Topsfield, .
Stow,
Wen ham, .
Tyngsborough,
Hubbardston,
Southampton,
Ash field,
Clarksburg,
Brim field, .
Mendon,
1,779
1,776
1,742
1,735
1,734
1,724
1,724
1,723
1,710
1,704
1,636
1,600
1,600
1,590
1,587
1.565
1,564
1,536
1,518
1,513
1,505
1,496
1,495
1,488
1,476
1,468
1,459
1,451
1,450
1,434
1,410
1,403
1,400
1,378
1,370
1,365
1,337
1,321
1,308
1,304
1,295
1,282
1,264
1,259
1,250
1,247
1,235
1,233
1,229
1,210
1,208
1,189
1,177
1,173
1,138
1,130
1,112
1,095
1,033
1,030
1,016
1,006
990
5
11
1
4
1
16
10
10
1
34
7
23
22
8
14
I
15
19
91
1
2
10
95
27
32
48
121
43
47
17
13
50
5
34
16
4
16
118
•>
1
13
56
48
1
15
1
No. 34.] DIVISION OF COMMUNICABLE DISEASES. 257
to the Public Health, 1920 — Continued.
92
Lobar
Pneu-
monia.
6
Measles.
19C
Mumps.
38A
Oph-
thalmia
Neona-
torum.
7
Scarlet
Fever.
28-29
Tuber-
culosis,
Pulmo-
nary.
30-35
Tuber-
culosis,
Other
Forms.
1
Ty-
phoid
Fever.
8
Whoop-
ing
Cough.
38C
Gonor-
rhea.
37
Syphi-
lis.
1
CO
O
1
d
IS
o
Q
en
6
P
CO
•S
i
CO
Q
O
to
J3
.^^
O
P
0
i
8
tc
..J
<o
P
03
P
O
(0
C3
P
O
o
c
3
1
1
2
2
4
1
7
3
2
3
2
4
1
1
1
4
7
1
2
3
1
1
3
1
1
1
2
1
1
1
1
3
1
1
1
1
1
2
3
2
1
4
1
3
1
1
1
1
2
1
1
1
2
1
4
1
14
30
25
19
61
1
1
2
12
5
2
3
141
13
3
6
12
19
57
2
3
3
75
3
1
6
1
2
1
7
2
2
15
35
1
1
29
1
1
1
5
1
3
1
24
2
4
2
58
1
5
1
7
2
1
21
-
1
1
-
5
13
6
9
6
3
4
4
5
2
2
1
2
27
5
1
1
1
4
24
8
1
3
3
-
2
6
5
5
1
5
1
3
~
2
8
1
5
4
1
6
1
3
1
2
2
2
1
3
2
3
2
1
3
1
1
1
1
3
1
3
43
1
3
3
51
2
2
3
4
1
2
1
2
1
3
2
1
1
1
1
2
5
2
1
1
1
1
1
2
1
1
1
\
X
1
2
1
1
1
2
1
-
26
1
5
7
1
12
35
4
3
~i
1
5
11
7
8
4
4
7
4
8
11
5
1
1
1
1
1
1
2
2
1
1
2
1
2
1
1
1
2
4
3
1
1
1
1
4
1
1
1
4
1
-
4
1
_
1
• —
1
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256
257
258
259
260
261
262
263
264
265
266
267
268
269
270
271
272
273
274
275
276
277
278
279
280
281
282
283
284
285
286
258
DEPAKTMENT OF PUBLIC HEALTH. [Pub. Doc.
Cases and Deaths from Diseases Dangerous
Cities and To
IN Order of
WNS GROUPED
POPUL.\TION.
Popu-
lation
esti-
mated
as of
July 1,
1920.
63A
An-
terior
Polio-
mye-
litis.
19A
Chicken
Pox.
9
Diph-
theria.
61A
Ep.
Cere-
bro-
spinal
Menin-
gitis.
19B
Ger-
man
Mea-
sles.
10
In-
fluenza.
6
C
3
I
CO
%
P
CO
03
U
2
Q
CO
%
03
CO
c3
a)
P
CO
U
CO
03
Q
CO
o
CO
A
03
O
Q
CO
6
CO
cS
5
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
Becket,
Berkley,
Gill, .
Ashby,
Charlemonf
Brewster,
Koyalston,
New Marlb
Burlington,
Granby,
Boylston,
Wellfleet,
Bernardstoi
Leverett,
Berlin,
Granville,
Princeton,
Bolton,
Enfield,
Halifax,
Boxford,
Hampden,
Petersham,
Cummingtc
Dana,
Truro,
Worthingto
Plympton,
New Salem
Egremont,
Chesterfield
Eastham,
Hancock,
Sandisfield,
Savoy,
Pelham,
Paxton,
Blandford,
Oakham,
Warwick,
Richmond,
Florida,
West Tisbu
New Braint
Westhampt
Hawley,
Carlisle,
Heath,
Greenwich,
Rowe,
Otis, .
Leyden,
Phillipston,
Monroe,
Plainfield,
Windsor,
Boxborough
Monterey,
Wales,
Shutesbury
Dunstable,
Goshen,
Chilmark,
orouj
1,
n,
n,
,
ry,
ree,
on.
;h,
988
970
961
959
951
940
935
931
918
898
856
847
842
831
822
789
780
773
734
731
709
696
696
686
686
673
670
639
610
594
585
572
566
562
546
531
528
524
501
477
475
459
446
442
436
432
427
420
400
392
390
365
353
348
344
344
336
327
327
318
315
299
294
1
1
1
1
1
I
_
_
1
4
1
38
1
3
1
1
1
1
1
1
1
5
4
1
4
1
1
-
-
1
1
-
100
54
55
4
1
6
3
12
2
145
6
8
13
3
12
1
24
13
1
1
1
1
1
1
2
1
1
1
5
1
1
1
J
1
No.
34.]
DIVISION OF COMMUNICABLE DISEASES.
259
to the Public Health, 1920 — Continued.
92
Lobar
Pneu-
monia.
6
Measles.
19C
Mumps.
38A
Oph-
thalmia
Neona-
torum.
7
Scarlet
Fever.
28-29
Tuber-
culosis,
Pulmo-
nary.
30-35
Tuber-
culosis,
Other
Forms.
1
Ty-
phoid
Fever.
8
Whoop-
ing
Cough.
38C
Gonor-
rhea.
37
Syphi-
lis.
03
QQ
i
o
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1
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3
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"
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
260
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
o
Z
350
351
352
353
354
355
356
357
358
359
360
361
362
363
364
65
366
Cases and Deaths from Diseases Dangerous
Cities and Towns gkotjped
IN Order of Population.
Popu-
lation
esti-
mated
as of
July 1,
1920.
63A
An-
terior
Polio-
mye-
litis.
oj
OO
J=
^
c§
u
W
O
19A
Chicken
Pox.
Middlefield,
Prescott,
Washington,
Tyringham,
Wendell, .
Alford,
Mashpee, .
Montgomery,
Tolland, .
Gay Head,
Holland,
Gosnold,
Peru, .
New Ashford,
Mount Washington,
Camp Devens,
State Infirmary, Tewksburt,
294
278
273
271
269
266
258
245
220
190
174
160
153
92
79
19
Diph-
theria.
O
16
61A
19B
Ep.
Cere-
Ger-
bro-
man
spinal
Mea-
Menin-
sles.
gitis.
OS
«
•
,C
•
JS
s
S
U
«
O
Q
10
In-
fluenza.
U
C3
Q
23
In addition to the above there
37 cases of dysentery, with 26
occurred 3 cases of actino-
deaths: —
Cases.
Deaths
mycosis, with 1 death: —
Cases.
Deaths.
Adams,
.
4
2
Barnstable, . . . ■ .
1
-
Boston,
4
3
Boston,
1
1
Cambridge,
1
-
Chelsea
1
~
Canton,
Chicopee, .
1
1
1
17 cases of anthrax, with 4
Fairhaven, .
1
-
deaths: —
Fall River,
3
3
Boston
2
-
Fitchburg, .
-
1
Chelsea,
1
1
Haverhill, .
2
-
Lawrence, .
1
1
Ipswich,
-
1
Lowell,
3
1
Maiden,
-
1
New Salem,
-
1
Maynard, .
-
1
Newton,
1
-
Medfield, .
13
-
Peabody, .
7
-
Milford, .
-
2
Stoneham, .
1
-
Montague, .
1
—
Worcester .
1
-
New Bedford,
1
1
Newton,
1
-
67 cases of dog bite (requiring
North Adams,
-
3
anti-rabic treatment) : —
Quincy,
1
—
Attleboro, ....
3
-
Springfield,
1
1
Barnstable,
1
-
Sterling,
3
—
Berkley,
2
-
Taunton, .
-
1
Beverly,
1
-
Worcester, .
-
4
Boylston, .
3
-
Fall River,
8
-
2 cases of hookwornr
i: —
Framingham,
3
-
Beverly,
.
1
-
Grafton,
7
-
Salem ,
.
1
~
Holden ,
1
-
Holyoke, .
1
-
3 cases of leprosj
', with S
Lowell,
9
-
deaths: —
Methuen, .
2
-
Boston,
2
-
Middleborough,
3
-
Gosnold,
.
-
3
New Bedford,
3
-
Lowell,
1
—
North Adams,
1
-
Seekonk,
1
-
60 cases of malari
a, with t
)
South Hadley,
1
-
deaths: —
Stoughton, .
1
-
Boston,
.
15
^
Taunton,
11
-
Brockton, .
.
3
—
Walpole,
1
-
Cambridge,
.
2
—
Westminster,
3
-
Camp Devens,
.
2
-
Winthrop, .
1
-
Dedham, .
•
4
~
No. 34.] DIVISION OF COMMUNICABLE DISEASES. 261
to the Public Health, 1920 — Concluded.
92
Lobar
Pneu-
monia.
6
Measles.
19C
Mumps.
38A
Oph-
thalmia
Neona-
torum.
7
Scarlet
Fever.
28-29
Tuber-
culosis,
Pulmo-
nary.
30-35
Tuber-
culosis,
Other
Forms.
1
Ty-
phoid
Fever.
8
Whoop-
ing
Cough.
38C
Gonor-
rhea.
37
Syphi-
lis.
O
CO
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03
0
6
OQ
1
%
O
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0
m
CD
P
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as
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1
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8
1
2
1
7
15
2
14
47
-
-
-
1
1
5
27
-
7
51
1
1
108
11
6
-
-
1
7
-
1
51
68
-
8
20
18
350
351
352
353
354
355
356
357
358
359
360
361
362
363
364
365
366
Deerfield, .
Everett,
Fall River,
Fitchburg, .
Framingham,
Haverhill, .
Holyoke, .
Lawrence, .
Lowell,
Lynn,
Mansfield, .
Marlborough,
Middleborough,
Northbridge,
Norwood, .
Pittsfield, .
Shelburne, .
Taunton,
Walpole,
Whitman, .
Winthrop, .
Worcester, .
16 cases of pellagra, with 14
deaths: —
Boston,
Danvers,
Lynn,
Maynard, .
Newburyijort,
Northampton,
Salem,
Swampscott,
Taunton,
Waltham, .
Wrentham,
Worcester, .
153 cases of septic sore throat,
with 29 deaths: —
Amherst,
Arlington
Cases.
Deaths.
1
_
Attleboro, .
2
_
Boston,
2
.
Brockton, .
2
_
Brookline, .
1
_
Cambridge,
1
_
Chelsea,
1
„
Clinton,
2
1
Dedham, .
1
1
Edgartown,
1
1
Everett,
2
Fall River.
1
^
Greenfield,
1
_
Holyoke, .
7
_
Lancaster, .
2
_
Lawrence, .
1
1
Leominster,
1
Lowell,
1
Lynn,
1
_
Maiden,
1
_
New Bedford,
2
_
Newburyport,
1
Newton,
Northampton,
Peabody, .
Plymouth, .
1
_
Salem,
4
Saugus,
1
Sharon,
Somerville,
1
Springfield,
2
Sutton,
Taunton, .
1
Waltham, .
1
Warwick, .
1
Westfield. .
3
Whitman, .
I
Winchester,
Winthrop, .
Woburn,
Worcester, .
2
-
1
-
Cases.
Deaths.
2
46
13
1
1
1
2
2
1
1
1
3
-
1
1
1
1
1
1
-
4
5
2
1
1
3
1
7
1
2
-
4
2
1
-
1
-
1
-
1
-
43
1
1
-
1
-
1
-
262
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
29 cases of tetanus
, with 21
Cases.
deaths: — Cases.
Deaths.
Fall River,
2
Boston, 4
3
Fitchburg
1
Chicopee, .
-
Holyoke
1
Dan vers,
-
Lawrence, ....
3
Dennis,
-
Lowell
3
Easthampton,
-
Lynn, ....
2
Fall River,
2
Maiden, ....
2
Hadley, .
1
Medford
3
Holyoke, .
1
Montague, ....
1
Lawrence, .
1
New Bedford,
1
Lenox,
-
Peabody
2
North Adams,
1
Somerville,
2
Northampton,
1
Springfield,
2
Northbridge,
-
Taunton, ....
1
Peabody, .
1
Uxbridge
1
Pittsfield, .
5
Worcester
3
Quincy,
1
Revere,
-
5 cases of trichinosis: —
Shirley,
-
Boston, ....
4
Springfield,
3
4
Westfield
1
87 cases of trachoma: —
29 cases of smallpox, with 1
Athol 1
-
death: —
Boston,
44
_
Boston, ....
9
Brockton, .
1
-
Braintree
1
Cambridge,
2
-
Chicopee
3
Chelsea,
2
-
Lowell, ....
1
Easton,
1
-
Methuen
14
Everett,
2
-
Somerville,
1
Fairhaven, .
4
-
Deaths.
Cases and Deaths, with Case and Death Rates, per 100,000 PoprL.A.TioN ^
FOR All Reportable Diseases during the Year 1920.
Disease.
Cases.
Deaths.
Case
Rate.
Death
Rate.
Fatality
Rate.
Actinomycosis,
3
1
.1
.0
33.3
Anterior poliomyelitis,
696
140
18.0
3.6
20.1
Anthrax,
17
4
.4
.1
23.5
Chicken pox, ....
5,355
11
138.4
.3
,2
Diphtheria, ....
7,513
595
194.2
15.4
7.9
Dog bite,
67
-
1.7
-
-
Dysentery, ....
37
26
1.0
.7
70.3
Epidemic cerebrospinal meningitis.
182
129
4.7
3.3
70.8
German measles,
484
-
12.5
-
-
Gonorrhea, ....
7,225
4
186.7
.1
.1
Hookworm, ....
2
-
.1
-
-
Influenza, ....
36,312
1,700
938.5
43.9
4.7
Leprosy,
3
3
.1
.1
100.0
Malaria,
60
5
1.6
.1
8 3
Measles
32,141
347
830.7
9.0
11
Mumps, .....
5,962
6
154.1
2
1
Ophthalmia neonatorum, 2
1,638
-
42.3
-
-
Pellagra,
16
14
.4
.4
87.5
Pneumonia, lobar, .
5,558
2,781
143.6
71.9
50.0
Scarlet fever
10,260
215
265.2
5.5
2.1
Septic sore throat, .
153
29
4.0
.7
19.0
Smallpox, ....
29
1
.7
.0
3.4
Syphilis,
2,987
225
77.2
5.8
7.5
Tetanus,
25
21
.6
.5
S4.0
Trachoma, ....
87
-
2.2
-
-
Trichinosis
5
-
.1
-
-
Tuberculosis, pulmonary.
6,696
3,743
173.1
96.7
55.8
Tuberculosis, other forms,
800
639
20.7
16.5
79.9
Typhoid fever,
935
96
24.2
2.5
10.3
Whooping cough.
9,994
542
258.3
14.0
5.4
Totals
135,242
11,277
3,495.4
291.5
8.3
1 Corrected population used.
^ Includes suppuirative conjunctivitis.
No. 34.] DIVISION OF COMMUNICABLE DISEASES.
263
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Division of Biologic Laboratories
Benjamin- White, Ph.D., Director
William A. Hinton, M.D., Assistant Director
David L. Williams, M.D., Assistant Director
12651
i
Kepokt of Division of Biologic Laboratories.
Antitoxin and Vaccine Laboratory.
1. Personnel.
On Feb. 1, 1920, Dr. Benjamin White was appointed assistant di-
rector of the Division and placed in charge of the Antitoxin and Vac-
cine Laboratory. On June 1, 1920, Dr. M. J. Rosenau resigned as
Director of the Division and Doctor White was appointed in his place,
and Dr. David L. Williams was made assistant director.
2. Produciion.
The accompanying table, compiled from all available data, shows the
amounts of the various biologic products prepared, distributed and in
stock at the end of the fiscal years 1919 and 1920.
Never before in the history of the laboratory have the reserve stocks
of products been as large as they are at the present time. There is
practically a year's supply of diphtheria antitoxin, of antimeningococcic
and antipneumococcic serum in storage, which in addition to current
production insures an adequate reserve to meet any epidemic emer-
gency.
Product.
1. Diphtheria antitoxin: —
Produced, ....
Distributed, ....
On hand
2. Diphtheria plasma: —
Produced, ....
Used in concentration, .
On hand
3. Concentrated diphtheria antitoxin
Produced
Distributed, ....
On hand, ....
1919.
Liters.
Total
11,000 Unit
Doses.
Units
per C. C.
602.28
646.067
72.3
165.95
109.05
60.
143,101
16,028
221
147
Liters.
1920.
Total
1,000 Unit
Doses.
Units
per C. C.
769.1
482.
232.4
179,756
1,126.6
725.
569.1
-
158.6
100.73
55.2
38,471
60,720
372
381
1,100
268
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Pboduct.
1919.
1920.
Liters.
Total Doses.
Liters.
Total Doses.
4. Antimeningococcic serum: —
Produced,
Distributed
On hand
5. Antipneumococcic serum. Type I: —
Produced
Distributed,
On hand,
6. Smallpox vaccine: —
Produced
Distributed,
On hand,
7. Typhoid paratyphoid vaccine: —
Produced
Distributed
On hand
86.5
67.365
31.
23.800
42.200
36.925
2.349
3.247
112.3
74.123
5,766
4,565
238
422
369.25
140,940
194,807
112,300
74,123
317.665
48.310
47.2
147.700
44.4
100.700
4,844
3.151
1.624
73.5
49.191
16.6
21,177
3,585
1,477
444
1,007
290,610
189,064
97,440
73,500
49,191
16,600
Outfits.
Total Doses.
Outfits.
Total Doses.
8. Schick outfits: —
Produced
Distributed,
On hand,
96
96
9,600
9,600
91
63
30
9,100
6,300
3,000
Liters.
Total Doses.
Liters.
Total Doses.
9. Diphtheria toxin-antitoxin: —
Produced,
Distributed
On hand,
1.108
1,108
6.443
3.614
2.829
6,443
3,614
2,829
Liters.
Potency.
Liters.
Potency.
10. Diphtheria toxin: —
Produced,
Used
On hand,
539.
583.
20.
.006
.006
.006
539.
456.
83.
.0025
.0025
.0025
These large supplies are due to two factors, one of which is the in-
creased amounts of blood yielded by the horses, and the other is in-
creased potency of all serums due to improvements in the methods of
immunization. For example, the horses producing diphtheria anti-
toxin are now producing serum containing nearly twice as many units
per cubic centimeter as the serum produced in 1919. The higher
potency of the serum at present produced enables physicians to ad-
minister the proper number of units of antitoxin to the patient in
about one-half the previous volume of fluid. The therapeutic effi-
ciency of the serum is accordingly greatly enhanced. In addition, the
horses are yielding from 30 to 40 per cent more serum. It is therefore
possible with the same number of horses to produce more than twice
No. 34.] DIVISION OF BIOLOGIC LABORATORIES. 269
the total number of diphtheria units formerly produced, and the cost
per 1,000 units is approximately halved.
Changes in the procedure of vaccinating calves for the production of
smallpox vaccine virus have increased the yield from each calf from
60 to over 100 per cent. This means that the present yearly supply
of nearly 200,000 doses can be produced from about two-thirds the
usual number of calves, thereby reducing the cost of vaccine virus
proportionately.
3. Econoviics.
Owing to the increased distribution of products and the prevailing
high prices of all apparatus and supplies, the last annual appropriation
for this laboratory barely covered the current expenses, and left no
funds available for many urgently needed improvements. On account
of the insufficient funds available and for the purpose of preparing
and distributing the largest possible quantity of products at the lowest
possible unit cost, many economies have been instituted and practiced.
All supplies have been standardized, thereby reducing the number of
articles on the stock list, and they have been purchased in quantity
and usually on competitive bids. A considerable saving in the expense
account has therefore been effected.
4. Improvements.
A new system of bookkeeping and of stock production and distribu-
tion records is being installed which conforms with modern business
systems, and whereby it is possible to make a more accurate and ac-
cessible accounting of expenditures, equipment on hand, of production
and finally of the production costs of each product. A full time clerk-
stenographer has been added to the staff, who acts as chief clerk for
the Division in addition to keeping all office records. This change re-
lieves the trained laboratory assistants of clerical duties and enables
them to devote their whole time to production.
5. Educational.
The teaching activities of the laboratory have been greatly expanded
during the past year. Instruction in immunity, both theoretical and
applied, and demonstrations of the preparation and use of biologic
products have been given to more than 300 persons, comprising
groups from medical societies, from medical and technical schools and
colleges, as well as individual physicians, nurses, public health workers
and students.
270 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Although such lectures and demonstrations cause considerable incon-
venience, they constitute one of the most valuable functions of the
laboratory. It is the intention of the Director to welcome all such
classes, any medical societies and interested individuals, because in
such a way we can not only acquaint the medical profession and pub-
lic health workers of the Commonwealth with the details of the pro-
duction of biologic products, but we can also stimulate a more lively
and widespread interest in the application of these products in the
diagnosis, prevention and treatment of infectious diseases.
6. Needs.
(a) Personnel. — The present staff is too small to perform the added
work entailed by the increased production. In the estimate already
submitted for the 1921 budget, a request was made for one more
laboratory assistant, Grade I. Since this estimate was submitted,
however, it has been found necessary to increase further the personnel.
If this laboratory is to meet the requirements of the Hygienic Labora-
tory of the United States Public Health Service, under whose license
the products are prepared and distributed, it will be necessary to con-
centrate all diphtheria antitoxin. This process involves constant and
careful attention and warrants the employment of a full-time laboratory
assistant. It is desirable that a chemist be obtained for this work, who
could also assist in other processes in the laboratory, especially during
vacation seasons. In addition to this, if the new regulations of the
Hygienic Laboratory are to be complied with in all details, it will be
necessary to add to the staff another trained bacteriologist. Further-
more, although the main function of such a laboratory as the Anti-
toxin and Vaccine Laboratory is the production of biologic products
for the needs of the Commonwealth, it is also well within its scope to
investigate and develop new methods, not only for the improvement
of its present products but also for the production of new biologic
agents. The procedures as now carried out in the immunization of
horses and in the preparation and testing of antitoxin and other serums
and vaccines should be made to yield scientific dividends in the way
of new and useful data. The present burden of work carried by the
employees of the present staff makes it impossible to take advantage
of this exceptional opportunity, but with the addition of these two
assistants some of the facilities offered might be utilized to good
advantage.
(6) Funds. — The increased appropriation requested in the estimate
for the 1921 budget is required not only to meet the increased over-
No. 34.] DIVISION OF BIOLOGIC LABORATORIES.
271
head charges but also to replace many antiquated and worn-out items
of apparatus and equipment, and also to provide for the heavy ex-
penses incident to the more elaborate tests required by the Federal
government.
(c) Laboratory Accommodations. — The buildings in which the ac-
tivities of the Antitoxin and Vaccine Laboratory are now housed are
inadequate for the number of workers and the volume of work done.
If the laboratory's activities are to expand even at the present rate, it
soon will be necessary either to enlarge and add to the present build-
ings or to provide suitable accommodations elsewhere. The buildings
now occupied are not the property of the Commonwealth but are
leased from the Bussey Institution of Harvard University. Under the
present circumstances it is not advisable to carry out many of the
urgent improvements, and it is also impossible at present to enlarge
the buildings to accommodate the workers and the work.
The problem of providing for the expansion and permanent housing
of the laboratory's activities is soon to be met and it is now being
studied in all its aspects.
Wassermann Laboratory.
1. Routine Tests.
During the past year the activities of the Wassermann Laboratory
have been confined to the execution of tests established during the
previous years. Its personnel has not changed in number, but the
volume of its work shows a noteworthy increase over that of 1919, as
indicated in the following table: —
1916.
1917.
1918.
1919.
1920.
Wassermann tests,
25,497
28,524
27,534
31,485
36,953
Gonococcus fixation tests
-
-
-
222
1,726
Diagnostic examinations for Division of Ani-
mal Industry: —
(a) Complement fixation tests for glanders,
985
1,330
646
122
221
(b) Examinations for rabies,
47
67
61
84
166
(c) Pathologic and bacteriologic examina-
tions.
10
3
45
79
64
2. Coviylemeyit Fixation Tests in Tuberculosis.
In addition to performing the increasing number of routine tests, an
investigation has been carried on to determine the utility of the com-
plement fixation test as a clinical aid in the diagnosis of tuberculosis.
272 DEPARTMENT OF PUBLIC HEALTH. [P. D. No. 34.
The various methods advocated by other workers as well as several
original modifications have been studied. This investigation indicates
that in its present stage of development the complement fixation test
in tuberculosis does not possess suflficient diagnostic or prognostic value
to be used as an aid in the clinical determination of tuberculosis.
3. Complement Fixation Tests in Gonococcal Infections.
During the past year the gonococcus fixation test has been utilized
to some extent as a clinical aid in the diagnosis of gonococcal infec-
tions. Its chief use has been in the determination of "cures," and
hence, in a decision, as to the communicability of the disease. The
demand for this test has not been as great as was expected, although
many of the best clinicians value it as an aid in obscure cases.
No small part of the work of the laboratory consists in the prep-
aration of standardized amboceptor and standardized antigen, which
is distributed to municipal, public health and hospital laboratories in
the State for use in Wassermann testing.
4. Costs.
The careful economy practiced during the past year is apparent
when it is stated that the cost of Wassermann examinations was 25
cents per test during the present fiscal year and that this cost in-
cludes the overhead of statistical investigations. The cost in 1916
was a fraction less than 20 cents, but in that year the amount in-
cluded no charge for statistical investigations, and the scale of salaries
and the price of supplies were on a much lower level than during the
present year.
I
Division of Hygiene
Merrill E. Champion^, M.D., Dir color
[273]
Keport of Division of Hygiene.
Changes in Personnel.
During the year just past there has been a great increase in the
scope of the Division's work, together with a shrinkage in the size of
its personnel. We have gained a cHnic physician and a health in-
structor in mouth hygiene and lost a chief of the Subdivision of Pub-
lic Health Nursing, together with two nurse health instructors. The
Division is at present badly undermanned.
In March, 1920, Miss Blanche Wildes, chief of the Subdivision of
Public Health Nursing, resigned to accept a position with the New
England Division of the American Red Cross. In September, 1920,
Miss Hazel Wedgwood and in October Miss Harriet Wedgwood re-
signed as health instructors to accept much more lucrative positions
with the Red Cross in other States. The loss of these three experi-
enced and efficient workers at the height of their usefulness to the
State, because of the poor salaries paid by this State, is most un-
fortunate.
In April, 1920, Miss Evelyn C. Schmidt, who had already been with
us as a temporary appointee as health instructor in mouth hygiene,
was made a permanent employee. In June Dr. Mary Putnam, who
likewise had been with us previously as a temporary appointee, was
appointed clinic physician on a permanent basis.
In November, 1920, Dr. Edwin N. Kent, who had given vaUant and
gratuitous service as supervisor of mouth hygiene, resigned this po-
sition and was appointed consultant in mouth hygiene.
In March Miss Josephine M. Cullen resigned as stenographer to ac-
cept a position in the office of a practicing physician. Miss Winifred
A. McPeake was appointed to the position of junior stenographer in
April, 1920, and Miss Anna E. Curran was employed in a similar
position in September, 1920.
Lines of Work.
The work of the Division for the past year will be discussed under
headings indicating the different activities which are being carried on.
276 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Investigations.
During the year 1919-20 two extensive pieces of investigation were
carried on by nurse health instructors in the Division of Hygiene.
One of these dealt with the present status of the midwife in Massa-
chusetts. A group of nine cities and towns was chosen in which to
make the study. The basis of choice was that the population of the
communities should be representative of the different races present in
any number in this State. Consequently, a study was made of con-
ditions as they existed at that time in Boston, Fall River, Brockton,
Fitchburg, Springfield, Barre, Pittsfield, Provincetown and Westfield.
The nurses making the investigation were thoroughly experienced in
that type of work.
It will be recalled that, according to law, in Massachusetts the
midwife has no standing except that she is obliged to report the births
she attends. On the other hand, if she attends any births, she is
liable to prosecution for practicing medicine without a license. It
would seem as if prohibition of this sort would be sufficient to drive
the midwife out of the State. As a matter of fact, however, diligent
inquiry in the nine cities and towns mentioned uncovered the presence
of 117 midwives. Without any question there are others practicing
there who were not found. The midwife is an important factor in the
confinement of the mother of foreign birth, the reasons for this fact
being that these women are accustomed to having a midwife in the
home country and also prefer a midwife because she combines house-
work with medical care, all for a comparatively reasonable fee.
Much of the information obtained during this investigation came
only in a roundabout way and some of it came in confidence. Many
of the midwives visited were apparently making an honest attempt to
carry on their work in a cleanly manner; others were not of a suf-
ficiently high type to recognize the need of cleanliness. Probably it
may be said with justice, however, that as a result of legal restriction
the tendency has been for the poorer midwife rather than the better
one to survive as the former is more willing to take chances with the
law. The results of the work of the midwife as measured by mor-
tality statistics were reasonably good in the cities and towns studied.
As a matter of fact, however, too much reliance cannot be placed upon
this because the midwife when in difficulty generally falls back upon
some physician to help her out, and also because there are no statistics
available on the morbidity which may result from the practice of the
midwife.
It is difficult to say at present just what change should be made in
No. 34.] DIMSION OF HYGIENE. 277
existing practice as regards michvives. It certainly can hardly be
considered an ideal arrangement to have a poorly trained individual
handling obstetrics. She is useful only because a certain group insists
upon having her and also because she does, in a certain measure, solve
the problem of caring for the family at the time of the mother's
confinement. More maternity clinics, some arrangement for provid-
ing those willing to do housework, and education of the foreign-born
mother as to the need of the best possible medical care at the time of
her confinement, represent probably the most satisfactory, though of
necessity, a slow solution of the midwife problem.
A second investigation undertaken last year by the Division was
one into the open-air school problem of the State. All such schools in
Massachusetts were visited, their methods of procedure studied, and
the results collected so far as was possible. Questionnaires sent to
similar institutions in other States furnished a basis for comparison.
It was hoped that possibly some standards might be evolved which
would enable us to estimate with some degree of assurance the number
of children in a given community who should be in such special schools
and also the probable cost of such care. We have come to the con-
clusion, however, that much more work is necessary throughout the
country on this problem before any such standards can be formulated.
Food and its Relationship to Health.
The nutrition work of this Division has been increasing very rapidly
during the year which has just passed. The demands upon the time
of our health instructor in foods have increased in two directions. On
the one hand, communities throughout the State have been asking
with increasing frequency for talks to school children and to groups
of adults interested in a general way in the problem of food and its
relationship to health. On the other hand, there has l)een an increas-
ing number of consultations with this Department with regard to the
establishment of new pieces of nutrition work, either under the aus-
pices of some municipality or under private agencies. The work has
thus grown to such an extent that one person is no longer able to
handle it. The advice to towns and to private agencies is, of course,
the more important phase of the work in that it means the extension
of the educational facilities to a larger group of people. For this
reason the assistance we have given to cities and towns in the way of
talks on food will have to be curtailed unless our force is augmented.
During the past year an advisory committee on nutrition was
formed, made up of representatives of the larger organizations inter-
ested in this subject. Several meetings of this committee were held
278 DEPAETMEXT OF PUBLIC HEALTH. [Pub. Doc.
and much discussion ensued which proved to be helpful in the De-
partment's work.
A special edition of our bimonthly bulletin, " The Commonhealth,"
has been issued which is devoted to setting forth the different phases
of the nutritional problem and the way in which it is being handled
by the different interested agencies in the State.
Mouth Hygiene.
Educational work along the lines of mouth hygiene has been de-
veloping with startling rapidity. Although a comparatively new move-
ment, it apparently has made an appeal to the public imagination far
in excess of that made by other phases of public health work which
have been for a much longer period before the public eye. The Di-
vision of Hygiene began its activities in this field last year with the
appointment of a public-spirited dentist as supervisor of mouth hy-
giene. The service rendered the State in this instance was gratuitous
but of the greatest value. An advisory committee on dental hygiene
was also established, consisting of a group of well-known dentists whose
interest in the preventive side of dentistry is sufficient to make them
willing to serve on such a committee. Later in the year a temporary
appointment was made of a health instructor in mouth hygiene.
This position proved to be of such value that an appropriation was
secured in 1920 which enabled us to make this a permanent appointment.
In mouth hygiene, as in nutrition, the first step taken was in the
direction of talks and literature designed to reach the general public
and to inform it as to the importance of the care of the mouth and
teeth. The health instructor in mouth hygiene visited many cities
and towns, talking to the school children and speaking before adult
audiences. Various pamphlets on the subject were written and dis-
tributed in very large numbers. A letter was prepared to be read in
all the schools in order to reach in a more personal way the many
thousands of school children in the State. A dental hygiene exhibit
was prepared which has been shown at fairs and during health weeks.
The second phase of the work has now been reached. The demand
for lectures continues as great as ever and in addition we are receiving
an increasing number of calls for expert advice as to the best ways of
starting dental work in the different cities and towns. It is easy to
see that if we are to furnish this advice and if we are to keep up
with the duty of preparing new written material from time to time,
we must have the services of at least one person for this work alone.
For this reason a second health instructor in mouth hygiene is being
asked for this year.
No. 34.] DIVISION OF HYGIENE. 270
Cliuici' for flic Child in the Rural Connuimtty.
During the agricultural fair season of 1919, as mentioned in my
last annual report, an attempt was made on a small scale to reach the
child in the rural districts through the offer of free medical examina-
tion hy a competent pediatrician. It Avas felt that the results of this
experiment justified the extension of the work. An appropriation was
obtained for 1920 to place this activity upon a permanent basis. One
clinic physician was appointed, and a tentative plan was made to
cover the more inaccessible parts of the State during the summer and
fall. Two objects were kept in view: to paint a comprehensive pic-
ture of the actual conditions under which the country child grows up
and the result as seen in the cliild, and to arouse local interest in im-
proving these conditions.
The clinic physician started in June, 1920, to carry out this pro-
gram. The Berkshires were selected as representing the most isolated
farming district. An additional fact of great interest was that here
could be found a chance to study the conditions under which our
country children of native stock live. A few weeks were spent at the
inception of the work in visiting the small towns of this territory, mak-
ing calls upon local physicians, teachers, school boards and others to
explain what we had in mind and particularly to emphasize that our
work was intended to be preventive rather than curative. Many of
the larger towns were also visited in order to determine the hospital
and dispensary facilities which might be useful to those found in need
of such service. Real co-operation was obtained from many, par-
ticularly farm bureaus, the Red Cross and school authorities. There
was very little antagonism on the part of any one, although, as was
naturally to be expected, the majority'' of those reached were rather
indifferent, probably because of the novelty of the undertaking.
These rural clinics were conducted in as simple a manner as possible.
The examinations were thorough, but the use of expensive accessories
was discouraged. Instead of using an automobile fitted up as a clinic,
the local schoolhouse or similar building was used. It was intended
that the community should be impressed in every way possible with
the fact that nothing was being done which they might not reasonably
hope to duplicate. Our purpose from the very start was to show the
community the existing need for better supervision of the health of its
children and to show them how such supervision could best be carried
out by themselves with what assistance in advice and demonstration
the State could give. In every instance where the children were ex-
amined, an attempt was made to have the parents present in order
280 DEPARTIMENT OF PUBLIC HEALTH. [Pub. Doc.
that the facts discovered might be discussed with them. If defects
were found which called for treatment, the case was at once referred
to the family physician if there were one. Where public health nurses
were available they were urged to follow up the children who were
shown to be suffering from defects in order that they might aid the
parents to have these defects corrected.
Most of the school examinations were made in the entry way of one-
room school buildings, the door into the schoolroom being closed for
privacy and the door overlooking the hillside being left open for light
and air. The children were dismissed from class one at a time without
interrupting the school routine, and examined as completely as was
possible under such conditions. Posture, nutrition, musculature, os-
seous system and any deformities were noted. Heart and lungs were
gone over and the possibility of abdominal disease was kept in mind.
Then the head, eyes, nasopharynx, teeth, scalp, skin and glands were
considered, also the nervous condition and general well or ill being.
So far as time permitted, diet and habits were discussed and suitable
advice given. A record was kept of all examinations, and copies of
a summary were sent to the superintendent, teacher or some one else
sufficiently interested to volunteer to follow up the cases needing over-
sight. In almost all of the small towns visited there was no school
nurse or visiting nurse of any kind.
During the summer twenty-eight clinics were held and nearly 1,600
children examined. From a study of the records of the first 200 school
children examined, between the ages of five and fifteen years, living
on farms in an unusually healthful section of the Berkshires, the fol-
lowing facts appear: Eighty-five per cent of these children have de-
caying teeth. Only 10 per cent have had any dental care whatsoever.
Sixteen and five-tenths per cent have pathologically enlarged tonsils.
Fourteen and five-tenths per cent have adenoids so hypertrophied as
to interfere seriously with respiration. Fourteen and five-tenths per
cent have vision so defective as to be evident without special tests.
Two and five-tenths per cent have scoliosis; 2 per cent, kyphosis; 5
per cent, enlarged thyroids; 2.5 per cent, heart symptoms; 1.5 per
cent, chronic otitis media. A notable fact, and one which reflects
upon the administration of health laws as regards school children, is
that 50.5 per cent of these school children have not been successfully
vaccinated.
Cancer Control.
Our activities in the direction of cancer control have followed the
lines laid down last year. We have continued our relationship with
the Cancer Commission of Harvard University, which has enabled us
No. 34.] DIVISION OF HYGIENE. 281
to offer free diagnosis to all physicians of the State for pathological
specimens suspected of being cancerous. A special booklet on the
subject of cancer was sent out to physicians in the State.
Edncaiional Work.
Our educational work carried on through health weeks, moving
pictures, lectures, including those with the stereopticon view, pam-
phlets and demonstrations on the care of the baby have been con-
tinued this year as in previous years. An exhibit on mouth hygiene
has been added and is proving of great value, also one on the school
lunc?h.
As many as possible of the agricultural fairs were reached again this
year. Noteworthy among these was the Eastern States Exposition at
Springfield, where we had the use of a small, well-arranged, separate
building, through the courtesy of Mrs. Storrow. At most of the fairs
we had, in addition to the demonstrations by the nurse in charge of
our exhibit, additional demonstrations by a dental hygienist and a
nutritionist. In a number of instances the home demonstration agents
of the Massachusetts Agricultural College joined with us for this
purpose. Our pediatrician also weighed and measured children at
many of the fairs and advised with such parents as were interested in
improving the health of their children.
The Division has issued a number of new or revised pamphlets this
year, including "The School Lunch," "Fly Danger," "Cancer Facts
Every Adult Should Know," "Suggested List of Books on Hygiene
for the Town Library," "Instructions for Home Care of the Mouth,"
" How Cooking affects the Digestibility of Foods," " Do You Know
That" (a pamphlet on mouth hygiene), "The Baby and You" (re-
vised edition), "Carbohydrate Foods" (revised edition), "The Control
^f Ophthalmia Neonatorum," "School Health Program," "Illustrated
Lectures and Moving Pictures."
We have purchased for use throughout the State two moving-pic-
ture films entitled "An Equal Chance" and "Mouth Hygiene." The
former film has to do with the importance of the public health nurse;
the title of the latter explains its subject-matter.
Our prenatal and postnatal letter service has been continued during
the year. New requests for prenatal letters have been received to
the number of over 2,000; requests for postnatal letters, exclusive of
those being carried along from our prenatal letter file, number about
500.
Two interesting developments of our lecture service during the past
year deserve to be recorded. The first was the giving of a series of
282
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
three talks before the students of the normal schools of the State on
public health subjects. These lectures were arranged through the
courtesy of the State Department of Education. It is planned to repeat
this course during the coming year. The second was a series of talks
to nurses in training given largely through the District Health Officers
and their nursing assistants, but participated in by the Division of
Hygiene, by the presentation of the subjects of child hygiene in gen-
eral and school nursing in particular. This course, also, is to be re-
peated during the coming year.
Statistical tables relative to health weeks, exhibits and lectures
follow: —
Exhibits were given at the following places for health weeks or
health days from Dec. 1, 1919, to Nov. 30, 1920: —
Barre^ (twice).
Bolton.
Boston ^ (five times) .
CUnton.
Hardwick^ (t\sice).
Harvard.
Hingham.
Lancaster.
Lee.
Leicester.
Lowell.
Ludlow.
North Adams.
North Brookfield.
Quincy.
Soraerville.
Uxbridge.
Winchendon.
Worcester.
Exhibits were given at the following agricultural fairs : —
Athol.
Nantucket.
Springfield.
Walpole.
Ware.
Westport.
Lectures were given on the following subjects during the year: —
Legislation, 19
Preventable Diseases, . . .17
Sanitation, 14
Work of State Department of
PubUc Health, .... 4
Rural Sanitation, .... 1
Wear and Tear Diseases of Adult
Life, 1
Mouth Hj'giene,
. 267
Public Health,
. 102
Venereal Diseases and Social
Hy-
giene, ....
. 95
Foods, ....
. 69
Child Welfare,
. 53
School Hygiene,
. 39
Communicable Diseases,
. 37
PubUc Health Nursing,
. 32
Personal Hygiene, .
. 24
Tuberculosis, .
. 20
Total,
. 794
1 Different sections of the town.
Xo. 34.]
DIVISION OF HYGIENE.
283
Lectures were given during the year, by months, with the approxi-
mate number of people reached, as follows: —
Month.
Lectures.
Number
present.
1919.
December, .....
1920.
January
February, .....
March,
April,
May
June,
July
August,
September
October
November, .....
Totals, .....
62
794
11,997
.50
9,580
26
2,886
68
6,867
168
20,342
177
18,444
80
8,467
24
1,278
7
265
13
1,627
56
4,518
63
9,039
95,310
During the fiscal year ending Nov. 30, 1920, lectures were given in
the following cities and towns: —
Abington,
1
Brookline,
2
Acton,
3
Burlington,
1
Acushnet,
1
Cambridge,
6
Agawam, .
2
Canton,
1
Amherst, .
4
Chatham,
2
Andover, .
4
Chelsea,
5
ArHngton,
5
Chesterfield,
3
Ashby,
2
Chnton, .
10
Attleboro,
1
Concord, .
1
Barnstable,
11
Conway, .
1
Barre,
8
Cummin gton,
1
Becket,
1
Danvers, .
1
Bedford, .
2
Dedham, .
1
Belchertown,
5
Deerfield,
6
Billerica, .
3
Dighton, .
2
Bolton,
2
Easthampton,
1
Boston, .
132
Easton,
6
Boxford, .
1
Everett,
2
Braintree,
3
Fall River,
3
Brewster, .
1
Falmouth,
1
Bridgewater,
7
FiTCHBURG,
9
284
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Foxborougli,
Framiugham,
Gardner, .
Gloucester,
Goshen, .
Grafton, .
Granby,
Greenfield,
Grot on,
Groveland,
Hadley, .
Hanover, .
Hanson, .
Hard wick,
Harvard, .
Harwich, .
Haverhill,
Hingham,
Holden, .
HOLYOKE,
Hopedale,
Huntington,
Lancaster,
Lawrence,
Lee, .
Leicester, .
Lenox,
Leominster,
Lexington,
LOAVELL, .
Ludlow, .
Lynn,
Malden, .
Marblehead,
Mattapoisett,
Medford,
Melrose,
Middleborough
Milford, .
Millbury, .
Milton, .
Natick,
Needham,
Newburyport,
Newton, .
North Adams,
Nortil\mpton,
2
Northborough,
4
North Brookfield,
3
Norton, .
1
Norwell, .
1
Norwood,
3
Orleans, .
1
Oxford,
7
Petersham,
1
Pittsfield,
1
Princeton,
9
QUINCY, .
9
Randolph,
1
Reading, .
8
Revere, .
3
Richmond,
3
Rockport,
16
Rutland, .
14
Salem,
4
Sandwich,
4
Saugus, .
1
Scituate, .
6
Shelburne,
1
Shirley,
5
Shrewsbury,
1
Somerville,
5
Southampton,
1
Southbridge,
5
Spencer, .
8
Springfield,
55
Sterling, .
1
Stoneham,
16
Sunderland,
5
Sutton,
2
Swampscott,
3
Topsfield,
1
Townsend,
1
Uxbridge,
6
Wakefield,
1
Walpole, .
1
\Valtil\m,
1
Ware,
1
Wareham,
1
Watertown,
4
Webster, .
13
Wellfleet, .
9
Westborough, .
9
West Boylston,
No. 34.]
DIVISION OF HYGIENE.
285
Westfield,
4
Williamsburg, .
2
Westhampton,
. 3
Winchendon, .
. . 7
Westport,
. . 3
Winchester,
. 8
West Springfield,
1
Winthrop,
2
Weymouth,
. 1
WOBURN, .
1
Whitman,
. 2
Worcester, .
. 84
This makes a total of 148 cities and towns in Massachusetts where
lectures were given by Department lecturers.
Special ]]'ork.
Reference was made in the last annual report of this Division to
the situation in Massachusetts as regards maternal and infant mor-
tality. It was pointed out that the trend of the total mortality of
infants under one year of age in this State is downward, with occa-
sional rises like that of 1918. The total rate for 1919 was lower than
we have yet had in this State. It was further pointed out, however,
that the infant mortality during the first four weeks of life is not
diminishing and that the mortality among women fifteen to forty-five
years of age from causes due directly to childbirth is increasing in this
State.
Certain bills introduced into last year's Legislature looked towards
financing an effort to reduce this mortality amongst mothers and
babies. No bill was passed during 1920 but a resolve which created
a special commission to study the whole question of the protection of
mothers and infants was passed instead. The Director of the Di-
vision of Hygiene served as director of investigations at the request of
the special commission. The results of the study of the commission
are available in the report to the special session of the Legislature held
in December, 1920. It is fitting, however, to point out here a few of
the facts brought out by the investigation because of their far-reach-
ing bearing upon infant and maternal mortality in Massachusetts.
It has been generally considered that poverty is one of the great
underlying causes of infant mortality. Studies by the Children's Bu-
reau have shown that in the areas studied the infant mortality in-
creased as the income of the fathers decreased. It has been generally
assumed that this would be true of the maternal mortality and of the
infant mortality during the first two or three weeks. The results of
the Massachusetts investigation show that this is not so. More than
half the mothers who died came from families where the total income
was undoubtedly sufficient to pay for medical care. It was shown that
none of the mothers who died had had what might reasonably be
286 DEPARTMENT OF PUBLIC HEALTH. [P. D. No. 34.
called adequate prenatal care. Furthermore, it was demonstrated in
a study of a thousand cases that 50 per cent of the infants who died
had one visit or none at all from a physician before death. Another
interesting fact brought out was that most of the homes where mothers
died showed, in the opinion of competent observers, fair or good hous-
ing conditions.
The logical conclusion to be drawn from the facts stated above seems
to be that mothers and infants die in Massachusetts largely because
of neglect of hygiene. This conclusion justifies us in continuing the
plan we have always followed of directing our efforts towards the
education of our citizens in matters of personal hygiene. It further
confirms us in our belief that this can be most effectually done through
the extension of public health nursing service in the homes of the
citizens of the Commonwealth.
Division of Tubeeculosis (Sanatoria)
William J. Gallivan, M.D., Director
[287]
Eeport of Diyision of Tuberculosis (Sanatoeia).
The Division of Tuberculosis was established Dec. 1, 1920, pur-
suant to chapter 350 of the General Acts of 1919. By the provisions
of this act the Board of Trustees of Hospitals for Consumptives was
abolished and all the rights, powers, duties and obligations of said
Board were transferred to the Department of Public Health. The
Commissioner of Public Health was further directed by said act to
establish a division within said Department to supervise the adminis-
tration of the sanatoria.
Previous to the passage of this act the tuberculosis work of the
Department of Public Health was confined to the Division of Com-
municable Diseases. An important step taken by this Division was
the compilation of all known cases of tuberculosis in Massachusetts
from Jan. 1, 1915, to Jan. 1, 1920. This work has been transferred to
the Division of Tuberculosis. The Division of Tuberculosis therefore
has the administrative supervision of the four State sanatoria, the
supervision of all known cases of tuberculosis in the State, and the
general supervision of all tuberculosis activity in the Commonwealth.
We are fond of referring to the fact that Massachusetts was the
first State in the Union to erect and maintain a hospital for consump-
tives. Always a pioneer in all that pertains to the benefit of humanity
this grand old Commonwealth blazed the trail in the effort to stamp
out the great white plague, and in 1898 opened the doors of the first
State sanatorium for consumptives in America at Rutland, Mass. The
wheels of legislation necessary for this glorious achievement were
started on Jan. 30, 1895, by the introduction of the following bill: —
An Act to establish the Massachusetts Hospital for Consumptives and
Tubercular Patients.
Be it enacted, etc., as follows:
Section 1. The governor, with the advice and consent of the council, shall
appoint five persons who shall constitute the board of trustees of the Massa-
chusetts hospital for consumptives and tubercular patients, and who shall hold
office for temis of one, two, three, four and five years respectively, beginning -with
the first Monday of July in the present year, and until their respective successors
are appointed and qualified; and previous to the first Monday in July in each
year hereafter, the governor shall in like manner appoint one such trustee to hold
office for the term of five years, beginning with the first Monday in July of the
290 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
year of his appointment, and until his successor is appointed and quahfied. Any
such trustee may be removed by the governor with the advice and consent of
the council for such cause as they may deem sufficient and as shall be assigned in
the order for removal. Any vacancy occurring in said board shall be filled in
like manner for the unexpired term.
Section 2. The lands held by said trustees in trust for the Commonwealth
for the use of said hospital, as hereinafter provided, shall not be taken for a
street, highway or railroad without leave of the legislature specially obtained.
Section 3. Said trustees shall be a corporation for the same purposes for
which the trustees of each of the state lunatic hospitals are made a corporation
under section five of chapter eighty-seven of the PubUc Statutes, with all the
powers necessary to carry said purposes into effect.
Section 4. Said trustees shall have authority to purchase in behalf of the
Commonwealth suitable real estate as a site for said hospital, and to cause to be
erected thereon suitable buildings for said hospital which shall furnish suitable
accommodations for not less than two hundred patients and for the officers, em-
ployees and attendants, and to provide for the equipment and furnishing of said
buildings : Provided, howeve •, that the expenditure for carrying out the purpose
of this act shall not exceed one hundred and fifty thousand dollars. No ex-
penditure shall be made for the erection of buildings except for plans therefor,
until said plans have been approved by the governor and council, and no such
approval shall be given unless the governor and council shall be satisfied that the
cost of the real estate and the erection and completion of buildings and the
equipment and furnishing of the same ready for occupancy will not exceed one
hundred and fifty thousand dollars. Said trustees shall have authority to make
all contracts and employ all agents necessary to carry into effect the provisions
of this act.
Section 5. Said trustees shall have the same powers vested in them and
shall be required to perform the same duties for the management and control of
said hospital as are vested in and required of the trustees of the Massachusetts
hospital for dipsomaniacs and inebriates.
Section 6. When the buildings constructed under the provisions of this act
are so far completed that in the opinion of said trustees they may be properly
used for the purposes of said hospital said trustees shall notify the governor, who
shall thereupon issue his proclamation establishing said hospital.
Section 7. After the establishment of said hospital said trustees shall receive
no compensation for their services, but they shall be reimbursed from the treas-
ury of the Commonwealth for all expenses actually incurred by them in the per-
formance of their official duties. The governor and council shall fix the com-
pensation to be made to them for services rendered in the selection and purchase
of real estate and the construction, equipment and furnishing of the hospital
buildings.
Section 8. Said trustees may appoint all necessary physicians, assistants
and employees necessary for the proper administration of the affairs of said
hospital and may incur all expenses necessary to the maintenance of the same;
but the annual expense incurred under this section shall not exceed
thousand dollars.
No. 34.] DIVISION OF TUBERCULOSIS (SANATORIA). 291
Sectiox 9. Such inmates of said hospital able to pay for their board shall
be charged for the same. The board of such inmates as have a legal settlement
in some city or town shall be paid by said city or to%vn if such patients are re-
ceived at said hospital on the request of the overseers of the poor of said city or
touTi. The trustees may in their discretion receive other patients who have no
means to pay for treatment; and the board of all such patients shall be paid from
the treasury of the Commonwealth.
Section 10. There shall be thorough visitations of said hospital by two of
the trustees thereof monthly, and by a majority of them quarterly, and by the
whole board semi-annually, at each of which a written account of the state of
the institution shall be drawn up, which shall be presented at the annual meet-
ing to be held between the first days of the months of October and November.
At the annual meeting the trustees shall make a detailed report in the same man-
ner as is required of the trustees of the state lunatic hospitals, and shall audit the
report of the treasurer, which shall be presented at said annual meeting, and
transmit it with their annual report to the governor and council.
Section 11. The accounts and books of the treasurer shall at aU times be
open to the inspection of the trustees.
Section 12. This act shall take effect upon its passage.
Many hearings were held on this measure; violent opposition as well
as enthusiastic support was in evidence, but in June, 1895, the bill
was passed and became a law. The three subsequent years were spent
by the trustees in investigation, study and construction. The various
problems of climate and altitude were carefully considered, and after
a most thorough and painstaking study the town of Rutland was
chosen as the best location for the sanatorium.
The original capacity of the sanatorium was 150 beds. From time
to time additional wards were added. Admission to the sanatorium
was obtained only upon the certificate of experts appointed to make
physical examinations and to certify for admission only cases which
were favorable for arrest. In spite of such precaution the 350 beds
in the sanatorium were constantly filled and a long waiting list of
applicants for admission drew attention to the tuberculosis situation
in Massachusetts.
In 1907 an appropriation was made for the construction of three
additional sanatoria. The work of constructing these institutions was
entrusted to a newly organized Board of Trustees of Hospitals for
Consumptives, and upon their completion the Board of Trustees of
the Rutland State Sanatorium was abolished.
The additional sanatoria were located at North Reading, Lakeville
and Westfield, and opened their doors for the admission of patients
in 1909 and 1910, respectively. The completion of these sanatoria
made available 450 additional beds for consumptives. From time to
time additions were made to these institutions so that to-day there
292 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
are available for consumptives in the four State sanatoria 1,100 beds,
as follows: Rutland, 350 beds; Lakeville, 275; Westfield, 275;
North Reading, 200.
Under the policy of the new Board of Trustees these sanatoria were
rapidly filled and a waiting list was easily established. The custom of
admitting to the Rutland Sanatorium only incipient cases was con-
tinued. Residence at Rutland was limited to two years and all
patients were admitted on a thirty days' trial. Cases which ap-
peared unfavorable for arrest and cases which had completed their
time limit were transferred from Rutland to the other sanatoria.
Admission to the State sanatoria was open to persons, male and
female, over fifteen years of age, except at Westfield where 165 beds
were reserved for children between the ages of five and fifteen years.
At Westfield a school with a modern curriculum was maintained so
that children undergoing treatment might have educational oppor-
tunities.
At this time of our world's history let it be remembered that gen-
eral hospitals had closed their doors to persons ill with pulmonary
tuberculosis. Outside of the few private hospitals which harbored
consumptives there was no "Inn at Bethlehem" for persons suffering
from this disease. The medical profession could only recommend a
change of climate, a form of treatment practiced by Hippocrates who
lived in 400 B.C. Such treatment could be had only by the well-to-do.
The poor consumptive had no alternative but to remain at home in-
fecting unwittingly those who were near and dear to him. And so the
wisdom of the policy of the trustees of admitting to the new sanatoria
advanced cases of consumption is apparent.
Such is the charge committed to our care: a group of sanatoria
successfully administered for twenty-six years by unpaid Boards of
Trustees, such as Massachusetts can always summon to her aid for
advice and achievement.
Additional milestones in the progress of tuberculosis work in Massa-
chusetts are: first, the act of the State Department of Health declar-
ing tuberculosis a disease dangerous to the public health; second, the
dispensary act, requiring every city and every town containing a pop-
ulation of 10,000 or more to maintain a dispensary for the diagnosis
and treatment of needy patients afflicted with tuberculosis; third, the
county hospital act.
The early colonists who settled in Massachusetts recognized the
danger to the community of communicable disease. One of the earliest
acts on the statute books in Massachusetts is chapter 75 of the Re-
vised Laws, requiring cities to make hospital provision for cases of
No. 34.] DIVISION OF TUBERCULOSIS (SANATORIA). 293
sickness declared by the State Department of Health to be dangerous
to the public health. In 1907, when tuberculosis was added to the
list of such diseases, automatically it became necessary for cities to
make provision for the hospital care of consumptives. This law was
pretty generally violated in regard to care of tuberculosis patients. In
1916 the county hospital act was passed, which provided that cities
of 50,000 or more in population must maintain hospitals for tubercu-
lous patients and that cities of less than 50,000 shall contract and
support a county hospital. All the counties of the State have com-
plied with this law except Worcester and Middlesex counties, and the
district of Chelsea, Revere and Winthrop, the latter having been
allowed to combine in meeting the requirements of the county act.
Extension of time has been granted these counties for the fulfillment
of their obligations on account of the abnormal conditions prevailing
at the present time regarding the high cost of building material and
labor. Five county hospitals are completed and functioning. The
Essex County Tuberculosis Hospital is nearing completion and will
admit patients at an early date. The total bed capacity of these
county hospitals is as follows: Bristol County at Attleboro, 60 beds;
Barnstable County at Bourne, 26 beds; Norfolk County at Braintree,
71 beds; Plymouth County at South Hanson, 66 beds; Hampshire
County at Northampton, 50 beds; Essex County at Middleton, 112
beds.
x\s a further result of this act there are in operation 14 municipal
tuberculosis hospitals in the State, with a total bed capacity of 1,127
beds; 8 private incorporated tuberculosis hospitals, with a total bed
capacity of 179 beds.
The dispensary act, passed in 1911, provided that every city and
town of 10,000 population or over shall maintain dispensaries for the
diagnosis of tuberculosis. As a result of this act there are 54 dis-
pensaries functioning under the supervision of the State Department
of Public Health.
Such is the machinery which Massachusetts has provided for the
conquest of consumption.
The present time seems opportune to revise the policy governing the
State sanatoria. With the excellent equipment which the State has
provided in its chain of county and municipal tuberculosis hospitals,
the time seems ripe to place the four State sanatoria on an even foot-
ing and to admit to these institutions only cases favorable for arrest.
The continued residence of patients in the sanatoria extending over
a period of five to ten years will simply convert the sanatoria into
homes for consumptives and will defeat the very object for which
294
DEPAETMENT OF PUBLIC HEALTH. [Pub. Doc.
sanatoria strive. Sanatorium treatment aims to arrest the disease
and to turn the patients back to society capable of self-support. The
heartiest co-operation on the part of the patient is essential for this
achievement. It is estimated that intensive sanatorium treatment of
one or two years' duration should accomplish this object, and failure
to record such results is believed to be due to lack of co-operation or
to the unsuitability of the case for sanatorium treatment. Before such
a policy can be put into effect much preliminary work is needed.
Some of these preliminary steps have been taken and will be described
under separate headings.
Consultation Clinics.
Medical literature teems with criticism of the general practitioner
for failure to recognize the early signs and symptoms of pulmonary
tuberculosis. Trite as this subject is, cases of pulmonary tuberculosis
in a hopeless condition are still being referred to the sanatoria by
general practitioners. In one instance a patient so referred died at
the doors of the sanatorium. In another instance a case classified as
pretuberculous was placed on the dangerous list immediately upon ad-
mission and died in a few weeks. To meet this condition a series of
consultation clinics has been inaugurated where general practitioners
may secure, without charge, the diagnosis of an expert. These clinics
consist of a high-grade consultation service. Patients examined at
these clinics must be accompanied or referred by their family phy-
sician, to whom a written report is made. The following table shows
the location of these clinics: —
City
OR Town.
Location.
Time.
Consultants.
Worcester,
Gardner,
Fitchburg,
Clinton,
Lowell, .
Lawrence,
Haverhill,
Woburn,
Municipal Tuberculosis Dispensary,
Belmont Hospital.
Municipal Tuberculosis Dispensary,
Municipal Building, 83 Pleasant
Street.
Municipal Tuberculosis Dispensary,
366 Main Street.
Municipal Tuberculosis Dispensary,
Municipal Building.
Municipal Tuberculosis Dispensary,
City Hall.
Municipal Tuberculosis Dispensary,
37 Jackson Street.
Municipal Tuberculosis Dispensary,
City Hall.
Municipal Tuberculosis Dispensary,
Board of Health Rooms.
1st Wednesday of each
month, 2 to 5 p.m.
2d Wednesday of each
month, 2 to 5 p.m.
3d Wednesday of each
month, 2 to 5 p.m.
4th Wednesday of each
month, 2 to 5 p.m.
1st Wednesday of each
month, 2 to 5 p.m.
2d Wednesday of each
month, 2 to 5 p.m.
3d Wednesday of each
month, 2 to 5 p.m.
4th Wednesday of each
month, 2 to 5 p.m.
Medical staff of the Rut-
land State Sanatoriimi.
Medical staff of the Rut-
land State Sanatoriimi .
Medical staff of the Rut-
land State Sanatorium.
Medical staff of the Rut-
land State Sanatorium .
Medical staff of the
North Reading State
Sanatorium.
Medical staff of the
North Reading State
Sanatorium.
Medical staff of the
North Reading State
Sanatorium.
Medical staff of the
North Reading State
Sanatorium.
No. 34.] DIVISION OF TUBERCULOSIS (SANATORIA). 295
City
OR Town.
Taunton,
Brockton,
Fall River,
Plymouth,
Pittsfield,
Springfield,
Holyoke,
Adams, .
Location.
Municipal Tuberculosis Dispensary,
City Hall.
Municipal Tuberculosis Dispensary,
Board of Health Office, City Hall.
Municipal Tuberculosis Dispensary,
Purchase Street.
Municipal Tuberculosis Dispensary,
Room G, Governor Bradford
Building, Town Square.
Municipal Tuberculosis Dispensary,
House of Mercy Hospital.
Municipal Tuberculosis Dispensary,
137' 2 State Street.
Municipal Tuberculosis Dispensary,
City Hall Annex, Room 412.
Municipal Tuberculosis Dispensary,
Greylock Bank Building.
Time.
Consultants.
1st Wednesday of each
month, 2 to 5 p.m.
2d Wednesday of each
month, 2 to 5 p.m.
3d Wednesday of each
month, 2 to 5 p.m.
4th Wednesday of each
month, 2 to 5 p.m.
1st Wednesday of each
month, 2 to 5 p.m.
2d Wednesday of each
month, 2 to 5 p.m.
3d Wednesday of each
month, 2 to 5 p.m.
4th Wednesday of each
month, 2 to 5 p.m.
Medical staff of the Lake-
ville State Sanatorium.
Medical staff of the Lake-
ville State Sanatorium.
Medical staff of the Lake-
ville State Sanatorium.
Medical staff of the Lake-
ville State Sanatorium.
Medical staff of the West-
field State Sanatorium.
Medical staff of the West-
field State Sanatorium.
Medical staff of the West-
field State Sanatorium .
Medical staff of the West-
field State Sanatorium.
Facilities for consultation are provided at each State sanatorium for
every day of the week (Saturdays, Sundays and holidays excepted)
between the hours of 2 and 5 o'clock.
Attendance at these clinics is not restricted to the inhabitants of the
cities named. Physicians are invited to make use of any clinic, it
being inferred that they will select the one nearest their home city or
town.
The Department of Public Health earnestly pleads for the co-oper-
ation of the family physician in this consultation service.
Further extension of this service will require additions to the sana-
toria staff and plans are already in preparation for this step, which
will increase the number of men properly trained for this work.
Examination Clinics.
No report of the progress in tuberculosis work in this State would
be complete without recording the untiring efforts of the Massa-
chusetts Anti-Tuberculosis League in securing expert examination of
contacts. In cities and towns of 10,000 population and over, such
service is rendered by tuberculosis dispensaries, as provided by chap-
ter 576, Acts of 191L In smaller towns where no such provision is
made, the League has vigorously prosecuted its work and has ap-
pealed to the sanatoria for assistance. Willing co-operation has been
granted by the creation of a series of examination clinics. Upon due
notice from the League, the sanatoria staff will examine all cases pro-
vided by the League. This service provides expert diagnosis for
cases of contacts and suspects which the case finding activity of the
Massachusetts Tuberculosis League provides.
296 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Observation Hospital.
Everybody agrees that the diagnosis of early pulmonary tubercu-
losis is oftentimes a very difficult matter. In many cases it requires
expert observation extending over a period of weeks. Under our
existing statutes only cases definitely classified as tuberculous can be
admitted to the State sanatoria. An observation hospital, conducted
on the same plan as the Psychopathic Hospital follows in its intensive
study of mental diseases, seems desirable. From this hospital cases
properly classified could be referred to the various sanatoria and tu-
berculosis hospitals.
Subsidy.
Cities and towns which under certain conditions provide hospital
care for bacillary cases of pulmonary tuberculosis are reimbursed by
the State at the rate of S5 per week for each person. Further legis-
lation extended the granting of this subsidy for hospital care of non-
bacillary cases. For the year ending Nov. 30, 1920, this Division has
received 2,481 claims for subsidy. Of this number, 1,662 claims,
amounting to $135,720.05, were approved.
Examination of Prisonees.
At the request of Mr. Sanford Bates, Commissioner of the Depart-
ment of Correction, a physical examination, with particular reference
to the diagnosis of pulmonary tuberculosis, was made of the inmates
of jails, prisons and houses of correction in the State. This examina-
tion was made by the staffs of the various State sanatoria, with the
following results: —
Number of prisoners examined, 1,500
Active pulmonary tuberculosis, 7
Further observation, 43
Public Health Nurses.
Local boards of health are entrusted with the supervision of dis-
eases declared dangerous to the public health which occur within their
territory. For this purpose public health nurses are employed. In
order to stimulate interest in the supervision of cases of pulmonary
tuberculosis the Division has organized the public health nurses of all
the cities and towns in the State into groups based upon the terri-
torial assignments of the District Health Officers. It is planned to
have these nurses meet at the various sanatoria, where tuberculosis
problems will be discussed and sanatorium conditions observed.
No. 34.] DIVISION OF TUBERCULOSIS (SANATORIA). 297
Consultants.
The need of consultants in diseases other than tuberculosis in the
State sanatoria is becoming more pressing. Patients in these institu-
tions often develop intercurrent complications which retard their im-
provement. Particularly is this true in cases of diseases of the nose,
throat, eye and ear. Defective teeth are a frequent source of com-
plaint. Surgical conditions frequently arise and mental cases are not
infrequent. To meet these conditions it is planned to place at an
early date in each sanatorium a full-time dental hygienist supple-
mented by a part-time dentist. Part-time consultants in the various
diseases mentioned must soon be furnished to insure the full measure
of care which Massachusetts provides for her afflicted ones.
Follow-up Work.
There is on file in this Division a list of all known cases of tuber-
culosis reported within the past five years. This list numbers about
20,000 cases. Supervision of these cases comes within the duties of local
boards of health. In every case an original history card is required, as
follows : —
DEPARTMENT OF PUBLIC HEALTH
Tuberculosis
(City or Town) Date
Form of disease S. M. W. Sex
Name of patient, Pos- sputum date, Age
(Surname first) Neg. sputum date, Color
Residence, Birthplace,
Last previous address. Nationality,
In U. S.,
Where is the patient at this date, In this place.
Reported (to local Board of Health) (to Dept. of Public Health)
(Section 52, Revised Laws, 75)
Institutional History
Date of Sanatorium Date of Condition Date of Condition Sputum
application or hospital admission on admission discharge on discharge
Occupation now. Full or part time
Occupation when illness began, Does working make patient worse.
Present medical supervision (name of physician, or dispensary, if any).
Illness began. Present condition,
If not working, how does patient spend time.
Personal hygiene (including care of sputum).
Home sanitation. Occupation sanitation.
Anything to suggest cause of disease or source of infection,
What immediate help, if any, should patient have.
Condition of other members of household,
(If tuberculous, give names)
Remarks (including briefly, family and personal history — with names and dates of respiratory dis-
eases, if any).
Husband's full name.
(Signature of tuberculosis worker or investigator)
If minor, father's full name.
298
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Follow-up work is continued by this Division. Every six months
a report of these cases is required, as follows:- —
DEPARTMENT OF PUBLIC HEALTH
Division of Tuberculosis
Follow-up Card
Town .
Name Address
Date.
Supervision.
Work.
Sputum.
Remarks (including any special
feature of case).
NORTH READING STATE SANATORIUM.
Resident Officers.
Carl C. MacCorison, M.D.,
Earle C. Willoughby, M.D.,
Joseph W. Redd-x, M.D.,
Kathrtn V. Daily,
MiRA B. Ross, .
J. Ellis Doucette,
Daniel J. Scott,
Edward Leary,
Superintendent.
Assistant Superintendent
and Physician.
Assistant Physician.
Sxiperintendent of Nurses.
Matron.
Steward.
Chief Engineer.
Head Farmer.
REPORT OF THE SUPERINTENDENT.
To the Director of the Division of Tuberculosis, Department of Public Health,
Room 365, State House, Boston, Mass.
I have the honor of presenting to you the report of the North Reading State
Sanatorium for the year ending Nov. 30, 1920.
The records show that during the year 471 patients have been treated, and
279 have been admitted. There were 68,919 daj^s of treatment in the year
as against 63,103 days of treatment for the preceding year. The lowest daily
census was 172 and the highest 203. The daily average number of patients
was 188.30, which is SJ per cent more than that of the preceding year.
There have been admitted during the year 3, or 1.09 per cent, incipient; 143,
or 51.25 per cent, moderately advanced; 127, or 45.48 per cent, advanced; 2,
or .71 per cent, nontuberculous ; 3, or 1.09 per cent, not determined.
There has been a daily average of 68 bed cases, — approximately 36 per cent
of the daily population.
No. 34.] DIVISION OF TUBERCULOSIS (SANATORIA). 299
Of the patients discharged, the average duration of residence in the sana-
torium was 209 days, as opposed to 315 days for the preceding year; the longest
residence of any one person was 1,948 days, and the shortest, 1 day.
Of the 279 cases admitted, 231, or 82.79 per cent, were inside workers. Two
hundred and six cases were admitted from cities and to\\iis having a popula-
tion of 25,000 or more, as follows: Boston, 95; Cambridge, 3; Chelsea, 6;
Everett, 13; Fall River, 2; Haverhill, 2; LawTence, 10; Ljmn, 12; Lowell,
16; Maiden, 16; Medford, 3; Newton, 5; Revere, 3; Salem, 4; Somerville, 16.
One hundred and nine cases have been supported from private funds; 224 by
cities and to^\^ls; 100 entirely by the State; 11 by the Bureau of War Risk
Insurance; and 13 private cases have either become State or town charges.
There were remaining on November 30, 18 private cases, 24 city or town cases,
35 State cases, 37 unknown cases, and 2 Bureau of War Risk Insurance cases,
making a total of 186.
Of the patients discharged during the year, 93 males and 68 females had
gained in weight, the total gain being 1,848 pounds. The average male gain
was 11.38 pounds, and the average female gain was 11.6 pounds; 4 patients
remained stationary; 56 had lost; 47 had died; and 17 were not considered.
Three patients, or 1.05 per cent, have been discharged arrested; 14, or 4.91
per cent, apparently arrested; 32, or 11.22 per cent, quiescent; 100, or 35.08
per cent, improved; 55, or 19.29 per cent, unimproved; 47, or 16.49 per cent,
have died; 11.93 per cent were not considered (duration of stay being less than
one month); and 2, or .70 per cent, nontuberculous. The decrease in the
number of deaths over that of preceding years is due to the fact that many
very ill patients were discharged, their relatives preferring to have them pass
away at home.
The average age was 31.43 years. One hundred and twenty-eight patients
were foreign born, and 89 were American born but of foreign parentage. Twenty-
four patients admitted have been previously treated at this sanatorium.
The total cost of maintenance for the year ending Nov. 30, 1920, was $159,-
531.40; deducting $1,008.72 from miscellaneous sources leaves a net amount
expended for maintenance of $158,522.68. The net per capita cost per week
was $16.1896. There has been collected from private patients 18,220.25, and
from cities and towns $21,102.05. Further details will be found in succeeding
pages of this report.
Medical Report.
Our problem relative to the care of bed cases is becoming more difficult. The
increase in admissions of advanced and moderately advanced cases needing
bed treatment has demonstrated more forcibly than ever the necessity of pro-
viding additional wards for this type of case. Our inability to care for bed
cases on open pavilions accounts for the low census of the past year.
Although an appropriation was granted for the employment of a full-time
dentist, we were unable to find a competent man who was wiUing to accept the
position.
300 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Clinics.
In addition to the consultation clinics held at Lowell, Lawrence, Haverhill
and Woburn, many patients have come directly to the sanatorimn for exam-
ination and advice. Quite frequently we have been handicapped in arriving
at a positive diagnosis in obscure cases, and we feel that an X-ray machine
would be of material assistance to us in overcoming this difficulty.
Recommendations.
Our present equipment for fire protection is practically worthless. The
buildings east of the power plant are entirely unprotected, owing to lack of
sufficient water pressure. Should a fire occur in the institution, we would have
to depend principally upon hand fire extinguishers and the water in our 25,000-
gallon tank, with a maximum pressure of about 60 pounds. Our water supply
has given us a great deal of trouble in the power plant, owing to excessive
scaling of the boilers. I would recommend that the sum of S24,470 be ap-
propriated for the installation of a fire protective system, as per plans and
specifications submitted in 1917.
An X-ray outfit would be of great assistance to us in the examination of
patients, and I would recommend that the sum of $5,370.22 be appropriated
for the purchase of an outfit.
We have had frequent vacancies from time to time in our engineering depart-
ment the past year. So many, in fact, that it has been absolutely impossible
for us to make the necessary repairs in the engine room and about the institu-
tion. I would recommend that we employ an additional mechanic for a period
of three months, or until such time as we can catch up on the necessary repairs.
Improvements.
The new chapel and nurses' dormitory was completed in June. Additional
henhouses have been built, and about 1 acre of sprout land cleared for cultiva-
tion. Work was started on the cottage for the chief engineer and steward in
September. In all probability this cottage will be ready for occupancy about
the middle of February.
Medical Staff.
Dr. C. P. Harkins resigned on June 29, 1920, from the staff, and Dr. Joseph
W. Reddy was appointed to fill the vacancy.
Acknowledgments.
The patients and employees appreciate the faithful services of the Catholic,
Protestant, and Jewish chaplains, who in addition to their regular services have
brought comfort and cheer by their frequent visits.
We wish especially to thank the First National Exhibitors for their many
favors.
We acknowledge with grateful thanks the gifts, from various individuals and
churches, of magazines, books, a Bible, various woolen and knit articles, and
the candy, fruit and flowers sent in at Christmas time.
No. 34.] DIVISION OF TUBERCULOSIS (SANATORIA). 301
I wish to thank the heads of departments and the employees for their co-
operation and assistance. I am deeply grateful to the Director of the Division
of Tuberculosis for his support and advice during the year.
Very truly,
Carl C. MacCorison,
Superintendent.
TREASURER'S REPORT.
To the Commissioner of Public Health .
I respectfully submit the following report of the finances of this institution
for the fiscal year ending Nov. 30, 1920: —
Balance Dec. 1, 1919,
Cash Account.
$1,801 04
Receipts.
Institution Receipts.
Board of inmates: — ■
Private,
Cities and towns,
Sales: —
Food
Clothing and materials,
Furnishings and household supplies,
Medical and general care, ....
Heat, light and power,
Farm and stable : —
Pigs and hogs .S19 00
Ice 5 25
Vegetables 2 33
Sundries 416 99
$8,220 25
21,102 05
$29,322 30
$55 37
169 56
40 85
33 34
30 75
Grounds,
Repairs, ordinary.
Miscellaneous receipts: —
Interest on bank balances,
Sundries, . . . .
443
57
8
03
14
66
$139
75
72
84
796 13
212 59
Refund, account of previous year's business.
30,331 02
23 70
Receipts from Treasury of Commonwealth.
Maintenance appropriations: —
Balance of 1919, $10,877 10
Advance money (amount on hand November 30) , . . 8,000 00
Approved schedules of 1920 134,635 96
Special appropriations,
Total,
153,513 06
40,533 34
$226,202 16
302 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Payments.
To treasury of Commonwealth: —
Institution receipts, $30,331 02
Refunds, account of maintenance, . . . $76 56
Account of other 23 70
100 26
,431 28
Maintenance appropriations: —
Balance November schedule, 1919 $12,678 14
Eleven months' schedules, 1920, . . . $134,635 96
Less returned, 76 56
134,559 40
November advances, 6,710 64
Special appropriations: —
Approved schedules $40,533 34
November advances, 129 91
153,948 18
40,663 25
Balance Nov. 30, 1920: —
In bank, $679 93
In office, 479 52
1,159 45
Total $226,202 16
Maintenance.
Balance from previous year, brought forward, ...'.... $789 48
Appropriation, current year, 163,355 00
Total $164,144 48
Expenses (as analyzed below) , 159,531 40
Balance reverting to treasury of Commonwealth, $4,613 08
Analysis of Expenses.
Personal services : —
Carl C. MacCorison, superintendent, ....
Medical,
Administration
Kitchen and dining-room service,
Domestic,
Ward service (male),
Ward service (female),
Engineering department,
Repairs,
Farm,
Stable, garage and grounds,
Religious instruction: —
Catholic,
Hebrew,
Protestant, .
Amount carried forward.
$3,600 00
3,504 57
5,132 04
7,940 17
10,005 48
2,977 40
9,442 00
6,361 89
3,306 94
3,547 36
2,058 50
$57,876 35
$600 00
500 00
500 00
1,600 00
$59,476 35
No. 34.] DIVISION OF TUBERCULOSIS (SANATORIA). 303
Amount brought forward, $59,476 35
Travel, transportation and office expenses: —
Advertising, $37 97
Postage, 199 07
Printing and binding, 487 18
Stationery and office supplies, 557 12
Telephone and telegraph, 334 59
Travel, 408 38
Freight H 75
2,036 06
Food : —
Flour ^2,213 35
Cereals, rice, meal, etc., 953 18
Bread, crackers, etc., 53 39
Peas and beans (canned and dried) , ^ . . . . 424 62
Macaroni and spaghetti, 68 20
Potatoes 1.242 85
Meat 14.626 72
Fish (fresh, cured and canned), 1,729 73
Butter 5.126 43
Butterine, etc., 451 60
Cheese 144 65
Coffee 634 75
Tea 145 67
Cocoa, 49 54
Whole milk 14,092 08
Milk (condensed, evaporated, etc.) 127 31
Eggs (fresh) 5,550 45
Sugar (cane), 3,255 15
Fruit (fresh) 452 01
Fruit (dried and preserved) 1,356 18
Lard and substitutes, 84 84
Molasses and syrups, 101 66
Vegetables (fresh) 348 56
Vegetables (canned and dried) 1,559 80
Seasonings and condiments, 578 14
Yeast, baking powder, etc., 358 00
Sundry foods 271 79
Freight 699 13
56,699 78
Clothing and materials : —
Boots, shoes and rubbers, $283 04
Clothing (outer), 490 65
Clothing (under) 109 05
Hats and caps, 75
Socks and smallwares, 48 26
Freight 4 88
936 63
Furnishings and household supplies: —
Beds, bedding, etc., $2,142 17
Carpets, rugs, etc., 133 12
Crockery, glassware, cutlery, etc., 632 37
Dry goods and smallwares, 112 38
Electric lamps 237 01
Amounts carried forward, $3,257 05 $119,148 82
304
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Amounts brought forward, $3,257 05 $119,148 82
Furnishings and household supplies — Concluded.
Fire hose and extinguishers, 40 32
Furniture, upholstery, etc 302 02
Kitchen and household wares, 1,172 93
Laundry supplies and materials, 458 45
Lavatory supplies and disinfectants, 390 39
Table linen, paper napkins, towels, etc., .... 562 27
Freight, 102 41
6,285 84
Medical and general care: —
Books, periodicals, etc., $65 30
Entertainments, games, etc., 794 07
Funeral expenses, 30 00
Ice and refrigeration, 144 62
Laboratory supplies and apparatus, 54 51
Medicines (supplies and apparatus), 1,550 05
Medical attendance (extra), 83 00
Sputum cups, etc., 346 14
Tobacco, pipes, matches 139 73
Sundries 8 00
Freight 92 84
3,308 26
Heat, light and power : —
Coal (bituminous), $5,515 85
Freight and cartage, 4,905 73
Coal (anthracite), 1,028 26
Freight and cartage, 476 54
Gas 34 93
Oil, 292 26
Operating supplies for boilers and engines 252 27
Freight, 8 94
12,514 78
Farm : —
Bedding materials $64 30
Blacksmithing and supplies, 41 10
Carriages, wagons and repairs, 32 03
Dairy equipment and supplies, 279 87
Fencing materials, 142 75
Fertilizers, 794 02
Grain, etc., 3,223 93
Hay, 209 11
Harnesses and repairs, 1 25
Other live stock, 293 00
Labor (not on pay roll) 2,245 26
Spraying materials, 47 52
Stab le and barn supplies, 24
Tools, implements, machines, etc., 381 81
Trees, vines, seeds, etc., 198 57
Veterinary services, supplies, etc., 135 60
Sundries, 23 73
Freight 286 16
8,400 25
Amount carried forward, $149,657 95
No. 34.] DIVISION OF TUBERCULOSIS (SANATORIA). 305
Amount brought forward, S149,C57 95
Garage, stable and grounds: —
Automobile repairs and supplies, .$1,410 21
Bedding and materials, 73 75
Blacksmithing and supplies .35 05
Carriages, wagons and repairs, 25 88
Grain 241 75
Hay, 23 68
Harnesses and repairs, 13 95
Rent, 425 00
Poad work and materials, 38 50
Spraying materials, 5 20
Tools, implements, machines, etc., 407 10
Trees, vines, seeds, etc., 7 75
Sundries, 1 25
Freight, 15 68
2,724 75
Repairs, ordinary: — /
Cement, lime, crushed stone, etc., $74 29
Electrical work and supplies, 257 57
Hardware, iron, steel, etc., 194 21
Labor (not on pay roll), 35 00
Lumber, etc. (including finished products), .... 460 70
Paint, oil, glass, etc., 497 72
Plumbing and supplies, 392 78
Steam fittings and supplies, 483 01
Tents, awnings, etc 259 82
Tools, machines, etc., 218 94
Boilers, repairs, 153 30
Engines, repairs, 38 47
Sundries, 254 09
Freight, 93 08
3,412 98
Repairs and renewals : —
Repairing piazza floors, $172 40
Shingling two pavilions, 337 49
Drying tumbler 893 31
Henhouse 1,102 12
Repairing tank and tower, 126 00
National marking machine, 383 99
Collar and cuff press, 289 65
Bed casters 263 93
Partitioning sleeping rooms, 166 83
3,735 72
Total expenses for maintenance, $159,531 40
Special Appropriations.
Balance Dec. 1, 1919 $30,927 63
Appropriations for current year, 16,500 00
Total $47,427 63
Expended during the year (see statement below), . . . $40,533 34
Reverting to treasury of Commonwealth, 5 58
40,538 92
Balance Nov. 30, 1920, carried to next year, $6,888 71
306
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Object.
Act or Resolve.
Whole
Amount.
Expended
during
Fiscal Year.
Total
Expended
to Date.
Balance
at End of
Year.
Nurses' hall and chapel,
Cottage for engineer and
steward.
Chap. 211, 1919,
Chaps. 225, 629, 1920,
$48,150 00
16,500 00
$30,922 05
9,611 29
$48,144 42
9,611 29
$5 58*
6,888 71
$64,650 00
$40,533 34
$57,755 71
$6,894 29
- -ns
Balance reverting to treasury of the Commonwealth,
Balance carried to next year,
$5 58
6,888 71 \
Total as above $6,894 29
Resources and Liabilities.
Resources.
Cash on hand,
November cash vouchers (paid from advance money) : —
Account of maintenance, $6,710 64
Account of special appropriations, . . . 129 91
$1,159 45
6,840 55
Due from treasury of Commonwealth from available appropriation, account
of November, 1920, schedule,
$8,000 00
16,972 00
Liabilities.
Schedule of November bills,
$24,972 00
$24,972 00
Per Capita,
During the year the average number of inmates has been 188.30.
Total cost for maintenance, $159,531.40.
Equal to a weekly per capita cost of $16.2926.
Receipt from sales $796.13.
Equal to a weekly per capita of $0.0813.
All other institution receipts, $212.59.
Equal to a weekly per capita of $0.0217.
Respectfully submitted,
Carl C. MacCorison,
Treasurer.
Examined and found correct as compared with the records in the office of the Auditor
of the Commonwealth.
Alonzo B. Cook,
Auditor.
VALUATION.
Real estate, .
Personal estate,
. $217,242 50
82,226 54
$299,469 04
No. 34.] DIVISION OF TUBERCULOSIS (SANATORIA). 307
SPECIAL REPORT.
The following special report is prepared in accordance svith a resolution of
the National Conference of Charities and Corrections, adopted May 15, 1908: —
Population.
Males.
Females.
Totals.
Number of inmates present at beginning of fiscal year,
Number received during the year
Number discharged during the year
Number at end of fiscal year
Daily average attendance (i.e., number of inmates actually
present) during year.
Average number of officers and employees during the year, .
112
141
149
104
106.75
43.58
80
138
136
82
81.55
30.78
192
279
285
186
188.30
74.36
Expenditures.
Current expenses : —
1. Salaries and wages,
2. Clothing,
3. Subsistence, .....
4. Ordinary repairs and improvements,
5. Office, domestic and outdoor expenses,
Total,
$57,876 35
936 63
72,522 82
3,412 98
21,046 90
$155,795 68
Extraordinary expenses,
Grand total.
3,735 72
$159,531 40
Summary of Current Expenses.
Total expenditure, .......
Deducting extraordinary expenses, .....
Deducting amount of sales,
Total, .
$159,531 40
3,735 72
$155,795 68
1,008 72
$154,786 96
Dividing this amount by the daily average number of patients — 188.30 — gives a
cost for the year of S822.90, equivalent to an average weekly net cost of $15.82.
308
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
STATISTICAL TABLES.
Table 1. — Admissions and Discharges.
Males.
Females.
Totals.
Patients in the sanatorium Dec. 1, 1919
112
80
192
Number of patients admitted from Dec. 1, 1919, to Nov. 30,
1920, inclusive.
Number discharged from Dec. 1, 1919, to Nov. 30, 1920, in-
clusive.
Number of deaths (included in preceding item),
141
149
21
138
136
26
279
285
47
Number remaining in the sanatorium Nov. 30, 1920, .
104
82
186
Daily average number of patients
103.86
83.40
187.26
Table 2. — Civil Condition of Patients admitted.
Males.
Females.
Totals.
Married,
73
65
138
Single
59
65
124
Widowed,
8
8
16
Divorced
1
-
1
Totals
141
138
279
TvBLE 3. — Age of Patients admitted
Males.
Females.
Totals.
14 to 20 years,
13
19
32
20 to 30 years,
46
63
109
30 to 40 years.
32
36
68
40 to 50 years.
40
17
57
Over 50 years,
10
3
13
Totals, .
141
138
279
No. 34.] DIVISION OF TUBERCULOSIS (SANATORIA).
309
Table 4. — Nativity and Parentage of Patients admitted.
Males.
Females.
Totals.
Places of Nativity.
a
.2
£
O
c
.2
£
IS
J3
O
a
.2
v>
£
1
2
o
United States: —
Massachusetts,
58
15
16
65
19
22
123
34
38
Other New England States
7
6
5
7
6
3
14
12
8
Other States, .
4
2
4
10
10
8
14
12
12
Total native.
69
23
25
82
35
33
151
58
58
Other countries: —
Austria, .
-
-
-
1
1
-
1
1
-
Australia,
-
-
1
-
-
-
-
-
1
Belgium, .
1
1
1
-
-
-
1
1
1
Canada, .
20
29
32
17
23
25
37
52
57
England, .
3
4
3
4
4
4
7
8
7
Finland, .
1
2
2
-
-
-
1
2
2
France,
-
1
-
1
2
2
1
3
2
Germany,
-
1
-
1
7
9
1
8
9
Greece,
5
5
5
-
-
-
5
5
5
Holland, .
-
-
-
1
1
1
1
1
1
Ireland, .
9
27
27
14
33
32
23
60
59
Italy,
5
7
7
4
4
4
9
11
11
Japan,
1
1
1
-
-
-
1
1
Poland, .
2
2
2
4
5
5
6
7
Portugal, .
2
3
4
1
4
2
3
6
Roumania,
1
1
1
-
-
-
1
1
Russia,
19
23
20
6
8
7
25
31
27
Scotland, .
1
3
1
1
4
3
2
4
South America,
-
1
-
1
-
-
1
-
Spain,
-
1
-
-
-
-
-
-
Sweden, .
1
4
3
-
3
2
1
5
Switzerland, .
-
-
-
-
1
1
-
1
Wales,
-
-
2
-
-
1
-
3
West Indies,
1
1
1
-
-
-
1
1
Total foreign,
72
117
113
56
100
98
128
217
211
Unknown,
-
1
3
-
3
7
-
10
Grand totals.
141
141
141
138
138
138
279
279
279
310
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Table 5. — Residence of Patients admitted.
Place.
Number.
Amesbury,
Andover, .
Arlington,
Ashburnham,
Athol,
Bedford, .
Belmont, .
Beverly, .
Boston, .
Cambridge,
Chelsea, -
Concord, .
Danvers, .
Dighton, .
Dracut, .
Essex,
Everett, .
Fall River,
Foxborough,
Framingham,
Gardner, .
Gloucester,
Haverhill,
Holliston,
Hudson, .
Ipswich, .
Lawrence,
Leominster,
Lowell,
Lunenburg,
Lynn,
1
1
2
1
1
1
4
2
97
3
6
1
1
1
1
1
13
2
1
1
1
4
3
1
1
1
10
1
16
1
12
Place.
Number.
Maiden, .
Marlborough, .
Medford, .
Melrose, .
Methuen,
Middleton,
Milford. .
Milton,
Natick, .
Newton, .
North Reading,
Norwood,
Peabody,
Pittsfield,
Quincy, .
Reading, .
Revere, .
Rockport,
Salem,
Somerville,
Stoneham,
Townsend,
Wakefield,
Waltham,
Watertown,
Westford,
Wilmington, .
Winchester,
Woburn, .
Total,
16
2
3
3
3
1
2
1
1
5
3
1
2
1
1
2
3
1
4
16
1
1
2
1
i
1
1
3
2
279
No. 34.] DIVISION OF TUBERCULOSIS (SANATORIA). 311
Table 6. — Occupation of Paiients admitted.
Attendant nurse, .
Baker,
Blacksmith, .
Bookbinder, .
Bookkeeper, .
Buyer, .
Carpenter,
Cashier, .
Chauffeur,
Cigarmaker, .
Civil engineer,
Clerk, .
Courier, .
Curator, .
Dressmaker, .
Electric worker,
Elevatorman,
Expressman, .
Factory worker,
Fireman (stationary)
Foundryman,
Housewife,
Housework, .
Janitor, .
Junk collector.
Laboratory worker.
Laborer, .
Laundry worker, .
Lens grinder, .
Lineman,
Linotype operator,
Longshoreman,
Machinist,
Manager,
Mate,
Metal worker.
Mill worker, .
Males.
1
1
2
1
10
2
1
1
6
1
1
1
14
1
1
2
1
10
1
1
2
1
1
10
1
2
3
6
Females.
11
55
15
Totals.
5
1
1
'"1
6
1
10
1
2
1
1
14
2
1
3
1
1
1
25
1
2
55
15
1
2
1
10
4
1
2
1
1
10
1
2
3
10
312
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Table 6. — Occu-pation of Patients admitted — Concluded.
Males.
Females.
Totals.
Musician,
2
-
2
No occupation,
1
6
7
Nurse,
-
2
2
Nursemaid,
-
1
1
Painter,
2
-
2
Peddler,
2
-
2
Photographer,
2
-
2
Plumber
2
-
2
Polisher (metal)
1
-
1
2
-
2
Poultryman
-
-
Roofer,
-
2
Salesman,
-
-
Shipper,
-
-
Steam fitter,
-
5
Student
6
-
Teacher,
1
-
Telephone operator
2
-
Trainman,
-
-
Varnisher (piano),
-
-
,
Waiter
3
3
6
141
138
279
No. 34.] DIVISION OF TUBERCULOSIS (SANATORIA). 313
Table 7. — Condition on Admission.
Males.
Females.
Totals.
Incipient
-
3
3
Moderately advanced
67
76
143
Advanced
70
57
127
Non-tuberculous,
2
2
Not determined,
2
2
4
Totals
141
138
279
T-V • 7
Table 8. — Condition on Discharge.
Males.
Females.
Totals.
Arrested,
Apparently arrested.
Quiescent,
Improved,
Unimproved, .
Died,
Not considered,
Non-tuberculous, .
Totals, .
3
20
58
29
21
18
3
11
12
42
26
26
16
149
136
3
14
32
100
55
47
34
285
Table Q. — Deaths.
Males.
Females.
Totals.
Length of Residence
AT Sanatorium.
Duration of uisease.
Males.
Females.
Totals.
Under 1 month,
-
-
-
-
3
3
1 to 2 months.
-
-
-
1
4
5
2 to 3 months.
-
-
-
2
2
4
3 to 4 months.
-
-
-
5
3
8
4 to 5 months.
-
1
1
1
1
2
5 to 6 months,
-
-
-
-
1
1
6 to 7 months.
1
-
1
-
-
-
7 to 8 months.
1
1
2
-
-
-
8 to 9 months,
-
-
-
1
1
2
9 to 10 months,
-
-
1
1
2
10 to 12 months,
1
-
1
-
2
2
12 to 18 months.
5
8
13
4
3
7
18 to 24 months,
2
2
4
3
-
3
Over 2 years, .
11
14
25
3
5
8
Totals, .
21
26
47
21
26
47
314
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Table 10. — Cause of Death.
Males.
Females.
Totals.
Tuberculosis of the lungs,
Mitral regurgitation of heart,
Parenchymatous nephritis
Aortic insufficiency of heart and chronic interstitial nephritis.
Totals,
21
21
23
1
1
1
26
44
1
1
1
47
WESTFIELD STATE SANATORIUM.
Re.?ident Officehs.
Henry D. Chadwick, M.D.,
Roy Morgan, M.D.,
Heman B. Chase, M.D., .
Russell H. Bethell, D.M.D.,
Emily B. Morgan, .
Benjamin J. Sandiford, .
Robert J. Goldberg,
Superintendent.
Assistant Superintendent.
Physician.
Dentist.
Superintendent of Nurses.
Chief Engineer.
Farmer.
REPORT OF THE SUPERINTENDENT.
To the Commissioner of Public Health.
I have the honor to submit the eleventh annual report of the Westfield State
Sanatorium for the year ending Nov. 30, 1920.
Days of Treatment.
The dailj' average number of patients has been 265.25. This is equivalent
to 96,816 hospital days, and represents the busiest year and the greatest service
that has been performed by the sanatorium since it was opened in 1910.
Number treated and Classification.
Three hundred and fourteen new patients were admitted. This, together
with the 265 that remained in the sanatorium Dec. 1, 1919, makes a total of
579 patients that have received treatment during the year. Of those admitted,
26 per cent were classified as incipient, 37 per cent as moderately advanced
and 36 per cent as advanced. Table No. 7 shows the subdi^^sions according
to symptoms, A class meaning mild, B class moderate and C class severe. The
daily average number of bed patients was 85, — 37 males and 48 females.
Length of Residence.
The average length of stay, considering all patients discharged, has been
312.5 days. This is 57.5 days less than the pre\dous year. Table No. 8 shows
the condition of patients discharged. The folloAving comparison is interesting
No. 34.] DIVISION OF TUBERCULOSIS (SANATORIA). 315
as showing how the number of apparently arrested cases depends upon the
average length of stay : —
1918.
1919.
1920.
Average length of stay (days)
Apparently arrested cases (per cent),
417
47
370
44
312
43
: 1
There are many children that could be discharged after from three to six
months' sanatorium care if they had suitable living conditions at home. Where
such is not the case, we have to keep them a longer time to insure as complete
an arrest as possible. We also in such cases try through local authorities to
have the home conditions improved before the child is dischai'ged.
Support of Patients.
Of the 314 patients admitted, 31 paid their own board, 189 were supported
by cities and towns, 8 were State minor wards, 59 were State charges, and the
status of 27 has not been determined. The receipts from private patients
were 13,922.70, and from cities and to^\^ls, $38,264.49. The gross per capita
cost of maintenance per week was 114.24. Deducting sales the per capita cost
was $14.13. This is $1.68 more than 1919.
Gain in Weight.
Two hundred and nineteen patients, or 70 per cent, of those discharged
gained; 92, or 30 per cent, failed to gain. The average of those that gained
was 11.6 pounds. Separating the discharged patients into two groups, we
find that 71 over sixteen years of age gained an average of 8.4 pounds; 148
under sixteen years of age gained an average of 12.6 pounds.
Dentistry.
The care of the patients' teeth occupies the full time of one dentist. His
work is a very important adjunct to the medical care of the patients. Nearly
every patient admitted needs dentistry in order to eliminate local sources of
infection or to improve mastication. Dr. John McCoy, our former dentist,
resigned on May 8 to go into private practice. He was succeeded by Dr. Russell
H. Bethell. The following gives a summary of the work that has been done
during the year : —
Number of patients examined,
Prophylaxis, .
Amalgam fillings,
Cement fillings,
Temporary fillings,
Pulp cappings,
Treatments, .
318
335
350
300
80
100
75
316
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Surgical dressings and irrigations,
Canal dressings,
Canal fillings,
Extractions, .
X-rays of teeth.
X-rays of antra,
Total operations and treatments, .....
Of the 318 patients examined, the work of 230 is completed.
75
30
50
220
10
1
1,944
Conditions on Discharge.
Of the 311 patients discharged, 43 per cent were apparently arrested, 16.7
per cent quiescent, 7.07 per cent improved, 14.4 per cent unimproved and
12.8 per cent died. Seventeen patients remained less than thirty days and
were not considered in this tabulation.
Sanatorium School.
The craft shop is getting more popular with the adult patients each year.
A large number of baskets have been made and they meet with a ready sale.
The product of the shop sold during the past year has advertised the quaUty
of the goods so well that we have customers for all the baskets that the patients
can make. The money received is sufficient to purchase most of the material
used, although many of the baskets are given to the patients who make them.
The average school attendance has been as follows : —
Grade I, .
Grade II, .
Grade III,
Grade IV,
Grade V, .
Grade VI,
Grade VII,
Grade VIII,
Domestic science,
Manual training,
Total,
Total enrollment.
11.509
14.467
13.980
15.800
19.560
16.970
11.060
11.590
6.900
16.800
138.636
371
Out-Patient Department.
We have maintained an out-patient examination service for several years.
The number of patients that come for advice has steadily increased. This
past year 118 patients came for examination, — 79 males and 39 females; 55 of
them were found to have active pulmonary tuberculosis.
Since September a consultation clinic has been held monthly in each of the
following cities, — Springfield, Holyoke, Pittsfield and Adams. In addition,
examination clinics have been held in co-operation with the Hampden County
No. 34.] DIVISION OF TUBERCULOSIS (SANATORIA). 317
Tuberculosis Association in Three Rivers, Ludlow, West Springfield, Palmer,
East Longmeadow and Westfield. A total of 148 people have been examined at
these clinics, classified as follows : —
Active tuberculosis, ............ 34
Further observation, ............ 41
Healed or quiescent tuberculosis, ......... 8
Negative, .............. 65
Two other clinics were held at the requests of the boards of health of Chicopee
and of Adams. At each of these, about 20 patients were examined.
We have also examined 160 undernourished children at the Fort Meadow
School in Westfield and 120 pupils of the Thomdike School in Palmer. In each
of these schools there were several children who had evidence of active tuber-
culosis. Twenty-eight per cent of the 700 children in the Fort Meadow School
were found to be more than 7 per cent underweight. Of this number, about
80 were found on physical examination to have signs of bronchial gland tuber-
culosis. Most of these children would respond to home treatment if they were
properl}^ advised and directions were followed as to correcting faulty habits of
diet and living. School nurses to follow up these infected children could do
much to prevent later development of pulmonary tuberculosis.
Improvements.
During the past year we have torn down the old farmhouse and rebuilt upon
its site a new farmhouse and dormitory for the head farmer and farm help. This
much needed improvement will enable us to house our farm help in a com-
fortable manner. The old bam, which was on the property when purchased
by the State, has always been an unsightly structure and of little use because
it was so poorly constructed. We have remodeled it b}^ removing the top of
the fourth story, rebuilding the roof and floors and reinforcing the frame. It
is now a very useful building.
An X-ray machine has been installed and has been of great value in the
medical work of the institution. We feel that we can make a more careful
diagnosis and treat our patients in a more scientific manner because of the
aid we get from this equipment.
Additional Improvements requested.
A special appropriation has been requested to provide more fire protection
by extending a 4-inch water main from the power house to the school and farm
buildings and the installation of hydrants at advantageous points along the
line.
I have renewed the request for the purchase of 28.8 acres of land o\med by
Rosina Pignatare, which adjoin our property. This is desirable for use as a
natural play ground for the boys to keep them away from the highway and
river, and one section is badly needed for a pasture. We have rented it for
the past two years but cannot use it to the best advantage unless we own it.
318 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Acknowledgments.
Religious services have been held each Sunday by the Catholic, Protestant
and Jemsh chaplains. The same chaplains have continued in service for sev-
eral years. Their interest in the work of the institution and their devotion to
the patients' welfare are worthy of much praise.
I am much indebted to Dr. Frederick T. Clark of Westfield, ocuUst and
oral surgeon, for his gratuitous service to many of our sanatorium patients.
Correction of eye strain and operative treatment of nasal obstructions and
sinus disease have benefited a number of patients, and their period of treat-
ment in the sanatorium has thereby been much shortened.
For the conscientious service of the heads of the departments and the faith-
ful work of their employees in carrjdng on the work of the institution, I am
extremely grateful. It has been a trying year on account of the labor situation
and the high prices of all supplies and materials, but in spite of these condi-
tions we have cared for more patients than ever before and this work has been
accomplished with fewer employees.
Respectfully submitted,
Henry D. Chad wick,
• Superintendent.
TREASURER'S REPORT.
To the Commissioner of Department of Public Health.
I respectfully submit the following report of the finances of this institution
for the fiscal year ending Nov. 30, 1920: —
Cash Account.
Balance Dec. 1, 1919, Sil98 41
Receipts.
Institution Receipts.
Board of inmates: —
Private, ?63,922 70
Cities and towns 38,264 49
$42,187 19
Sales: —
Food • ^383 43
Clothing and materials 1 00
Heat, light and power, 20 98
Farm and stable: —
Cows and calves, .... $725 00
Pigs and hogs, . . . . 113 00
Vegetables H 75
Sundries 271 80
1,121 55
Repairs, ordinary, 15 00
1,541 96
Amounts carried forward 843,729 15 $198 41
No. 34.] DIVISION OF TUBERCULOSIS (SANATORIA). 319
Amounts brought forward §43,729 15 Sl9S 41
Miscellaneous receipts: —
Interest on bank balances, .... $182 26
Sundries, 35 09
217 35
43,946 50
Receipts from Treasury of Commonwealth.
Maintenance appropriations: —
Balance of 1919, $5,447 48
Advance money (amount on hand November 30), . . 10,000 00
Approved schedules of 1920 177,065 93
192,513 41
Special appropriations, 16,962 89
Total, $253,621 21
Payttients.
To treasury of Commonwealth, institution receipts $43,946 50
Maintenance appropriations: —
Balance November schedule, 1919 $5,645 89
Eleven months' schedules, 1920, 177,065 93
November advances, 9,759 79
192,471 61
Special appropriations : —
Approved schedules, 16,962 89
Balance Nov. 30, 1920: —
In bank $202 35
In office 37 86
240 21
Total $253,621 21
Maintenance.
Appropriation, current year, $196,503 00
Expenses (as analyzed below) 196,485 66
Balance reverting to treasury of Commonwealth $17 34
Analysis of Expenses.
Personal services: —
Henry D. Chad wick, superintendent, $3,900 00
Medical, 3,584 59
Administration, 3,424 81
Kitchen and dining-room service, 12,376 60
Domestic 6,838 02
Ward service (male) , 3,477 07
Ward service (female) 10,379 75
Industrial and educational department, .... 3,704 00
Engineering department, 9,373 58
Repairs, 2,926 31
Farm, 20,108 90
Stable, garage and grounds, 2,904 45
$82,998 08
Amount carried forward, $82,998 08
320
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Amount brought forward, . . . §82 998 08
Religious instruction : —
Catholic $600 00
Hebrew 249 60
Protestant 340 00
1,189 60
Travel, transportation and office expenses: —
Advertising, $20 12
Postage 135 66
Printing and binding, 8 31
Stationery and office supplies, 587 09
Telephone and telegraph, 699 11
Travel 380 16
Freight, 10 93
1,841 38
Food: —
Flour, $2,529 77
Cereals, rice, meal, etc., 1,409 49
Bread, crackers, etc., 187 62
Peas and beans (canned and dried), 417 54
Macaroni and spaghetti, • . 96 39
Potatoes 555 50
Meat, 13,127 21
Fish (fresh, cured and canned), 1,505 44
Butter, 3,816 71
Butterine, etc 536 70
Peanut butter, 31 33
Cheese 113 18
Coffee 449 06
Tea, 134 30
Cocoa, 70 85
Milk (condensed, evaporated, etc.), 83 43
Eggs (fresh), 6,956 20
Egg powders, etc., 102 96
Sugar (cane), 2,465 12
Fruit (fresh), 386 65
Fruit (dried and presers-ed) , 1 ,950 67
Lard and substitutes, 873 13
Molasses and syrups, 185 53
Vegetables (fresh), 951
Vegetables (canned and dried), 857 11
Seasonings and condiments, 487 53
Yeast, baking powder, etc., 196 42
Sundry foods, 168 48
Freight 264 47
39,968 30
Clothing and materials : —
Boots, shoes and rubbers, ....
SllO 23
Clothing (outer),
541 74
Clothing (under)
84 70
Dry goods for clothing
206 98
Hats and caps
2 00
Socks and smallwares, ....
34 24
979 89
Amount carried forward,
$123,977 25
No. 34.] DIVISION OF TUBERCULOSIS (SANATORIA). 321
Amount brought forward, $126,977 25
Furnishings and household supplies: —
Beds, bedding, etc., $2,152 91
Carpets, rugs, etc., 200 49
Crockery, glassware, cutlery, etc., 1,051 14
Dry goods and smallwares, 641 12
Electric lamps, 261 66
Furniture, upholstery, etc., 391 81
Kitchen and household wares, 1,247 45
Laundry supplies and materials, 1,519 55
Lavatory supplies and disinfectants, 1,573 40
Table linen, paper napkins, towels, etc., .... 599 74
Sundries 262 50
Freight 132 67
10,034 44
Medical and general care: —
Books, periodicals, etc., $55 60
Entertainments, games, etc., 168 00
Funeral expenses, 60 00
Ice and refrigeration, 168 80
Laboratory supplies and apparatus, 269 22
Manual training supplies, 130 77
Medicines (supplies and apparatus) 1,657 02
Medical attendance (extra), 93 45
School books and supplies, 266 92
Sputum cups, etc., 469 13
Sundries, 1 40
Freight 25 56
3,365 87
Heat, light and power: —
Coal (bituminous), $7,936 93
Freight and cartage, 5,374 81
Coal (anthracite), 631 02
Freight and cartage, 232 21
Oil 239 04
Operating supplies for boilers and engines, .... 426 81
Freight, 18 81
14,859 63
Farm : —
Bedding materials, $290 29
Blacksmithing and supplies, 142 10
Carriages, wagons and repairs, 68 11
Dairy equipment and supplies, 174 07
Fencing materials, 77 00
Fertilizers, 855 57
Grain, etc., 8,801 68
Hay, 2,291 82
Harnesses and repairs 34 26
Cows 947 50
Rent, 25 50
Spraying materials, 141 50
Stable and barn supplies, 223 50
Tools, implements, machines, etc., 466 58
Trees, vines, seeds, etc., 346 08
Amounts carried forward, $14,885 53 $155,237 1ft
322 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Amounts brought forward, $14,885 56 $155,237 19
Farm — Coti.
Veterinarj' services, supplies, etc., 102 87
Freight 576 46
Tractor, 1,325 00
16,889 89
Garage, stable and grounds: —
Motor vehicles, $2,500 00
Automobile repairs and supplies, 2,178 14
Rent 240 00
Road work and materials, 26 74
Tools, implements, machines, etc., 16 95
Trees, vines, seeds, etc., 117 42
Freight 3 73
5,082 98
Repairs, ordinarj': —
Cement, lime, crushed stone, etc., $208 50
Electrical work and supplies, 563 12
Hardware, iron, steel, etc., 835 97
Labor (not on pay roll) 1,744 65
Lumber, etc. (including finished products), .... 1,15226
Paint, oil, glass, etc 1,138 82
Plumbing and supplies, 1,185 09
Roofing and materials, 259 36
Steam fittings and supplies, 1,569 82
Tents, awnings, etc., 80 35
Tools, machines, etc., . 726 56
Boilers, repairs, 86 07
Engines, repairs 205 08
Sundries, 11 13
Freight, 183 28
9,950 06
Repairs and renewals : —
Asbestos slate roofing and labor, $4,355 82
Boiler instruments 358 58
X-ray apparatus, 2,239 16
Repairs on house and barn, 2,371 98
9,325 54
Total expenses for maintenance $196,485 66
Special Appropriations.
Appropriations for current year, $24,090 00
Expended during the year (see statement below) , 16,962 89
Balance Nov. 30, 1920, carried to next year, $7,127 11
No. 34.] DIVISION OF TUBERCULOSIS (SANATORIA). 323
Object.
Act or Resolve.
Whole
Amount.
Expended
during
Fiscal Year.
Total
Expended
to Date.
Balance
at End of
Year.
Purchase of land,
Remodeling farmhouse and
dormitory.
Remodeling barn.
Installing engine and genera-
tor.
1920
1920
1920
1920
$1,890 00
10,000 00
5,700 00
6.500 00
$9,988 23
5,662 76
1,311 90
$9,988 23
5,662 76
1,311 90
$1,890 00
11 77
37 24
5,188 10
$24,090 00
$16,962 89
$16,962 89
$7,127 11
Resources and Liabilities.
Resources.
Cash on hand $240 21
November cash vouchers (paid from advance money), ac-
count of maintenance 9,759 /9
Due from treasury of Commonwealth from available appropriation, account
of November, 1920, schedule,
Liabilities.
Schedule of November bills,
$10,000 00
9,419 73
),419 73
$19,419 73
Per Capita.
During the year the average number of inmates has been 265.25.
Total cost for maintenance, $196,485.66.
Equal to a weekly per capita cost of $14.2453.
Receipt from sales, $1,541.96.
Equal to a weekly per capita of $0.1117.
All other institution receipts, $42,404.54.
Equal to a weekly per capita of $3,074.
Respectfully submitted,
Henry D. Chad wick,
Treasurer.
Examined and found correct as compared with the records in the office of the Auditor
of the Commonwealth.
Land,
Buildings, .
Miscellaneous,
Total, .
Personal estate.
Total valuation.
VALUATION.
Alonzo B. Cook,
Auditor.
$13,524 00
176,206 29
60,487 77
$240,218 06
88,945 29
$329,163 35
324
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
SPECL\L REPORT.
The follo^\ing special report is prepared in accordance M'ith a resolution of
the National Conference of Cha/ities and Corrections, adopted Maj^ 15, 1906: —
Populotion.
Males.
Females.
Totals.
Number received during the year
162
152
314
Number passing out of the institution during the year, .
162
149
311
Number at end of fiscal year in the institution, .
131
135
266
Daily average attendance (i.e., number of inmates actually
present) during the year.
Average number of employees and officers during the year, .
132.339
57
132.918
41
265.25
98
Expenditures.
Current expenses: —
1. Salaries and wages,
2. Clothing,
3. Subsistence, . . . ...
4. Ordinary repairs, ....
5. Office, domestic and outdoor expenses,
Total, .....
$84,187 68
979 89
39,968 30
9,950 06
61,399 73
!»196,485 66
Extraordinary expenses: —
1. Permanent improvements to existing buildings and construction, . 16,962 89
Grand total, 8213,448 55
Summary of Current Expenses.
Total expenditures, .......
Deducting extraordinary expenses, .....
Deducting amount of sales, . .
Total, .
$213,448 55
16,962 89
$196,485 66
1,541 96
55194,943 70
Dividing this amount by the daily average number of patients — 265.25 — gives a cost
for the year of $734.94, equivalent to an average weekly net cost of $14.13.
No. 34.] DIVISION OF TUBERCULOSIS (SANATORIA).
STATISTICAL TABLES.
Table 1. — ■ Admissions and Discharges.
Number of patients admitted Dec. 1, 1919, to Nov. 30, 1920,
inclusive.
Number of patients discharged Dec. 1, 1919, to Nov. 30, 1920,
inclusive.
Number of deaths (included in preceding item).
Number in sanatorium Dec. 1, 1919
Number remaining Nov. 30, 1920,
Males.
162
162
131
131
Females.
152
149
132
135
Totals.
314
311
263
266
Table 2.
— Civil Condition of Patients admitted.
Males.
Females.
Totals.
Married,
Single, .
Widowed.
.
30
125
7
19
126
7
49
251
14
Totals,
r—
162
152
314
5
T
ABLE 3. — Ages of Patients admitted.
Males.
Females.
Totals.
1 to 13 years, .
72
( t
149
13 to 20 years,
29
30
59
21 to 30 years.
22
23
45
31 to 40 years.
23
17
40
41 to 50 years,
11
3
14
51 to 60 years,
4
1
5
60 years,
1
1
2
Totals.
162
152
314
326
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Table 4. — Nativity and Parentage of Patientf^ admitted.
Males.
Females. ■ 1
Totals.
Places of Nativity.
i
d
.2
Pi
E
o
.£3
1
2
.s
o
i
a
.2
(2
2
o
.a
-**
1
CO
M
o
a
.2
Ol
2
E
2
*^
o
United States: —
\
Massachusetts,
104
37
30
100
32
33
204
69
63
Other New England States,
10
8
9
10
7
12
20
15
21
Other States. .
16
10
9
8
9
1
24
19
16
Total native.
130
55
48
118
48
52
248
103
100
Other countries: —
Armenia
-
1
1
1
1
1
1
2
2
Asia
1
1
1
-
-
1
1
1
2
Austria, ....
1
5
5
-
2
2
1
7
6
Azores, ....
-
1
1
-
-
-
i
1
1
Bohemia, ....
-
-
1
-
-
-
-
1
Canada
10
24
25
11
24
28
21
48
53
Czecho-Slovakia,
1
-
-
-
-
-
1
-
-
Denmark,
-
-
-
1
1
2
1
1
2
England
3
5
4
1
5
4
4
10
8
Finland
-
-
-
1
3
3
1
3
3
France, ....
1
1
1
-
-
1
1
1
2
Germany,
-
1
1
-
1
2
_
2
3
Greece
-
2
2
-
1
1
-
3
3
Ireland, . . . .
3
23
26
3
23
21
6
46
47
Italy
2
7
8
1
7
6
3
14
14
Poland, . . . .
-
3
2
3
5
4
3
8
6
Porto Rico,
1
-
-
-
-
-
1
-
-
Portugal, . . . .
-
2
2
-
1
1
-
3
3
Russia, . . . .
1
4
4
3
6
6
4
10
10
Scotland, . . . .
3
4
5
1
2
1
4
6
6
Sweden
-
2
1
-
2
2
-
3
Switzerland,
-
-
-
-
1
1
-
1
Syria
1
1
1
-
-
-
1
1
Turkey
-
-
-
1
1
-
1
-
Wales
-
1
-
-
-
-
-
—
West Indies,
-
-
1
-
-
-
-
1
Total foreign,
28
88
90
27
86
87
55
174
178
Unknown,
4
19
22
7
18
14
11
37
14
Grand total.
. 162
162
162
152
152
152
314
314
314
-J
No. 34.] DIVISION OF TUBERCULOSIS (SANATORIA). 327
Table 5. — Residence of Patients admitted.
Place
Adams,
Amesbury,
Bedford, .
Beverly, .
Boston,
Brockton,
Brookline,
Cambridge,
Chelsea, .
Chicopee,
Concord, .
Dartmouth,
Dennis, .
Dudley, .
East Bridgewater, .
Easthampton, .
Everett, .
Fall River,
Falmouth,
Fitchburg,
Gardner, .
Gloucester,
Grafton, .
Greenfield,
Haverhill,
Holyoke, .
Hudson, .
Lancaster,
LawTence,
Leominster,
Longmeadow, .
Lowell,
Ludlow, .
Lynn,
Maiden, .
Marlborough, .
Number.
4
1
1
2
43
2
1
2
1
4
1
1
1
1
1
3
7
13
1
2
3
1
8
1
1
3
10
1
6
2
12
3
7
Place.
Number.
Medford, .
Melrose, .
Montague,
New Bedford,
Newton, .
North Adams,
Northampton,
Northbridge, .
North Brookfield,
Norwood,
Peabody,
Pittsfield,
Plymouth ,
Quincy, .
Salem,
Somerville,
Southbridge,
South Hadley,
Spencer, .
Springfield,
Templeton,
Tewksbury,
Tyngsborough,
Uxbridge,
Watertown,
Webster, .
West borough,
Westfield,
Westfield State I
Westford,
West Springfield,
Williamstown,
Winchester,
Worcester,
Total,
Sanatorium
4
1
1
5
2
7
4
1
1
1
1
8
1
1
2
5
3
4
1
42
1
2
1
2
2
4
1
13
4
1
5
1
314
328
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Table 6. — Occvpations of Patievts admitted.
Males.
Females.
Totals.
Baker,
Bookbinder, .
Cabinetmaker,
Car inspector,
Carpenter,
Chauffeur,
Cigarmaker, .
Civil engineer,
Clerk, .
Domestic,
Dyer,
Errand boy, .
Gardener,
Hospital attendant
Hotel clerk, .
Housewife,
Janitor, .
Laborer, .
Machinist,
Marble cutter.
Meat cutter, .
Mill hand,
Nurse,
Office, .
Orderly, .
Painter, .
Paper worker.
Plumber,
Printer, .
Salesman,
School, .
Shipping clerk.
Shoemaker,
Steelworker, .
Stenographer,
Stonecutter, .
Teacher,
f :
1
2
4
1
1
14
2
2
3
2
1
3
2
85
2
2
1
20
14
4
1
94
1
1
1
1
4
3
1
1
9
3
1
1
1
3
2
20
1
2
4
1
1
28
6
1
2
3
2
1
3
2
No. 34.] DIVISION OF TUBERCULOSIS (SANATORIA). 329
Table 6. — Occtipations of Patients admitted — Concluded.
Males.
Females.
Teamster,
Telephone operator,
Toolmaker,
Waiter, .
Weaver, .
None,
Totals,
162
152
Totals.
314
Table 7. -
— Condition on
Admission
•
Males.
Females.
Totals.
Incipient: —
A
39
38
77
B
2
4
6
C
-
1
1
TWoderately advanced: —
A. . . .
35
39
74
B
25
18
43
C
-
-
-
Tar advanced : —
A, . . .
28
26
54
B, . . .
26
18
44
C. . . .
7
7
14
"N^ontut>prculous.
-
1
1
Totals, .
162
152
134
Table 8. — Condition on Discharge
Males.
Females.
Totab.
Apparently arrested
70
64
134
Quiescent
30
22
52
Improved
13
9
22
Unimproved
18
27
45
Died
20
20
40
Nontuberculoiis
-
1
1
Not considered (stayed less than thirty days), .
11
6
17
Totals
162
149
311
3
330
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Table 9. — Deaths.
Duration op Disease.
Under 1 month,
1 to 3 months,
3 to 6 months,
6 to 9 months,
9 months to 1 year,
1 to 2 years, .
2 to 5 years, .
5 to 10 years, .
Over 10 years.
Totals, .
Males.
Females.
Totals.
Length of Residence
AT Sanatorium.
Males.
Females. Totals.
-
-
-
1
-
1
-
-
-
2
-
2
3
3
7
3
10
2
1
3
1
10
11
-
2
2
5
2
7
5
10
15
3
3
6
4
4
8
1
2
3
6
2
8
-
-
-
-
1
1
-
-
-
20
20
40
20
20
40
Table 10. — Cause of Death.
Males.
Females.
Totab.
Tuberculosb of lungs, ....
Tuberculosis of lungs and bowels.
Tuberculosis of lungs and kidney.
Tuberculosis of lungs and larynx,
Tuberculosis of lungs, kidney and larynx.
Accidental drowning
Totals
17
1
20
17
1
1
1
34
1
1
2
1
1
40
LAKEVILLE STATE SANATORIUM.
Resident Officers.
Sumner Coolidge, M.D.,
MiNOT W. Gale, M.D., .
Frederick P. Moore, M.D.,
Mrs. Mart M. Coakley,
Mrs. Harriet M. Gassett,
Robert A. Kennedy,
Thomas Francis Mahoney,
Superintendent.
Assistant Superintendent.
Senior Assistant Physician,
Steward.
Head Matron.
Operating Engineer.
Head Farmer.
No. 34.] DIVISION OF TUBERCULOSIS (SANATORIA). 331
REPORT OF THE SUPERINTENDENT.
To the Commissioner of Public Health.
I have the honor to submit he^e^\•ith the report of the Lakeville State Sana-
torium for the year ending Nov. 30, 1920.
There were remaining in the institution on Nov. 30, 1919, 232 patients.
This, together with 504 admitted during the year, brings the total number of
patients cared for to 736, as against 704 for the year 1919.
The daily average number of patients for the year has been 231, which shows
that we carried 19 more empty beds throughout the year than in any pre\aous
5'ear since the institution was opened, a total daily average of 42.
The average stay of 485 patients discharged was 176| days, or 13f days
less than the pre\'ious year. The longest residence was 2,393 days and the
shortest was 1 day.
The average of 104.8 bed parients daily maintains approximately the per-
centage of the pre^•ious year, showing that as the years pass we are taking
care of sicker patients, as a whole, than in former years.
The total days of treatment for the year just finished was 84,671, 7,305 less
than in 1919.
The following table shoeing the classification of cases admitted indicates
no improvement in the class of patients cared for, and also shows discrepancies
between the sanatorium classification and that of the outside practitioners.
Classification
on Appli-
cation Blank.
Incipient,
Moderately advanced,
Far advanced,
Not classified, .
Apparently arrested,
Not examined,
Totals,
Our Classifica-
tion
on Admission.
Table 8 shows a shght improvement over the preceding year in the condi-
tion of patients discharged.
Of the 736 cases cared for, the proportion of self-supporting cases shows a
slight improvement over 1919. There were 75 private cases, 273 tovm cases,
and 144 State cases. The unusually large number of 200 settlements still
remain undetermined at the end of the year. Forty-six ex-service men have
been cared for, of whom 44 were acknowledged by the Bureau of War Risk
Insurance.
Of the 485 patients discharged during the year, 196 made an average gain
of 14.13 pounds. The greatest gain for a man was 45^ pounds and for a woman
43j pounds.
332
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Medical Report.
No innovations have been introduced in medical treatment during the year.
Hehotherapy has been practiced as in the previous j^ear, although the complica-
tions calling for this treatment have been fewer than in 1919.
As usual tubercular laryngitis heads the list of complications. There were
65 cases of this complication, 14 cases of fistula in ano, 11 cases of tubercular
adenitis, 7 cases of pleurisy, 7 cases of tubercular peritonitis, and 5 cases of
nephritis. Besides these cases 32 other distinct complications were met with.
Of 3,017 sputum examinations, 1,084 were positive and 1,933 were negative.
Six hundred and twenty-five urinalyses were made, which disclosed 5 cases
of nephritis and 1 of diabetes.
The tuberculosis clinic at Middleborough was discontinued in July and was
not resumed in the autumn because the field was covered by the consultation
chnic plan which was instituted in September.
Work performed.
An attempt was made to continue occupational therapy throughout the
year by the assignment of suitable patients to small duties of a helpful char-
acter. The results have been fragmentary on account of the small number of
patients who were well enough to put on regular exercise.
The aggregate number of work hours of patients during the year was 9,700,
1,304 hours less than in 1919. The following list of canned goods represents
the combined work of the janitor's department with the patients.
Farm Produce canned and 'preserved.
Cans, No.
10.
Cans, No.
3.
2-quart
Cans.
Pounds.
Barrels.
Strawberries, .
Cherries, .
Plums
Pears,
String beans, .
Lima beans,
Peas,
Corn,
Tomatoes,
Ketchup, .
Piccalilli, .
Currant jelly, .
Cucumber pickles.
146
20
249
158
564
231
152
1,516
3,036
616
1.307
1,923
141
327
468
1,400
1,400
No. 34.] DIVISION OF TUBERCULOSIS (SANATORIA). 333
Improvements.
An appropriation was made available during the year for the purchase of
an SO-kilowatt generator unit and for a temporary shelter for young stock at
the dairy barn. Plans were completed for the installation of the generator
and it was ordered in midsummer. Delivery has been delayed, however, so
that at this writing the machine has not yet been shipped. The necessary pro-
vision has been made for the protection of young stock by building a part of
the permanent foundation of the addition at the dairy barn which was
requested.
The sewerage system has been extended by the addition of 800 feet of absorp-
tion trenches, and 3,600 square yards of road about the sanatorium grounds
have been macadamized.
Farm.
The results obtained on the farm during the year just ended have been fairiy
satisfactory. The earUest planted garden crops were considerably damaged
by the cold and rain, but the main crops have been of good quality and of
average quantit5^
By improved methods in the curing of bacon and ham we are now in a posi-
tion to produce all classes of pork products which are used in the sanatorium,
and the installation of illumination in the poultry plant has already shown
remarkable results in egg production.
Recommendations.
Again our first recommendation is that the institution be provided with an
adequate storehouse. Present conditions under which supplies are stored and
handled are unbusinesslike and wasteful as the supplies cannot be properiy
protected, and handling under present conditions is verj^ expensive. Estimated
cost, $1,200.
Our next recommendation in order of importance is an addition to the dairy
barn to provide storage for hay produced on the farm and to provide quarters
for young stock which it is necessary for us to raise if we are to eradicate tuber-
culosis from the herd. Estimated cost, $9,500.
I also recommend the erection of a 30,000-gallon tank for additional water
supply, and a duplicate pumping unit at the pumping station.
There is verj' urgent need for a moving-picture apparatus, and an X-ray
equipment. The moving picture should be installed at once.
The chapel should be enlarged by extending the building about 20 or 25
feet in a southerly direction, providing anterooms for the various uses of enter-
tainers, speakers and clergA'men who ser\'e us from time to time. This enlarge-
ment will also furnish an excellent room for the X-ray apparatus.
The poultry plant should be made more complete by slightly increasing its
capacity, and by the installation of an incubation plant. It does not seem rea-
sonable to spend $1,200 or $1,300 per year for day old chicks when the same
can be hatched on the place at about half that cost.
334 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
I urgently recommend also a definite policy in regard to the providing of
quarters by the institution for permanent married employees. In Lake\'ille
this may best be done by purchasing a small property which will soon come into
the market, with two houses already built, and the purchase of a small lot situ-
ated conveniently near to the sanatorium for the erection of new houses.
The farm is adequate if the available good land can be reclaimed, although
it has not sufficient pasturage. Additional pasture land is available adjoining
the dairy farm which should be purchased as soon as practicable.
Changes in Personnel.
During the year the resignation of Dr. George M. Sullivan was accepted, and
Dr. Minot W. Gale, then assistant physician, was promoted to the position of
assistant superintendent. For the position of assistant physician made vacant
by the promotion of Dr. Gale we were fortunate in obtaining the services of Dr.
Frederick P. Moore, formerly assistant superintendent of the Norfolk State
Hospital.
Acknowledgments.
I wish to express my appreciation of the faithful services of the Catholic,
Protestant and Jewish clergymen who have attended to their respective religious
ministrations during the year.
The heads of departments and their subordinates have maintained a helpful
attitude through the hardest year in the history of the institution.
Gifts of flowers and books to the patients are also gratefully acknowledged.
Respectfully submitted,
Sumner Coolidge,
Superintendent.
TREASURER'S REPORT.
To the Commissioner of Public Health.
I respectfully submit the following report of the finances of this institution
for the fiscal year ending Nov. 30, 1920: — •
Cash Account.
Balance Dec. 1, 1919 S314 81
Receipts.
Institution Receipts.
Board of inmates: —
Private $4,193 06
Cities and towns 29,753 90
Reimbursements, charitable, .... 246 28
Other reimbursements, War Risk patients'
board 380 86
$34,574 10
Amounts carried forward, $34,574 10 $314 81
Ko. 34.] DIVISION OF TUBERCULOSIS (SANATORIA). 335
Amounts brought forward, $34,574 10 $314 81
Sales: —
Travel, transportation and office expenses, . $89 85
Clothing and materials, 60 00
Furnishings and household supplies, . . 63 31
Medical and general care, .... 21 18
Farm and stable: —
Cows and calves,
Grease,
Hides,
Vegetables,
Use of teams.
Sundries, .
$40 00
514 72
12 76
128 40
2 25
133 19
831 32
Repairs, ordinary 4 50
1,070 16
Miscellaneous receipts: —
Interest on bank balances, 164 14
35,808 40
Receipts from Treasury of Commonwealth.
Maintenance appropriations: —
Balance of 1919 $7,625 10
Advance money (amount on hand November 30), . . 8,000 00
Approved schedules of 1920 182,943 98
198,569 08
Special appropriations, 1,932 38
Total $236,624 67
Payments.
To treasury of Commonwealth: —
Institution receipts, $35,808 40
Refunds, account of maintenance, 158 43
Income account of 1919 not paid over until 1920 account, 23 40
$35,990 23
Maintenance appropriations: —
Balance November schedule, 1919, $7,918 94
Eleven months' schedules, 1920, . . . $182,943 98
Less returned 158 43
— 182,785 55
November advances, 3,498 32
Special appropriations: —
Approved schedules, $1,932 38
Less returned , 2 43
Balance Nov. 30, 1920: —
In bank, $4,240 99
In office 260 69
194,202 81
1,929 95
4,501 68
Total, $236,624 67
336 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Maintenance.
Appropriation, current year, $201,810 48
Expenses (as analyzed below) 198,740 87
Balance reverting to treasury of Commonwealth, S3,069 61
Analysis of Expenses.
Personal services : —
Sumner Coolidge, M.D., superintendent* . . • • . $3,600 00
Medical 3,637 74
Administration, 5,061 91
Kitchen and dining-ioom service 5,545 03
Domestic, 16,221 36
Ward service (male) 6,301 01
Ward service (female) 5,482 64
Engineering department, 7,202 57
Repairs 4,970 43
Farm, 26,231 45
Stable, garage and grounds 1,990 97
$86,245 11
Religious instruction : —
Catholic. $600 00
Hebrew • • 101 44
Protestant 430 00
1,131 44
Travel, transportation and office expenses: —
Postage, $177 44
Printing and binding, 163 38
Stationery and office supplies 413 11
Telephone and telegraph, 320 64
Travel 781 22
Sundries, 75 98
Freight, 15 60
1,947 37
Food: —
Flour $2,972 56
Cereals, rice, meal, etc 852 27
Bread, crackers, etc., 88 17
Peas and beans (canned and dried), . - . . • 400 14
Macaroni and spaghetti, 73 02
Potatoes, 444 25
Meat, 10.838 23
Fish (fresh, cured and canned) , 2,171 58
Butter, , 4,586 00
Cheese 148 96
Coffee 399 63
Tea, 170 07
Cocoa 50 59
Milk (condensed, evaporated, etc.) 39 60
Eggs (fresh), 2,084 55
Sugar (cane), 3,882 31
Fruit (fresh) 296 81
Fruit (dried and preserved), 256 06
Amounts carried forward $29,754 80 $89,323 92
No. 34.] DIVISION OF TUBERCULOSIS (SANATORIA). 337
Amounts brought forward, $29,754 80 $89,323 92
Food — Con.
Lard and substitutes, 434 50
Molasses and syrups, 44 51
Vegetables (fresh), 11 b5
Seasonings and condiments, 723 90
Yeast, baking powder, etc., 137 54
Sundry foods, 53 02
Freight 545 36
31,771 18
Clothing and materials: —
Boots, shoes and rubbers $1 50
Clothing (outer) 13 10
Freight, 35
4 95
Furnishings and household supplies: —
Beds, bedding, etc., $650 66
Carpets, rugs, etc., 187 06
C^ocker5^ glassware, cutlery, etc., 464 56
Dry goods and smallwares, 346 94
Electric lamps, 197 11
Furniture, upholstery, etc. 225 82
Kitchen and household wares 1,977 62
Laundry supplies and materials, 750 40
Lavatory supplies and disinfectants, 518 26
Table linen, paper napkins, towels, etc., .... 445 98
Sundries, 54 46
Freight, 127 21
5,946 08
Medical and general care: —
Books, periodicals, etc., $30 13
Entertainments, games, etc., 324 25
Funeral expenses 228 50
Ice and refrigeration, 187 74
Laboratory supplies and apparatus, 212 16
Medicines (supplies and apparatus) 2,120 50
Medical attendance (extra), 13 50
Sputum cups, etc 712 56
Sundries, 3 00
Freight, 34 01
■ 3,866 35
Heat, light and power: —
Coal (bituminous) $6,790 59
Freight and cartage 4,249 60
Coal (anthracite), 366 74
Freight and cartage 335 18
Oil, 474 99
Operating supplies for boilers and engines, .... 398 05
Sundries 180 05
Freight 31 84
12,827 04
Amount carried forward, $143, /49 52
338 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Amount brought forward, $143,749 52
Farm : —
Bedding materials, $229 34
Blacksmithing and supplies, 248 64
Carriages, wagons and repairs, 68 12
Dairy equipment and supplies, 455 04
Fencing materials 226 44
Fertilizers 4,266 24
Grain, etc 18.046 34
Hay 4.574 64
Harnesses and repairs, 244 20
Cows, 890 00
Other live stock 947 58
Labor (not on pay roll), 1,527 14
Rent 303 76
Spraying materials, . • 308 06
Stable and barn supplies, 237 53
Tools, implements, machines, etc., 2,026 86
Trees, vines, seeds, etc., 1-108 35
Veterinary services, supplies, etc., 223 56
Sundries 407 76
Freight 2,897 28
39,236 88
Garage, stable and groimds: —
Motor vehicles ^3,792 50
Automobile repairs and supplies 2,515 45
Carriages, wagons and repairs, 498 56
Road work and materials 212 37
Spraying materials 27 75
Tools, implements, machines, etc 448 15
Trees, vines, seeds, etc., 257 53
Freight 114 85
7,867 16
Repairs, ordinary: —
Brick '^Q 60
Cement, lime, crushed stone, etc 608 61
Electrical work and supplies, 437 50
Hardware, iron, steel, etc., 723 43
Labor (not on pay roll) 509 41
Lumber, etc. (including finished products), .... 1,30945
Paint, oil, glass, etc 1'196 02
Plumbing and supplies, 477 11
Roofing and materials 217 32
Steam fittings and supplies, 124 47
Tents, awnings, etc 313 38
Tools, machines, etc., 583 92
Boilers, repairs, ^^^/^
Dynamos, repairs, ■^"'* ^"^
Engines, repairs 196 00
Sundries 10^ ^^
"-«" '— 7,23325
Repairs and renewals: —
Repair old house, ^^4 06
Total expenses for maintenance $198,740 87
No. 34.] DIVISION OF TUBERCULOSIS (SANATORIA). 339
Special Appropriations.
Balance Dec. 1, 1919, S2,500 00
Appropriations for current year, 11,505 00
Total, • $14,005 00
Expended during the year (see statement below) , 1,849 82
Balance Nov. 30, 1920, carried to next year, $12,155 18
Object.
Act or Resolve.
Whole
Amount.
Expended
during
Fiscal Year.
Total
Expended
to Date.
Balance
at End of
Year.
Shelter for young stock.
Generator unit, .
Purchase of land.
Chap. 629, 1920,
Chap. 629, 1920,
Chap. 153, 1919,
S2,500 00
9,005 00
2,500 00
$1,696 52
153 30
$1,696 52
153 30
$803 48
8,851 70
2,500 00
1
$14,015 00
$1,849 82
$1,849 82
$12,155 18
Resources and Liabilities.
Resources.
Cash on hand $4,501 68
November cash vouchers (paid from advance money), ac-
count of maintenance, 3,498 32
$8,000 00
Due from treasury of Commonwealth from available appropriation, account
of November, 1920, schedule 7,796 89
$15,796 89
Liabilities.
Schedule of November bills $15,796 89
Per Capita,
During the year the average number of inmates has been 231.34.
Total cost for maintenance, $198,740.87.
Equal to a weekly per capita cost of $16,520.
Receipt from sales, $1,070.16.
Equal to a weekly per capita of $0.0889.
All other institution receipts, $34,738.24.
Equal to a weekly per capita of $2.8877.
Respectfully submitted,
SuiklNER COOLIDGE,
Treasurer.
Examined and found correct as compared with the records in the office of the Auditor
of the Commonwealth.
Alonzo B. Cook,
Auditor.
340
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
VALUATION.
Land.
Grounds (63 acres),
Woodland (10 acres),
Mowing (42 acres).
Tillage (53 acres),
Orchard (5 acres).
Pasture (13 acres),
Waste and miscellaneous (23 acres) ,
Buildings and Equipment
Institution and buildings.
Farm, stable and grounds,
Miscellaneous,
$8,868 50
535 70
2,019 25
4,502 90
442 66
696 41
1,018 96
$117,394 50
23,642 87
83,782 88
Present value of all personal property as per inventory of Nov. 30, 1920,
Grand total, .........
$18,084 38
224,820 25
$242,924 63
115,192 25
$358,116 88
SPECIAL REPORT.
The following report is prepared in accordance with a resolution of the Na-
tional Conference of Charities and Corrections, adopted May 15, 1906: —
Population.
Males.
Females.
Totals.
Number of patients at beginning of year
Number received during year
Number discharged or died during the year.
Number at end of fiscal year,
Daily average attendance {i.e., number of inmates actually
present) during the year.
Average number of officers and employees during the year,
r
150
351
424
166
206
94
82
153
192
85
129
24
232
504
616
251
335
118
Exfenditures.
Current expenses: —
1. Salaries and wages, ....
2. Clothing
3. Subsistence, .....
4. Ordinary repairs and improvements,
5. Office, domestic and outdoor expenses, .
$86,245 11
14 95
31,771 18
7.887 31
72,822 32
$198,740 87
1,849 82
Total, ......
Extraordinary expenses : —
1. Shelter for young stock,
2. Generator unit, .....
$1,696 52
153 30
Grand total, .....
$200,590 69
No. 34.] DIVISION OF TUBERCULOSIS (SANATORIA). 341
Summary of Current Expenses.
Total expenditures, .......
Deducting extraordinary expenses, ....
Deducting amount of sales, ......
Total,
$200,590 69
1,849 82
$198,740 87
1,070 16
$197,670 71
Dividing this amount by the daily average number of patients — 231.34 — gives a cost
for the year of $854,459, equivalent to an average weekly net cost of $16,434.
STATISTICAL TABLES.
Table 1. — Admissions and Discharges.
Males.
Females.
Totals.
Number of patients admitted Dec. 1, 1919, to Nov. 30, 1920,
inclusive.
Number of patients discharged Dec. 1, 1919, to Nov. 30, 1920,
inclusive.
Number of deaths (included in preceding item),
Number remaining in sanatorium Nov. 30, 1920,
Daily average number of bed patients Dec. 1, 1919, to Nov.
30, 1920.
Daily average number of patients,
351
335
89
166
58
148
153
150
42
85
46
83
504
485
131
251
104
231
Table 2. — Civil Condition of Patients admitted.
Males. Females.
Totals.
Married, .
Single,
Widowed,
Divorced,
Totals,
160
170
18
3
351
79
65
6
3
153
239
235
24
6
504
Table 3. -
— Age of Patients admitted
Males.
Females.
Totals.
14 to 20 years,
.
19
22
41
20 to 30 years,
124
06
190
30 to 40 years,
91
43
134
40 to 50 years,
80
17
97
Over 50 years,
37
5
42
Totals, .
351
153
504
342
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Table 4
. — Nativity and Pa
rentage
of Pat
lents a
imttted
•
Males.
Females.
Totals.
Places of Nativity.
Patients.
2
o
03
■s
.2
2
1
■s
a
1
2
1
United States: —
Massachusetts,
121
37
31
65
19
20
186
56
51
Other New England States,
17
13
12
10
9
5
27
22
17
Other States, .
18
10
16
12
15
17
30
25
33
Total native,
156
60
59
87
43
42
243
103
101
Other countries: —
Albania, ....
1
1
1
-
-
-
1
1
1
Armenia
7
7
7
-
-
-
7
7
7
Austria
2
2
2
-
-
-
2
2
2
Azores, ....
1
1
1
-
-
-
1
1
1
Canada, ....
28
41
44
8
12
13
36
53
57
Cape Verde Islands,
4
4
4
-
-
-
4
4
4
China, ....
1
1
1
-
-
-
1
1
1
Denmark,
-
1
1
-
-
-
-
1
1
England
7
11
9
7
10
7
14
21
16
Europe, ....
-
-
-
1
1
1
1
1
1
Finland, ....
4
5
5
3
3
3
7
8
8
France
-
2
1
-
-
-
-
2
1
Germany,
-
4
1
1
1
1
1
5
2
Greece
17
17
17
2
2
2
19
19
19
Ireland, ....
21
62
69
13
35
39
34
97
108
Italy, . . . .
26
29
30
4
5
5
30
34
35
Lithuania,
1
2
2
1
1
1
2
3
3
Madeira, ....
-
-
-
1
1
1
1
1
1
Newfoundland,
1
3
3
1
1
1
2
4
4
Norway, ....
4
4
4
1
1
1
5
5
5
Nova Scotia, .
6
12
14
7
10
11
13
22
25
Poland
10
10
11
2
5
5
12
15
16
Portugal
6
6
6
4
4
4
10
10
10
Russia
29
32
29
7
8
8
36
40
37
Scotland, . . . .
5
10
7
2
3
3
7
13
10
Spain, . . . .
1
1
1
-
-
-
1
1
1
Sweden, . . . .
7
12
10
-
2
2
7
14
12
Switzerland,
-
-
1
-
-
-
~
-
1
Syria, . . . .
3
3
3
1
1
1
4
4
4
Turkey, . . . .
2
2
2
-
-
-
2
2
2
West Indies,
-
-
-
-
-
1
-
—
1
Total foreign, .
194
285
286
66
106
110
260
391
396
Unknown,
1
6
6
-
4
1
1
10
7
Grand totals,
351
351
351
153
153
153
504
504
504
No. 34.] DIVISION OF TUBERCULOSIS (SANATORIA). 343
Table 5. — Residence of Patients admitted.
Place.
Number.
Place.
Number.
Adams,
2
Leominster
5
Andover, .
2
Lexington,
1
Arlington,
Athol,
4
2
Longmeadow, .
Lowell,
1
19
Avon,
1
Lynn,
13
Bedford, .
1
Maiden, .
10
Belmont, .
2
Marblehead, .
1
Beverly, .
2
Marlborough, .
6
Boston,
169
Maynard,
1
Braintree,
Medford, .
1
Bridgewater, .
Merrimac,
1
Brockton,
11
Methuen,
1
Buffalo. N. Y.,
Middleborough,
10
Cambridge,
12
Milford, .
4
Chelmsford,
Millbury,
1
Chelsea, .
11
Natick, .
1
Clinton, .
Needham,
1
Concord, .
New Bedford, .
26
Danvers, .
2
Newton, .
6
Dedham,
2
Northbridge, .
2
Essex,
2
Norton, .
1
Everett, .
9
Norwood,
2
Fairhaven,
1
Ormbay, Conn.,
Fall River,
23
Pawtucket, R. I.,
Framingham,
4
Peabody,
Freetown,
1
Providence, R. I.,
Gardner, .
5
Quincy, .
10
Gay Head,
1
Randolph,
Gloucester,
5
Reading, .
Hardwick,
1
Revere, .
Haverhill,
3
Rockport,
Holderness, N.
H..
1
Saugus, .
Holyoke, .
1
Somerset,
Hopkinton,
1
Somerville,
12
Hudson, .
1
Southbridge, .
Lakeville,
1
Spencer, .
Lawrence,
1
9
Springfield,
344
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Table 5. —
- Residence of Patients admitted —
- Concluded.
Place.
Number.
Place.
Number.
Stoneham,
1
Watertown,
2
Stoughton,
1
Webster, .
Sturbridge,
1
Westborough,
Taunton,
6
Weston, .
Upton,
1
Winchendon,
Wakefield,
2
Winchester,
Walpole, .
2
Woburn, .
Waltham,
1
1
Worcester,
Total,
20
Warren, .
504
Table 6. — Occiipations of Patients admitted.
Males.
Females.
Totals.
Actor,
1
-
1
Agricultural extension leader,
1
-
1
Attendant
-
4
4
Baker
2
-
2
Barber
5
-
5
Beltmaker,
1
-
1
Blacksmith,
1
-
1
Bookbinder,
-
1
1
Bookkeeper,
-
2
2
Brakeman,
2
-
2
Brassworker,
-
1
Bricklayer
-
1
Brickmason,
-
1
Butcher,
-
1
Butler
-
1
Cabinetmaker
-
3
Canvasser
-
1
Card room in mill,
-
1
Car inspector,
-
1
Carpenter,
4
-
4
Chair shop,
2
-
2
Chauffeur,
5
- '
5
No. 34.] DIVISION OF TUBERCULOSIS (SANATORIA). 345
Table 6. — Occupations of Patients admitted — Continued.
Males.
Females.
Totals.
Chemical laboratory worker,
Chorus girl, .
Cigarmaker, .
Clerk
Coal passer, .
Coal sampler.
Cobbler,
Conductor,
Contractor,
Cook, ....
Coppersmith,
Corset factory.
Cotton factory.
Creamery hand,
Dairyman,
Domestic,
Draftsman,
Dressmaker, .
Driver
Druggist,
Electrical salesman.
Electrician,
Engineer,
Errand boy, .
Expressman, .
Factory: ....
Farmer
Fireman,
Fisherman,
Foreman shoe factory, .
Freight carrier,
Fruit dealer, .
Gardener,
General helper.
Granite works,
Hairdresser, .
Hatter, ....
1
23
1
1
1
1
1
4
1
2
1
1
1
1
1
3
6
1
1
1
4
1
2
1
1
3
4
1
1
1
1
1
24
1
1
1
1
1
4
1
2
9
1
1
3
1
1
1
1
1
3
6
1
1
4
4
1
2
1
1
3
4
1
1
1
1
346
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Table 6. — Occupations of Patients admitted — Continued.
Males. Females.
Totals.
Horse trainer,
Hotel worker,
Housekeeper, .
Hoiisewife,
Iceman, .
Inspector in library.
Iron and wire worker.
Janitor, .
Jeweler, .
Journalist,
Junk dealer, .
Kitchenmaid,
Labor agent, .
Laborer, .
Laundress,
Leading rigger.
Leather worker.
Linen worker.
Longshoreman,
Machine operator, .
Machinist,
Magician,
Mason, .
Metal polisher.
Meter reader, .
Mill operative,
Molder, .
Motorman,
Mule spinner.
Munition worker, .
Nailnaaker,
None,
Nurse,
Nursemaid,
Office clerk, .
Office work, .
Orderly, .
1
1
3
1
1
1
1
1
35
1
5
1
1
1
24
1
3
1
2
9
3
1
2
1
1
10
64
1
1
10
64
1
2
3
1
1
1
1
1
1
35
4
1
6
1
1
2
24
1
3
1
2
15
3
1
2
1
1
2
4
1
3
4
2
No. 34.] DIVISION OF TUBERCULOSIS (SANATORIA). 347
Table 6. — Occupations of Patients admitted — Continued.
Packer, .
Painter, .
Paper hanger.
Pattern maker.
Peddler, .
Pharmacist, .
Piano maker, .
Piano tuner, .
Plasterer,
Plumber,
Police officer, .
Postman,
Post office clerk,
Poultryman, .
Potter, .
Printer, .
Purser, .
Railroad porter.
Real estate dealer,
Restaurant, .
Retoucher in studio.
Rubber work.
Saleslady,
Salesman,
Scholar, .
Seaman, .
Sheet metal, .
Shipbuilder, .
Shipper, .
Shirt waist factory,
Shoe repairer.
Shoe worker, .
Sign painter, .
Silk cutter,
Singer, .
Spinner, .
Spring winder,
r
Males.
Females. Totals
2
2
3
1
3
1
1
29
1
1
1
3
2
3
2
4
3
1
3
1
2
1
30
1
1
1
4
1
348
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Table 6. — Occupations of Patients admitted — Concluded.
Males.
Females.
Totals.
Steam fitter, ....
Stenographer,
Steward, ....
Stitcher, ....
Stone cutter, ....
Stove molder,
Straw shop
Student, ....
Superintendent, rubber works,
Tailor
Tailoress, ....
Tanner,
Teacher, ....
Teamster, ....
Telegraph messenger.
Telephone operator.
Tinsmith, ....
Toolmaker, ....
Waiter
Waitress, . .
Watchman, ....
Weaver, .....
Winder tender.
Totals
r
10
2
3
1
1
7
1
10
351
1
2
1
4
8
1
1
4
1
8
1
2
1
10
2
4
1
1
7
1
1
12
1
153
504
Table 7. — Condition on Admission.
Males.
Females.
Totals.
Incipient
2
1
3
Moderately advanced, ....
187
87
274
Advanced,
145
62
207
Not classified
15
2
17
Nontuberculous
-
-
-
Not examined
2
-
2
Apparently arrested,
-
1
1
Totals,
351
153
504
No. 34.] DIVISION OF TUBERCULOSIS (SANATORIA). 349
Table S. —
- Condition
on Discharge
Males.
Females.
Totals.
Apparently arrested,
•
■
9
11
20
Quiescent,
8
8
16
Improved,
142
37
179
Unimproved, .
25
34
59
Died, ....
88
43
131
Not considered.
63
17
80
Nontuberculous, .
-
-
-
Totals,
335
150
485
r .... .- ... _.... — . ._-.
Table 9.
— Deaths.
DUKATXON OF DISEASE.
Males.
Females.
Totals.
Length op Residence
AT Sanatorium.
Males.
Females. Totals.
Under 1 month,
-
1
1
1 23
3
26
1 to 2 months,
4
1
5
1
11
4
15
2 to 3 months.
2
-
2
, 7
6
13
3 to 4 months.
6
1
7
i 5
3
8
4 to 5 months.
-
-
-
7
2
9
5 to 6 months.
5
3
8
6
3
9
6 to 7 months.
9
1
10
-
2
2
7 to 8 months.
3
-
3
! 4
1
5
8 to 9 months,
1
2
3
: 3
4
7
9 to 10 months,
-
1
1
' 3
4
10 to 11 months.
1
1
2
2
3
11 to 12 months,
6
2
8
2
3
12 to 18 months,
20
8
28
1 '
4
18 to 24 months,
3
1
4
1
1
5
Over 2 years, .
24
16
40
12 .
6
18
Unknown,
5
4
9
-
-
-
Totals,
89
42
131
89
42
131
Table 10. — Cause of Death.
Males.
Females.
Totals.
Phthisis pulmonalis,
Suicide, .
Influenza,
Totals,
89
41
42
129
1
1
131
350
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
RUTLAND STATE SANATORIUM.
Resident Officers.
Ernest B. Emerson, M.D.,
Leon A. Alley, M.D.,
Halbert C. Hubbard, M.D.,
William B. Davidson, M.D.,
William J. O'Connor, D.M.D.,
Delta E. Nardi,
Cora A. Phillips, .
Walter C. Brown, .
Joseph A. Carroll,
Superintendent.
Assistant Superintendent.
Physician.
Physician.
Physician.
Physician.
Dentist.
Superintendent of A'urses.
Head Matron.
Chief Engineer.
Farmer.
REPORT OF THE SUPERINTENDENT.
To the Commissioner of Public Health.
Dear Sir: — The annual report of the Rutland State Sanatorium for the
year ending Nov. 30, 1920, is hereby submitted.
During the year there have been expended $301,330.01 for maintenance and
$3,317.51 from the appropriation authorized by chapter 55, Resolves of 1918.
The details of these disbursements are contained in the report of the treasurer.
There were 359 patients in the sanatorimn at the beginning of the year and
356 at the close. The largest number present at one time was 372 and the
smallest was 311. The daily average number of patients was 345.27. There
were 548 cases admitted during the year; 179 incipient, 200 moderately ad-
vanced, 150 advanced and 19 unclassified. Including deaths, there were 551
discharged, and the average duration of residence was seven months and twenty-
five daj's. Of those discharged, 362 gained 4,107 pounds, an average gain of 11.35
pounds per person. Including deaths, there were 135 who lost 978 pounds, an
average loss of 7.24 pounds per person, and 54 neither gained nor lost. Of the
discharges, there were 25 arrested cases, 2 more than last year; 34 apparently
arrested, 10 more than last year; 187 quiescent, 37 more than last year; 118
improved and 65 unimproved. There were 45 patients not considered, the
duration of treatment being less than one month. There were 62 deaths, 38
more than last year. There were 15 discharged nontuberculous.
The following table shows the classification on the application blank and our
classification on admission. The variation in the classification of cases suggests
a different method of admission: —
Our Classifica-
tion
on Admission.
No. 34.] DIVISION OF TUBERCULOSIS (SANATORIA). 351
At the present time patients are assigned to the sanatorium on the application
of the attending physician, and during the past year, with no waiting list or at
least a waiting list of only a few days, the disease could not have progressed
from mcipiency to far advanced between the tune of application and admission.
In many instances the real condition of the patient has not been indicated on
the application blank, and frequently patients mdicated on the application
blank as suitable for sanatorium treatment have arrived in the last stages and
should not have been subjected to the hardship of the journey to Rutland.
Some of these patients have passed away within two weeks and 25 per cent of
the deaths occurred witliin four months after arrival. The rule that patients
may be transferred or discharged after the thirty-day period of observation, if
found unsuitable for sanatorium treatment, is frequently unworkable for the
reason that we do not feel that we should subject them to the hardship of travel.
Consequently, many beds are filled with incurables while the early and favor-
able case for treatment is compelled to wait until the disease has progressed
beyond the point when anything more than temporary relief can be expected.
If the sanatorium is to be conducted for the relief and cure of the greatest num-
ber, our facilities should be resented, I believe, for those patients who have a
reasonable chance for improvement at least, and not taken over by those more
properly classified in the municipal hospitals. I would suggest that applicants
for admission be referred either to one of the consultation clinics or to the sana-
torium for final examination before admission. Including the State sanatoria,
there are twenty points in the State, and more could be established, where these
examinations may be made without involving any great hardship on the part of
the patient. It would seem to me that any patient imable to attend one of these
clinics would in the majority of cases at least be an unsuitable case for sana-
torium treatment and should be sent to the local hospital.
Medical.
Staff meetings have been held once a week, when administrative, medical
and other questions have been freely discussed and suggestions offered. These
meetings have been of great value not only to the superintendent but also to the
assistant physician, to whom a broader perspective of the problem has been
presented than that obtained when duties and responsibilities end Tvath ward
and clinical work.
Weekly clinics have also been held, when the new cases have been presented
by the different members of the staff for examination, diagnosis and classifica-
tion.
A course of six lectures in early diagnosis and methods of treatment of pul-
monary tuberculosis was given at the sanatorium by the medical staff under
the auspices of the Wachusett Medical Improvement Society. These exercises
were well attended by the physicians of the neighboring towns, and it is pro-
posed to repeat the course the coming yesiv.
Consultation clinics in the diagnosis of pulmonary tuberculosis initiated by
the Department of Public Health in September have been conducted in Worces-
352
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
ter, Clinton, Gardner and Fiichburg. The response of the profession has been
most gratifying and has shown the need for such a point of contact between tlie
sanatorium and the phj^sician in general practice. There have been 92 exam-
inations.
During the year Dr. William J. O'Connor has made 1,452 dental examinations
and treatments. The following table shows briefly the scope of this work: —
Prophylactics, .
Amalgam fillings,
Cement fillings,
Gutta-percha fillings
Temporary fillings,
Pulp treatments,
Treatment cases,
Surgical dressings,
Extractions,
Abscess cases, .
Mouth washes,
Vincent's disease,
Inlays,
Repairs to plates.
Bridges, .
Plates,
Crowns, .
X-rays, .
Repairs to bridges.
142
205
78
118
142
22
301
8
110
42
44
4
68
12
54
14
67
78
4
Dr. Marj^ E. Gaffney resigned under date of Sept. 15, 1920, to accept the
superintendency of the Woman's Hospital in Philadelphia. Dr. David E. Mann
resigned Oct. 15, 1920, to accept a position at the National Sanatorium, Johnson
City, Tenn. The resignations of Dr. Gaffney and Dr. Mann are much regretted.
Both had rendered good service, and with their knowledge of tuberculosis the
call to broader fields is distinctly our loss. Neither of these vacancies has been
filled.
Miss Delya E. Nardi continues in charge of the training school for nurses.
In order to maintain the standard of nursing required by the State Board of
Registration of Nurses the traming school has been affiliated with that of the
Milford Hospital. There are 8 probationers, 6 juniors and 8 seniors now in
training.
The following have been awarded diplomas: Jane L. Cross, Mary Belz, Mary
E. O'Brien, Helen Trombley, Freida Katz, Mary E. Moore, Alice B. McDonald
and Alice Tucker.
Entertainments and diversion so far as compatible with the physical condition
of our patients have been provided throughout the year. A Camera Club,
Debating Society and a Garden Club were organized and afforded much en-
tertainment, and, in some instances, a considerable degree of profit for the
members. The Garden Club was organized rather late in the spring on account
of the unsettled conditions on the farm. The plowing and other heavj' work
necessary to prepare the land for garden crops was done by the regular farm
force. This land was then turned over to the Garden Club, with seeds, tools
and overalls, and left to the management and direction of the patients them-
No. 34.] DIVISION OF TUBERCULOSIS (SANATORIA). 353
selves with no supervision whatever other than medical. The results more than
justified the experiment by the amount of produce raised, the season's supply
of fresh vegetables, and by the improved physical condition of the patients tak-
ing part in this work.
Numerous talks and demonstrations have been given to the patients on
health subjects, particularly those relating to tuberculosis, by members of the
staff. These talks have been universally attended and we believe that, as a
result of them, there has been better co-operation between patients, physicians
and nurses.
Entertainments have been provided by members of the household, the Red
Cross, the Knights of Columbus, Commimity Service and players from the
Polls Theatre of Worcester.
Farm.
Charles E. Chapman, head farmer, resigned May 19, 1920, and Joseph A.
Carroll was appointed to that position May 25, 1920.
Recommendations.
Plans and specifications have been submitted for a building to provide
quarters for 42 employees now located in dormitories adjacent to the wards and
using toilets, lavatories and locker rooms in common with the patients. Non-
tuberculous employees will not submit to these conditions, and the ex-patient
who has become an employee is entitled to the privacy of his own room.
Furthermore, the overcrowding results in more or less friction between patients
and employees. The removal of these employees to a separate building will
increase the capacity of the institution without proportionately increasing the
number of workers. The dormitories now occupied by emploj^ees would afford
space for reading and recreation rooms. At the present time there is no place,
with the exception of the toilets and lavatories, where patients may congre-
gate in the evening or go during the day where heat is provided. The lack
of such facilities is a hardship particularly during the winter months. It is
estimated that the building described in the specifications can be erected at the
present time for S96,000.
I recommend that S10,000 be appropriated for the installation of steel lockers
to replace the present wooden lockers, which are obsolete and unsanitary. Also
that $4,000 be appropriated for the erection of a garage. Attention has been
called to the condition of our roofs in a previous report and I recommend an
appropriation of $16,000 for repairs and renewals be included in the estim.ate
for maintenance for the ensuing year.
In closing, I wish to acknowledge the loyalty and fidelity of the members of
the household who have made it possible to carry through the work of the year.
I am furthermore obligated to you for your courtesy and many suggestions
which have gone far in improving our service.
Respectfully,
Ernest B. Emerson,
S^iperintcndent.
354 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
TREASURER'S REPORT.
To the Commissioner of Public Health.
I respectfully submit the following report of the finances of this institution
for the fiscal year ending Nov. 30, 1920: —
Cash Account.
Balance Dec. 1, 1919 $1,128 94
Receipts.
Institution Receipts.
Board of inmates: —
Private, $8,556 32
Cities and towns 40,103 91
Reimbursements, charitable, State minor
wards, 52 00
$48,712 23
Sales: —
Furnishings and household supplies, . . $28 65
Medical and general care, 282 46
Farm and stable: —
Cows and calves, .... $316 00 i
Hides, 31 61
Ice 7 72
Sundries, 108 64
463 97
Repairs, ordinary 55 79
830 87
Miscellaneous receipts: —
Interest on bank balances, .... $432 78
Sundries 193 29
626 07
50.169 17
Receipts from Treasury of Commonwealth.
Maintenance appropriations: —
Balance of 1919, $19,065 29
Supplementary schedule, 3,504 33
Advance money (amount on hand November 30), . . 20,000 00
Approved schedules of 1920 267,735 26
310,304 88
Special appropriations, 3,317 51
Total, $364,920 50
Payments.
To the treasury of Commonwealth, institution receipts, .... $50,169 17
Maintenance appropriations: —
Supplementary November schedule $3,504 33
Balance November schedule, 1919, 20,194 23
Eleven months' schedules, 1920 267,735 26
November advances 8,513 81
299,947 63
Amount carried forward, $350,116 80
1 Adjustment entry, March 4, 1920, treated as income, ciirrent year, by Auditor instead of refund,
account of previous year's business.
No. 34.] DIVISION OF TUBERCULOSIS (SANATORIA). 355
Amount brought forward, S350,116 80
Special appropriations: —
Approved schedules 3,317 51
Balance Nov. 30, 1920: —
In bank, $7,578 16
In office 3,908 03
11,486 19
Total, §364,920 50
Maintenance.
Balance from previous year, brought forward $3,722 33
Appropriation, current year, 304,280 00
Total, $308,002 33
Expenses (as analyzed below), 301,330 01
Balance reverting to treasury of Commonwealth, $6,672 32
Analysis of Expenses.
Personal services : —
Ernest B. Emerson, M.D., superintendent, .... $3,546 77
Medical, 8,443 52
Administration 8,161 82
Kitchen and dining-room service, 20,441 25
Domestic 15,548 99
Ward service (male), 9,886 01
Ward service (female) 14,500 29
Engineering department 12,960 74
Repairs 4,907 02
Farm 11.099 01
Stable, garage and grounds, 5,612 48
$115,107 90
Religious instruction: —
Catholic $600 00
Hebrew 600 00
Protestant, 600 00
Travel, transportation and office expenses: —
Advertising, $6 40
Postage 255 00
Printing and binding, 467 56
Stationery and office supplies, 683 42
Telephone and telegraph 1,228 62
Travel 517 08
Sundries, 12 25
Freight 14 01
1,800 00
3,184 34
Amount carried forward, $120,092 24
356 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Amount hr ought forward, $120,092 24
Food: —
Flour, $4,268 64
Cereals, rice, meal, etc 1,783 62
Bread, crackers, etc., 212 22
Peas and beans (canned and dried), 1,261 92
Macaroni and spaghetti, 134 97
Potatoes, 3,572 29
Meat, 30,667 71
Fish (fresh, cured and canned), 2,393 26
Butter 9.722 95
Butterine, etc., 56 70
Cheese, 164 77
Coffee 1.449 60
Tea 228 10
Cocoa, 80 68
Whole milk 15,132 90
Milk (condensed, evaporated, etc.), 165 33
Eggs (fresh) 7,621 82
Sugar (cane) 4,377 34
Fruit (fresh) 1,03539
Fruit (dried and preserved), 3,407 92
Lard and substitutes, 35 00
Molasses and syrups, 637 08
Vegetables (fresh) 828 96
Vegetables (canned and dried) 1,470 31
Seasonings and condiments, 1,242 11
Yeast, baking powder, etc., 158 79
Sundry foods, 6 39
Freight 1-082 57
93,199 34
Clothing and materials: —
Clothing (outer), . . .' $215 31
Dry goods for clothing, 24 33
239 64
Furnishings and household supplies: —
Beds, bedding, etc., $2,689 36
Carpets, rugs, etc., 8 10
Crockery, glassware, cutlery, etc., 1,250 02
Dry goods and smallwares, 150 02
Electric lamps, 700 57
Fire hose and extinguishers 741 32
Furniture, upholstery, etc., 340 41
Kitchen and household wares 2,053 12
Laundry supplies and materials 468 53
Lavatory supplies and disinfectants, 1,253 98
Table linen, paper napkins, towels, etc., .... 692 86
Freight, 107 39
10,455 68
Medical and general care: —
Books, periodicals, etc., $196 83
Entertainments, games, etc., 354 39
Funeral expenses, 50 00
Amounts carried forward, $601 22 $223,986 90
No. 34.] DIVISION OF TUBERCULOSIS (SANATORIA). 357
Amounts hroicght forward $60122 $223,986 90
Medical and general care — Con.
Gratuities 23 03
Ice and refrigeration, 279 82
Laboratory supplies and apparatus 605 07
Medicines (supplies and apparatus) , 2,623 89
Medical attendance (extra), 100 00
Sputum cups, etc., 975 87
Tobacco, pipes, matches, 12 75
Water 3,492 93
Freight, 73 31
8,787 89
Heat, light and power: —
Coal (bituminous), $18,386 58
Freight and cartage, 10,466 84
Coal (anthracite), 344 23
Freight and cartage 157 76
Charcoal 50 00
Electricity • 120 00
Oil, 884 71
Operating supplies for boilers and engines 307 02
Sundries 7 22
Freight, 9 86
30.734 22
Farm: —
Bedding materials, $379 81
Blacksmithing and supplies, 204 34
Carriages, wagons and repairs, 14 70
Dairy equipment and supplies, 42 16
Fencing materials 141 11
Fertilizers, 1-513 63
Grain, etc 11,758 46
Harnesses and repairs, 340 42
Horses 600 00
Cows ■ 2,025 00
Other live stock, 479 00
Laboi;(not on pay roll), 209 25
Spraying materials, 87 20
Stable and barn supplies, 107 06
Tools, implements, machines, etc., 997 12
Trees, vines, seeds, etc. 913 62
Veterinary services, supplies, etc., 314 73
Sundries 13 00
Freight 279 24
20,419 85
Garage, stable and grounds: —
Motor vehicles $3,555 99
Automobile repairs and supplies, 2,849 64
Bedding and materials, 45 92
Blacksmithing and supplies 179 45
Amounts carried forward, $6,631 00 $283,928 86
358
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Amounts brought forward, $6,631 00 $283,928 86
Garage, stable and grounds — Con.
Carriages, wagons and repairs.
Grain,
Harnesses and repairs.
Spraying materials,
Stable supplies, ....
Tools, implements, machines, etc.,
Trees, vines, seeds, etc.,
Freight,
Repairs, ordinary: —
Cement, lime, crushed stone, etc., .
Electrical work and supplies, .
Hardware, iron, steel, etc.,
Labor (not on pay roll)
Lumber, etc. (including finished products).
Paint, oil, glass, etc.,
Plumbing and supplies, ....
Roofing and materials, ....
Steam fittings and supplies,
Tools, machines, etc., ....
Boilers, repairs
Dynamos, repairs,
Engines, repairs,
Freight,
Repairs and renewals : -
Boiler repairs, 1919,
Linoleum,
Freight on scales.
6 50
393 33
49 00
13 75
30 38
44 08
13 29
25
7,181 58
$395 04
299 72
446 61
2,589 07
789 86
1,248 84
633 82
447 80
530 58
663 23
506 59
361 91
121 37
94 65
9,129 09
$679 97
406 24
4 27
1,090 48
Total expenses for maintenance, . $301,330 01
Special Apphopriations.
Balance Dec. 1, 1919
Appropriations for current year,
Total
Expended during the year (see statement below) ,
Balance Nov. 30, 1920, carried to next year.
%4,411 77
$4,411 77
3,317 51
$1,094 26
Object.
Act or Resolve.
Whole
Amount.
Expended
during
Fiscal year.
Total
Expended
to Date.
Balance
at End of
Year.
Kitchen, service and store-
house buildings,
Chap. 55, 1918, .
$55,000 00
$3,317 51
$53,905 74
$1,094 26
J55,000 00
$3,317 51
$53,905 74
$1,094 26
No. 34.] DIVISION OF TUBERCULOSIS (SANATORIA). 359
Resources and Liabilities.
Resources.
Cash on hand $11,486 19
November cash vouchers (paid from advance money), ac-
count of maintenance, 8,513 81
$20,000 00
Due from treasury of Commonwealth from available appropriation, account
of November, 1920, schedule, 10,090 42
$30,090 42
Liabilities.
Schedule of November bills, including supplementary November, 1919,
schedule of $218, $30,090 42
Per Capita.
During the year the average number of inmates has been 345.27.
Total cost for maintenance, $301,330.01.
Equal to a weekly per capita cost of $16.7834.
Receipt from sales, $830.87.
Equal to a weekly per capita of $0.04627.
All other institution receipts, $49,338.30.
Equal to a weekly per capita of $2.7480.
Respectfully submitted,
Leon A. Alley,
Treasurer.
Examined and found correct as compared with the records in the office of the Auditor
of the Commonwealth.
Alonzo B. Cook,
Auditor.
VALUATION.
Land.
Grounds (42.147 acres) $17,945 80
Lawns and buildings, 32.147 acres.
Roads, 10 acres.
Woodland (77.71 acres) 2,683 65
Mowing (84.74 acres) 8,474 00
Tillage (46.26 acres) 4,670 25
Tillage, 37.16 acres.
Garden, 9.10 acres.
Orchard (1.64 acres), 328 00
Pasture (76.58 acres) 1,182 60
Waste and miscellaneous (35.65 acres), . . 1,671 90
Rough pasture, 10.95 acres.
Meadow swamp land, 18.22 acres.
Sewer beds, 5.98 acres.
New coal trestle, .50 acres.
$36,956 20
Sewerage system 15,508 32
$52,464 52
Amount carried forward, $52,464 52
360 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Amount brought forward, $52,464 52
Buildings.
Institution buildings $482,885 44
Farm, stable and grounds, 25,175 00
Miscellaneous, 29,536 25
537,596 69
Total $590,061 21
Present value of all personal property as per inventorj^ of Dec. 1, 1920, . 106,152 59
Grand total $696,213 80
SPECIAL REPORT.
The following report is prepared in accordance with a resolution of
the National Conference on Charities and Corrections, adopted May
15, 1906: —
Pojiulation.
Males.
Females.
Totals.
Number received during the year,
Number passing out of the institution during the year,
Number at end of fiscal year in the institution, .
Daily average attendance (i.e., number of inmates actually
present during the year).
Average number of employees and officers during the year.
325
334
182
180.53
119.60
223
217
174
164.74
52.68
548
551
356
345.27
172.28
Expenditures
Current expenditures: —
1. Salaries and wages,
2. Clothing,
3. Subsistence, ....
4. Ordinary repairs,
5. Office, domestic and outdoor expenses,
Total
$115,107 90
239 64
93,199 34
9,129 09
82,563 56
$300,239 53
Extraordinary expenses: —
1. Permanent improvements to existing buildings,
Summary of Current Exyenses.
Total expenditures, ........
Deducting extraordinary expenses, . . . . .
Deducting amount of sales, ......
Total
1,090 48
$301,330 01
$301,330 01
1,090 48
$300,239 53
630 87
$299,608 66
Dividing this amount by the daily average number of patients — 345.27 — gives a
cost for the year of $864,884, equivalent to an average weekly net cost of $16.63.
No. 34.] DIVISION OF TUBERCULOSIS (SANATORIA). 301
STATISTICAL TABLES.
Table L — Admissions and Discharges.
Males.
Females.
Totals.
Number of patients in sanatorium Nov. 30, 1920,
193
166
359
Number admitted Dec. 1, 1919, to Nov. 30, 1920,
325
223
548
Number discharged Dec. 1, 1919, to Nov. 30, 1920,
334
217
551
Number remaining in sanatorium Nov. 30, 1920,
182
174
356
Daily average number of patients,
180.53
164.74
345.27
Died (included in number discharged), ....
32
30
62
Table 2. — Civil Condition of Patients admitted.
Males.
Females.
Totals.
Single
161
112
273
Married
152
97
249
Widowed,
10
14
24
Divorced
2
-
2
Totals
325
223
548
Table 3. — Age of Patients admitted.
Males.
Females.
Totals.
Under 14 years,
14 to 20 years,
20 to 30 years,
30 to 40 years,
40 to 50 years,
Over 50 years.
Totals,
37
164
84
36
4
325
1
41
110
52
17
2
223
1
78
274
136
53
6
548
362
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Table 4. — Nativity and Parentage of Patients admitted.
'Males.
Females.
Totals.
Places of Nativity.
00
a
a
(2
2
01
..J
o
o
to
a
.2
(2
u
JS
Id
CO
f-l
o
ji
■*^
o
a
o
2
o
JS
tn
o
o
United States: —
Massachusetts,
151
55
61
110
33
30
261
88
91
Other New England States,
25
24
20
15
12
14
40
36
34
Other States, .
15
16
14
11
11
8
26
27
22
Total native.
191
95
95
136
56
52
327
151
147
Other countries (25),
134
225
223
87
163
169
221
388
392
Unknown,
-
5
7
-
4
2
-
9
9
Grand totals.
325
325
325
223
223
223
548
548
548
Table 5. — Reside7ice of Patients admitted.
Place.
Number.
Place.
Number.
Boston,
Cambridge
Chelsea
Lawrence,
Lowell,
200
16
10
13
10
11
Salem,
Somerville,
Springfield
Worcester,
Other cities and towns (85), .
Total
9
9
12
61
197
Lynn,
548
Table 6. — Occupations of Patients admitted.
Males.
Females.
Totals.
Accountant,
Attendant,
Baker,
Barber, .
Bartender,
Blacksmith,
Bookkeeper,
Box nailer,
Brakeman,
No. 34.] DIVISION OF TUBERCULOSIS (SANATORIA). 363
Table 6. — Occupations of Patients admitted — Continued.
Males.
Bridgeman,
Carpenter,
Cashier, .
Chauffeur,
Cigarmaker, .
Clerk, .
Colorist, .
Conductor,
Cook,
Corsetifire,
Cutter, clothing,
Cutter, meat.
Cutter, shoe, .
Cutter, stone.
Dentist, .
Designer, machine.
Dishwasher, .
Draftsman,
Dressmaker, .
Dyer,
Electrician,
Engineer,
Engineer, civil,
Factory, .
Fireman,
Florist, .
Foreman, section.
Foundry,
Garage man, .
General work,
Glassblower, .
Guard, .
Hairdresser, .
Hatter, .
Housewife,
Housework, .
Iceman, .
1
6
1
8
1
25
2
2
1
1
1
1
1
2
1
3
2
1
54
3
1
1
1
1
13
1
Females. Totals
20
1
29
"4
27
1
6
2
8
1
45
1
3
6
1
2
2
1
I
1
1
1
2
3
1
3
2
1
83
3
1
1
1
1
17
1
1
1
1
74
27
0
364
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc
Table 6. — Occupations of Patients admitted — Continued.
es.
Females.
Totals
1
-
1
2
-
2
2
-
2
1
-
1
18
-
18
-
2
2
1
-
1
3
-
3
-
1
1
2
-
2
25
-
25
1
-
1
1
-
1
1
-
1
1
-
1
2
-
2
1
-
1
-
1
1
3
-
3
-
3
3
1
1
-
1
1
3
12
15
1
3
4
2
6
8
-
7
7
1
-
1
1
-
1
2
-
2
2
-
2
1
-
1
3
-
3
1
-
1
1
1
2
4
-
4
1
-
1
1
_
1
Insurance agent,
Ironworker,
Janitor, . . . .
Junkdealer,
Laborer
Laundress,
Letter carrier.
Lineman,
Lodging-house keeper, .
Longshoreman,
Machinist,
Manager, assistant,
Manager, hotel.
Manager, store.
Marine
Mechanic,
Merchant,
Messenger,
Metal worker,
Milliner, . . . .
Molder
Needlework, .
No work.
Nurse, student,
Nurse, trained.
Nursemaid, .
Oiler, ship,
Optician,
Orderly, . . . .
Painter
Pharmacist, .
Plumber,
Pressor, clothes,
Pressman,
Printer
Printer, wallpaper,
Proprietor, bowling alley,
No. 34.] DIVISION OF TUBERCULOSIS (SANATORIA). 365
Table 6. — Occupations of Patients admitted — Concluded.
Males.
Females.
Publisher, music, .
Real estate,
Repairer, auto.
Repairer, engine, .
Repairer, shoe.
Roofer, .
Sailor,
Salesman,
Ship builder, .
Shipper, .
Sign writer.
Soldier, .
Steam fitter, .
Stenographer,
Student,
Tailor, .
Teacher, school,
Teamster,
Telephone operator.
Upholsterer, .
Waiter, .
Wireworker, .
Totals, .
1
1
1
2
3
1
1
12
5
2
1
4
3
1
325
223
Totals.
1
1
1
2
3
1
1
14
5
2
1
4
3
3
13
4
2
4
6
1
7
9
548
Table 7. — Condition on Admission.
Males.
Females.
Totals.
Per Cent.
Incipient,
Moderately advanced.
Far advanced,
Unclassified,
Totals, .
113
120
79
13
325
66
80
71
6
223
179
200
150
19
548
32.66
36.50
27.37
3.47
100.00
366
DEPARTMENT OF PUBLIC HEALTH. [P. D. No. 34.
Table 8. — • Condition on Discharge.
Males.
Females.
Totals.
Arrested,
Apparently arrested,
Quiescent,
Improved,
Unimproved, .
Died,
Nontuberculous, .
Not considered.
Totals,
12
18
120
84
27
32
13
28
334
13
16
67
34
38
30
2
17
217
25
34
187
118
65
62
15
45
551
Table 9. — Deaths.
^„ T
~V,„
Males.
Females.
Totals.
Length of Residence
AT Sanatorium.
Males.
Females.
Totals.
Under 1 month,
-
-
-
-
3
3
1 to 2 months.
-
-
-
2
-
2
2 to 3 months.
-
-
-
2
2
4
3 to 4 months.
-
-
-
3
2
5
4 to 5 months,
-
-
-
2
3
5
5 to 6 months.
-
-
-
4
3
7
6 to 7 months,
-
-
-
3
5
8
7 to 8 months.
-
-
-
3
2
5
8 to 9 months.
-
-
-
2
1
3
9 to 10 months.
-
-
-
4
1
5
10 to 11 months.
-
-
-
2
2
11 to 12 months.
2
2
4
2
2
4
12 to 18 months.
4
5
9
2
4
6
18 to 24 months.
3
5
8
1
1
2
Over 2 years, .
8
5
13
-
1
1
Unknown,
15
13
28
-
-
-
Totals, .
32
30
62
32
30
62
Table 10. — Cause of Death.
Males.
Females.
Totals.
Phthisis pulmonalis
32
30
62
Totals
32
30
62
Repoet of State Examinees of Plumbees
James C. Coffey, Chairman
[3671
Eeport of State Examinees of Plumbers.
Information concerning Examinations for Plumbers, showing the Place and Date
of Examination and Number examined, together with the Results of the Ex-
aminations, etc.
Examinations.
Examined.
Passed.
Refused.
Boston, Dec. 6, 1919,
90
12
78
Lowell, Dec. 20, 1919, .
18
5
13
Boston, Jan. 3, 1920, .
70
15
55
Pittsfield, Jan. 17, 1920,
17
1
16
Boston, Feb. 7, 1920, .
70
8
62
Springfield, Feb. 21, 1920,
40
5
35
Boston, Mar. 6, 1920, .
101
11
90
Fall River, Mar. 20, 1920,
32
4
28
Boston, Apr. 3, 1920, .
86
13
73
Worcester, Apr. 17, 1920,
51
7
44
Boston, May 1, 1920, .
96
20
76
Lowell, May 15, 1920, .
34
7
27
Boston, June 5, 1920, .
96
17
79
Pittsfield, June 19, 1920,
17
6
11
Boston, July 3, 1920, .
93
23
70
Boston, Sept. 4, 1920, .
93
17
76
Springfield, Sept. 18, 1920,
26
5
21
Boston, Oct. 2, 1920, .
91
12
79
Fall River, Oct. 16, 1920,
14
3
11
Boston, Nov. 6, 1920, .
55
6
49
Worcester, Nov. 20, 1920,
38
4
34
Totals, .
1,227
201
1,026
Masters.
Journeymen.
Total.
Licenses granted on account of examination, Dec. 1,
1919. to Dec. 1. 1920.
Probationary licenses issued during year, .
77
123
6
200
370
DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Registratioxs.
Masters.
Journej'men.
December, 1919,
January, 1920,
February, 1920,
March, 1920, .
May, 1920, .
June, 1920,
July, 1920,
August, 1920, .
September, 1920,
October, 1920,
November, 1920,
Totals, .
Meetings, 54 Examinations,
2^
Fees received.
Paid to the
Treasurer of
the Common-
wealth.
1,227 examination fees, at $0.50, . . . .
97 master plumber licenses issued, at $2,
148 journejrmen plumber licenses issued, at SO. 50,
1,803 master plumber renewals issued, at $0.50, .
4,247 journeymen plumber renewals, at $0.50,
Back fees, at $0.50
Total
Interest during May, 1920
$613 50
194 00
74 00
901 50
2,123 50
167 00
$4,073 50
1 74
$4,075 24
No. 34.]
EXAMINERS OF PLUMBERS.
371
For carrying out the Provisions of the Act relative to the Examination of Plumbers.
Salaries, S3,068 06
Examiners' wages,
Traveling,
Express,
Printing,
Postage.
Books, stationery and typewriting supplies,
Plumbers' materials, • • •
Extra services,
Cleaning,
Office supplies,
Telephone and lighting, 106 16
Miscellaneous, • • • "
Total. S4,831 87
Unexpended balance, 7 99
460 00
510 94
34 97
349 56
79 44
42 32
30 25
105 15
17 00
19 77
106 16
8 25
Summary of Registration.
Certificate holders (individuals),
Licenses, year ending May 1, 1920 (individuals),
4621
1,821 =
2,283
$4,839 86
Masters. Journeymen.
461
2,966
3,427
' Holding journeymen also, 311.
- Holding journeymen also, 1,593.
Number of last master license issued up to Aug. 1, 1920, 2,845
Number of last journeyman license issued up to Aug. 1, 1920, 6,573
Masters,
Deceased Plu77ibers reported to Examiners.
. 7 I Journeymen,
Papers written in 1920 and Pamphlets
ISSUED
[373]
Papers written in 1920 and Pamphlets issued.
Papers written by Members of the State Departaient of Public Health
DURING THE YeAR 1920.
Division of Administration.
Eugene R. Kelley, M.D., Commissioner of Public Health.
"The Development of Nutrition Activities by the Massachusetts Depart-
ment of Public Health." The Commonhealth, Vol. 7, No. 4, July-
August, 1920.
"The Development of Mouth Hygiene Activities in the Department of
Public Health." The Commonhealth, Vol. 7, No. 5, September-
October, 1920.
"The Control and Prevention of Bubonic Plague." Current Events, Bos-
ton Chamber of Commerce, November, 1920.
"Some General Considerations Relative to the Tuberculosis Problem."
Annual Report, Massachusetts Tuberculosis League, Vol. II, No. 5,
June, 1920.
Division of Sanitary Engineering.
Mr. X. H. Goodnough.
"Boating and Fishing in Ponds and Reservoirs used as Sources of Water
Supply." Journal of the New England Water Works Association, Vol.
XXXIV, No. 3, 1920.
Mr. Arthur D. Weston,
"Epidemic of Gastro-Enteritis in Peabody, Mass., October, 1913." Jour-
nal of the New England Water Works Association. Vol. XXXIV, No.
3, 1920.
Division of Communicable Diseases.
Stanley H. Osborn, M.D.
"Health Dividends You Have Drawn." Boston Medical and Surgical
Journal, May 13, 1920; also in The Commonhealth, Vol. 7, No. 2,
March-April, 1920.
"Influenza in Massachusetts." The Commonhealth, Vol. 7, No. 3, May-
June, 1920.
"Anthrax Problem in Massachusetts." American Journal of Public Health,
August, 1920.
Stanley H. Osborn, M.D., and Edith A. Beckler, S.B.
"Once a Typhoid Carrier Always a Tj^jhoid Carrier." The Journal of In-
fectious Diseases, August, 1920.
376 DEPARTMENT OF PUBLIC HEALTH. [Pub. Doc.
Louis L. Williams, Jr., M.D.
"The Carrier in an Outbreak of Diphtheria." The Commonhealth, Vol.
7, No. 2, March-April, 1920.
Mary R. Lakeman, M.D.
"Study Groups. A Feature of the Program of the Sub-Division of Venereal
Diseases, Massachusetts Department of Public Health." Journal of
Social Hygiene, Vol. VI, No. 4, October, 1920.
George T. O'Donnell, M.D.
"Causes of Typhoid Fever in Massachusetts." American Journal of Public
Health, June, 1920.
Francis A. Finnegan, M.D.
"Institutional Control of Diphtheria." Boston Medical and Surgical
Journal, Jan. 22, 1920.
Division of Hygiene.
Merrill E. Champion, M.D.
"School Hygiene." The Commonhealth, Vol. 7, No. 3, May-June, 1920.
"A Nutritional Program for Massachusetts." The Commonhealth, Vol.
7, No. 4, July-August, 1920.
Mary Ritnam, M.D.
"A Survey of Rural Children in Western Massachusetts." The Common-
health, Vol. 7, No. 6, November-December, 1920.
Edwin N. Kent, D.M.D.
"Mouth Hygiene and Public Health." The Commonhealth, Vol. 7, No.
5, September-October, 1920.
Hazel Wedgwood, R.N.
"Child Welfare." The Com.monhealth, Vol. 7, No. 3, May-Jime, 1920.
Alzira Wentworth Sandwall, S.B.
"The School Lunch." The Commonhealth, Vol. 7, No. 1, January-
February, 1920.
"How Cooking Affects the Digestibility of Foods." The Commonhealth,
Vol. 7, No. 2, March-April, 1920.
"Nutrition Activities in Massachusetts." The Commonhealth, Vol. 7,
No. 4, July-August, 1920.
Evelyn C. Schmidt, D.H.
"What is an Oral Hj^gienist?" The Commonhealth, Vol. 7, No. 5, Sep-
tember-October, 1920.
Division of Water and Sewage Laboratories.
Mr. H. W. Clark.
"Bacillus Coli and Bacillus Aerogenes." The Commonhealth, Vol. 7, No.
3, May- June, 1920.
"A Study of Massachusetts Water Supplies and the Tji^hoid Rate." Jour-
nal of the New England Water Works Association, Vol. XXXIV, No.
3, 1920.
No. 34.] PAPERS AND PAIMPHLETS ISSUED. 377
Division of Biologic Laboratories.
William A. Hinton, M.D.
"A Standardized Method of Performing the Wassermann Reaction."
American Journal of Sj^jhilis, Vol. IV, October, 1920.
Division of Tuberculosis.
William J. Gallivan, M.D.
"A Plea for a Department of Tuberculosis in Medical Schools." Boston
Medical and Surgical Journal, Vol. 183, p. 348, Sept. 16, 1920.
Pamphlets issued by the State Department of Public Health.
A Health Creed for Massachusetts Boys and Girls.
Cancer: Facts wliich eveiy Adult should know.
Carbohydrate Foods.
Constipation.
Diet No. 1. The Breast-fed Baby.
Diet No. 2. The Bottle-fed Baby.
Diet No. 3. Diet for Child from Ten Months to Eighteen Months.
Diet No. 4. Diet for Child from Eighteen Months to Two Years.
Diet for the Mother.
Diphtheria Bulletin.
Do you know that —
Encephalitis Lethargica.
Fly Danger.
Food for Children from Two to Six Years Old.
Food for the Child.
Foodwaj's to Health.
Food : What it is and what it does.
Health Habits.
Height and Weight Tables: Adults.
How Cooking affects the Digestibility of Foods.
Infantile Paralysis: Committee Report, State and Provincial Boards of
Health.
Infantile Paralj^sis in Massachusetts in 1909.
Infantile Paralysis in Massachusetts, 1907-12.
Influenza Bulletin.
Lime Water as a Mouth Wash.
List of Illustrated Lectures and Moving Pictures on Public Health Work.
Mosquitoes and Malaria.
Posture and its Relation to Health.
Simple Facts about Digestion.
The Abatement of Nuisances.
The A B C of Eating.
The Baby and You.
378 DEPARTMENT OF PUBLIC HEALTH. [P.D.Xo.34.
The Control of Ophthalmia Neonatorum.
The Food of Working Women in Boston.
The Home Care of the Mouth.
The Importance of Minerals in the Diet.
The Importance of Mouth Cleanliness.
The Occurrence of Infantile Paralysis in Massachusetts in 1908.
The Venereal Diseases.
The 1916 Epidemic of Poliomyelitis.
Tissue-forming Foods.
Vitamines or Accessory Food Factors.
INDEX
13791
INDEX.
229,
237, 240, 241, 248
report of
Abington, water supply
Accord Pond, analysis of water
Actinomycosis
Acton, water supply
Adams, water supply .
Administration, Division of .
Amesbury, water supply
Amethyst Brook reservoirs, analysis of water
Amherst, water supply
Andover, water supply
Anterior poliomyelitis .
Anthrax
Antimeningococcic serum
Antipneumocoecic serum
Antitoxin and Vaccine Laboratory
Economics .
Educational work of
Improvements
Needs ....
Personnel
Production .
Appropriations and expenditures
Administration, Division of
Arsphenamine, manufacture and distribut
Biologic Laboratories, Division of .
Communicable Diseases, Division of
Venereal Diseases, Subdivision of
Food and Drugs, Division of .
Hygiene, Division of . . .
Penikese Hospital
Plumbers, State Examiners of
Recapitulation ....
Sanitary Engineering, Division of .
Tuberculosis sanatoria:
Appropriations of, special .
Expenditures of . . .
Tuberculosis (Sanatoria), Division of
Water and Sewage Laboratories, Division
Arsphenamine ....
Manufacture and distribution of
Artichoke River, analysis of water
Ashburnham, water supply .
Ashby Reservoir, analysis of water
Ashfield, water supply
Ashland, water supply
Ashland Reservoir, analysis of water
Ashley Brook, analysis of water
Ashley Lake, analysis of water
ion o
of
250,
252,
PAGE
56, 67
58,69
243, 260, 262, 263
. 61,72
56, 61, 67
19
. 61, 72
. 56, 67
. 56, 67
. 56, 67
254, 256, 258, 260, 262, 263
243, 260, 262, 263
268
268
267
269
269
269
270
267
267
36
36
40
39
37
38
39
37
43
42
44
41
46
45
42
41
214
40
59
56,67
57, 68
56,67
61.72
56,67
59,70
59
382
INDEX.
Assabet River, condition of .
Assawompsett Pond, analysis of water .
Athol, water supply ....
Attleboro, water supply
Aust'n Brook Reservoir, analysis of water
Avon, water supply ....
Ayer, water supply ....
Bacillus coli and bacillus aerogenes
Bacillus coli in the water of swimming pools
Bacterial measurement of the degree of pollution of
Bacteriological Laboratory, report of
Diphtheria ....
Pneumococcus type determination
Typhoid fever
Barnstable, water supply
Barre, water supply
Easin Pond Brook, analysis of water
Bassett Brook, analysis of water .
Beaman Reservoir, analysis of water
Bear Hole Brook, analysis of water
Bear Swamp Brook, analysis of water
Bedford, water supply
Big Sandy Pond, analysis of water
Billerica, water supply
Biologic Laboratories, Division of
Appropriations and expenditures of
Report of . .
Antitoxin and "Vaccine Laboratory
Wassermann Laboratory
Birch Reservoir, analysis of water
Black Brook, analysis of water
Blackstone River, condition of
Blandford, water supply
Eondsville (Palmer), water supply
Bottomly Reservoir, analysis of water
Braintree, water supply
Breed's Reservoir, analysis of water
Bridgewater, water supply .
Brockton, water supply
Brookfield (East), water supply
Brookline, water supply
Buckman Brook Reservoir, analysis of water
Buckmaster Pond, analysis of water
Buttery Brook Reservoir, analysis of water
Cady Brook, analysis of water
Cambridge, water suppl.v
Camps, water supplies of
Cancer control
Canton, water supply .
Cape Pond, analysis of water
Cerebrospinal meningitis
Charles River:
Analysis of filtered water
Condition of
water
57,68
56, 57. 67, 68
53
280
62,72
60,70
237, 240, 241 248, 250, 252, 254, 256, 258, 260
59,70
Ill
P.\GE
111
60,71
56,67
61, 72
57,68
61,72
61,72
121
125
134
210
210
211
211
61,72
56,67
58, 69
56,67
59,70
60,71
56,67
61,72
56,67
61,72
32
39
267
267
271
58, 69
60,70
111
56, 67
64,74
61,71
62,72
58,69
62,72
56,67
62,72
62,72
56,67
59
60,71
INDEX.
383
Chelmsford, water supply
Chelmsford (North), water supply
Cheshire, water supply
Chester, water supply . . . ■
Chestnut Hill Reservoir, analysis of water
■Chicken pox 243,248
Chicopee, water supply
Chicopee (Fairview), water supply
Chicopee River, condition of
Clinics:
Child in the rural community, for the
Tuberculosis ....
Venereal disease ....
Advertising of .
Directors of, meeting of
Clinton, water supply ....
Codding Brook reservoirs, analysis of water
Cohasset, water supply
Cold Brook Reservoir, analysis of water
Collinsville (Dracut), water supply
Color, removal of, from water
Colrain (Griswoldville), water supply
Commissioner of PubHc Health, report of
Communicable diseases:
Epidemiological significance of age distribution
Incidence of, by months
Outbreaks of . . . ■ •
Sex distribution of ....
Communicable Diseases, Division of
Appropriations and expenditures of
Report of . . . . ■ •
Bacteriological Laboratory, report of
Epidemiologist, report of . . .
Health officers, report of . . .
Penikese Hospital ....
Venereal Diseases, Subdivision of, report of
Concord, water supply ....
C'oncord River, condition of . . . ■
Connecticut River, condition of .
C'ook Allen Reservoir, analysis of water
Coolej' Brook (Chicopee), analysis of water .
Cooley Brook (Longmeadow), andysis of water
Corrosion of pipes, investigation in regard to .
Crystal Lake (Gardner), analysis of water
Crystal Lake (Haverhill), analysis of water .
Crystal Lake (Wakefield), analysis of water .
250
m ce
252, 254, 256, 258, 260
tan
PAGE
62.72
62,72
57, 68
57, 68
56,67
262, 263
57,68
62,72
112
279
294, 295
212
215
216
57
58,69
62,72
58, 69
62. 72
131
57,68
4
221
263
229
228
22
37
197
210
221
203
219
211
57, 68
112
112
59,70
57,68
58,69
119
57, 68
58, 68
60.71
Dalton, water supply .
Danvers, water supply
Dedham, water supply
Deerfield, water supply
Deerfield (South), water supply
Deerfield River, condition of
Dike's Brook Reservoir, analysis of water
Diphtheria 210, 224, 228, 233, 236, 240, 241
57,68
57,68
62, 72
62,72
57, 68
112
57,68
248, 250, 252, 254, 256, 258, 260, 262, 263
384
INDEX.
Diphtheria antitoxin
Concentrated
Diphtheria plasma
Diphtheria toxin
Diphtheria toxin-antitoxin .
Disease prevalence
Diseases dangerous to the public health
Cases and deaths from .
Doane Pond, analysis of water
Dog bite .....
Douglas, water supply
Dow's Brook Reservoir, analysis of water
Dracut, water supply .
Dracut (Collinsville) , water supply
Dry Brook, analysis of water
Dudley, water supply .
Duxbury, water supply
Dysentery .....
East Brookfield (Brookfield), water supply
Easthampton, water supply .
East Mountain Reservoir, analysis of water
Easton (North Easton) , water supply .
Edgartown, water supply
Educat'onal work of:
Biologic Laboratories, Division of .
Health officers ....
Hygiene, Division of . . .
Venereal Diseases, Subdivision of .
Egremont (South) , water supply .
Egypt Brook Reservoir, analysis of water
Elder's Pond, analysis of water
Epidemic cerebrospinal meningitis
Epidemiologist, report of . . .
Cases and deaths from diseases dangerous to the public health
Cases and deaths, with case and death rates, per 100,000 population for all
reportable diseases
Epidemiological significance of age distribution in certain communicable
diseases .....
Incidence of communicable diseases by months
Outbreaks of communicable diseases
Anterior poliomyelitis
Diphtheria
Influenza .
Measles
Scarlet fever
Septic sore throat
Typhoid fever .
Whooping cough
Progress made in past five-year period
Sex distribution of communicable diseases
Exhibits .......
Fairhaven, water supply ....
-Fairview (Chicopee), water supply
Fall Brook Reservoir, analj^sis of water .
243, 260
243, 260,
PAGE
267
267
267
268
268
13
205
245
59,70
262, 263
62,72
58, 69
62,72
62,72
56, 67
62, 72
62,72
262, 263
62,72
62, 72
57,68
62,73
62,73
269
204
281
215
57, 68
57,68
60, 71
262, 263
221
245
262
221
263
229
229
233
230
232
233
234
234
233
235
228
282
62,73
62,72
58, 69
INDEX.
385
Fall River, water supply
Falmouth, water supply
Falulah Brook, analysis of water .
Farnham Reservoir, anatysis of water
Filters:
Intermittent sand, in operation thirty-three years
Trickling, operation of .
Fitehburg, water supply
Flow of streams ....
Follow-up work (tuberculoses)
Fomer Reservoir, analysis of water
Food and Drugs, Division of
Appropriations and expenditures of
Report of .
Food and its relationship to health
Foxborough, water supply
Fox Brook, analysis of water
Framingham, water supply .
Framingham reservoirs, analysis of water
Franklin, water supply
Freeland Brook, analysis of water
French River, condition of .
Fresh Pond, analysis of water
Fulling Mill Pond, analysis of water
Gardner, water supply
Gas company's wastes, purification of
Gates Pond, analysis of water
German measles 243, 248, 250,
Glanders ....
Glen Brook reservoirs, analysis of water
Gloucester, water supply
Gonorrhea 242, 249, 251
Cases reported
Goodale Brook, analysis of water
Grafton, water supply .
Granville, water supply
Gravel Pond, analysis of water
Great Barrington, water supply
Great Barrington (Housatonic), water supply
Great Pond (North Andover), analysis of water
Great Pond (Randolph), analysis of water
Great Pond (Weymouth), analysis of water
Great Quittacas Pond, analysis of water
Great South Pond, analysis of water
Greenfield, water supply
Green River, analysis of water
Griswoldville (Colrain), water supply
Groton, water supply .
Groton (West Groton), water supply
Hadley, water supply .
Haggett's Pond, analysis of water
Hart's Brook Reservoir, analysis of water
Haskell Brook Reservoir, analysis of water
Hatchet Brook reservoirs, analysis of water
253,
252, 254, 2
255, 257, 259, 261
6, 258, 260
PAGE
57, 68
57, 68
57, 68
60,70
129
126
57, 68
54,91
297
58, 69
34
39
137
277
62, 73
60, 71
62, 73
56, 67
62, 73
56,67
112
57, 68
58
57, 68
125
58, 69
262, 263
243
57,68
57, 68
262, 263
219
57,68
62,73
62,73
59,69
57, 68
57, 68
59, 70
60,70
60,71
59,70
60,70
57, 68
57,68
57, 68
62, 73
62, 73
58, 68
56,67
58,68
57,68
60,71
38G
INDEX.
Hatfield, water supply
Hathaway Brook, analysis of water
Haverhill, water supply
Hawkes Reservoir, analysis of water
Haynes Reservoir, analysis of water
Health districts, changes in .
Health ofBcers, report of . . .
Hick's Spring, analysis of water
High-service reservoir, analysis of water
Hingham, water supply
Hinsdale, water supply
Holliston, water supply
Holyoke, water supply
Hookworm .....
Hocsick River, condition of .
Hopkinton, water supply
Hopkinton Reservoir, analysis of water .
Horn Pond, analysis of water
Housatonic (Great Barrington), water supply
Housatonic River, -condition of
Hudson, water supply ....
Huntington, water supply
Hygiene, Division of .
Appropriations and expenditures of
Report of .... .
Personnel, changes in
Work, lines of .
Cancer control . . .. .
Clinics for the child in the rural communit
Educational ....
Exhibit ....
Food and its relationship to health
Investigations
Lectures ....
Mouth hygiene
Special .....
260
PAGE
58,68
59,70
58, 68, 69
59,69
58,69
206
206
63,74
58, 69
58, 62, 69
58,69
63,73
58,69
262, 263
113
63, 73
56,67
57
57,68
113
58, 69
58, 63, 69
30
37
274
274
274
280
279
281
282
277
276
282
278
285
Infant and child hygiene ..........
Infant mortality ............
Influenza 230, 242, 248, 250, 252, 254, 256, 258, 260, 262,
Intermittent sand filters in operation thirty-three years . ' .
Investigations by Division of Hygiene ........
Ip.swich, water supply .
Ipswich River, analj'sis of water
5
285
263
129
276
58, 69
60
Jails and houses of correction, inspection of
Johnson's Pond, analysis of water
Jonathan Pond, analysis of water .
216
58, 68
60, 71
Keeping fit campaign .
Kendall Reservoir, analysis of water
Kenoza Lake, analysis of water
Kent Reservoir, analysis of water .
Kingston, water supply
Kitchen Brook, analysis of water .
217
61,71
58,69
61,71
63, 73
57,68
INDEX.
387
Laboratory problem of the department
Lake Averic, analysis of water
Lake Cochituate, analysis of water
Lake Pleasant, analysis of water
Lake Saltonstall, analysis of water
Lake Williams, analysis of water
Lakeville State Sanatorium .
Report of superintendent of
Report of treasurer of .
Special report of .
Statistical tables of
Valuation of
Laurel Lake, analysis of water
Lawrence, water supply
Leaping Well Reservoir, analysis of water
Lectures ....
Lee, water supply
Legislative recommendations
Leicester, water supply
Leicester (Cherry Valley and Rochdale Water District), water suppl
Leicester Reservoir, analysis of water
Lenox, water supply
Leominster, water supply
Leprosy .......... 10,
Lincoln, water supply .
Liquid chlorine or bleach, the effect of low temperature upon steriliza
by means of
Little Quittacas Pond, analysis of water
Little South Pond, analysis of water
Littleton, water supply
Lobar pneumonia .... 242, 249, 251, 253, 255, 257,
Longham Reservoir, analysis of water .
Longmeadow, water supply ....
Long Pond (Falmouth), analysis of water
Long Pond (Great Barrington), analysis of water
Lowell, water supply .....
Lower Hobbs Brook Reservoir, analysis of water
Lower Holden Reservoir, analysis of water
Lynn, water supply .....
Malaria .......
Manchester, water supply ....
Mann Reservoir, analysis of water
Mansfield, water supply ....
Marblehead, water supply ....
Marion, water supply .....
Marlborough, water supply ....
Marshfield, water supply ....
Massachusetts Hospital for Consumptives and Tubercular Patients
establish the
Maternal mortality
Mattapoisett, water supply .
Maynard, water supply
McClellan Reservoir, analysis of water
Measles. . . 222,228,232,235,240,241,249,251,253,255,257,259,
Medfield, water supply
PAGE
, ^
17
, ,
60,71
,
56,67
,
59, 70
.
58,69
, ,
59,69
330
331
334
.r-
340
341
.
340
,
58
,
58,69
.
60,71
, ,
282
58,69
,
19
63, 73
,
63, 73
61, 71
, ,
58, 69
58, 69
243, 260,
262, 263
58,69
of water
133
, ,
59, 70
60,70
63, 73
259, 261,
262, 264
.
60,71
, ,
58, 69
, ,
57, 68
,
57,68
63, 73
56,67
.
61,71
58, 59, 69
243, 260,
262, 263
. 59, 63, 69, 73
61, 71
63, 73
63
63, 73
59, 69
63,73
n act to
289
285
63,73
59,69
57,68
259, 261,
262, 263
.
63,73
388
INDEX.
Medway, water supply
Meetinghouse Pond, analysis of water
Merrimac, water supply
Merrimack River:
Analysis of filtered water
Condition of . . ,
Flow of ...
Methuen, water supply
Metropolitan Water District, water supply
Middleborough, water supply
Middleton Pond, analysis of water
Midwife investigation .
Milford, water supply .
Mill Brook, analysis of water
Millburj', water supply
Miller's River, condition of .
Millham Brook Reservoir, analysis of water
Millis, water supply
Millvale Reservoir, analysis of water
Monson, water supply
Montague, water supply
Montgomery Reservoir, analysis of water
Morse Reservoir, analysis of water
Morton Brook, analysis of water .
Mountain Street Reservoir, analysis of water
Mouth hygiene ....
Muddy Pond Brook, analysis of water
Mumps 244, 249. 251
Muschopauge Lake, analysis of water
Nagog Pond, analysis of water
Nantucket, water supply
Nashua River:
Condition of
Flow of . . .
Rainfall on drainage area
Natick, water supply .
Needham, water supply
Neponset River, condition of
New Bedford, water supply .
Newburyport, water supply .
Newton, water supply .
North Adams, water supply
North Attleborough, water supply
Northampton, water supply
North Andover, water supply
Northborough, water supply
Northbridge, water supply .
North Brookfield, water supply
North Chelmsford (Chelmsford), water supply
North Easton (Easton), water supply
Northfield, water supply
North Pond, analysis of water
North Reading State Sanatorium
Report of superintendent of
Report of treasurer of .
J53,
255,2
57, 259, 261
PAGE
6.3, 73
57,68
63, 73
5S, 69
113
97
63, 73
56,67
63, 73. 74
57.68
276
59,70
60
63,74
113
59,69
63, 74
58, 69
63,74
59, 70
60,71
58.69
57,68
59,70
278
60, 71
, 262, 263
60,70
57,68
59, 63, 70
113
94, 99, 100
96
63,74
63,74
114
59, 70
59, 63, 74
63, 74
59.70
64,74
59,70
59,70
59,70
59,70
59.70
62.72
62.73
59.70
59.70
298
298
301
INDEX.
389
North Reading State Sanatorium — Concluded.
Special report of .
Statistical tables of
Valuation of
North River, condition of
North Watuppa Lake, analysis of water
Norton, water supply .
Norwood, water supply
Notch Brook Reservoir, analysis of water
Nursing assistants
Oak Bluffs, water supply
Observation hospital
Onset (Wareham), water supply
Open-air schools .
Ophthalmia neonatorum . . . 244, 249, 251
Orange, water supply .
Oxford, water supply .
alth
Public
Palmer, water supply .
Palmer (Bondsville), water supply
Pamphlets issued by the State Department of Public He
Papers written by members of the State Department of
Peabody, water supply
Pellagra .....
Penikese Hospital
Appropriations and expenditures of
Pentucket Lake, analysis of water
Pepperell, water supply
Personnel problems
Phillipston Reservoir, analj-sis of water
PittsP.eld, water supply
Plague problems ....
Plainville, water supply
Plumbing Board, special
Plumbers, State Examiners of:
Appropriations and expenditures of
Report of .
Plymouth, water supply
Pneumococcus type determination
Police departments
Pollution of water, bacterial measurement of the degree
Prisoners, examination of
Provincetown, water supply
Public Health Council, report of .
Public health nurses
Public health nursing .
Rabies .....
Rainfall:
In Massachusetts .
On Nashua River drainage area
On Sudbury River drainage area
Randolph, water supply
Reading, water supply
Removal of color from water
Reportable diseases, cases and deaths, with case and death rates
Rivers, examination of .......
253,
Health
of
55,2
57, 259, 261
244, 261
PAGE
307
308
306
114
57,68
64,74
59, 64, 74
59,70
204
64,74
296
60,71
277
262, 264
59, 70
64,74
59,70
64, 74
377
375
59, 70
262, 264
219
43
58, 69
64,74
7
56,67
59,70
S
74
18
42
309
60,70
211
216
134
296
64,74
3
296
16
243
54,90
96
92
60,70
64,74
131
262
111
390
INDEX.
Roaring Brook, analysis of water .
Rockport, water supply
Running Gutter Brook Reservoir, analysis of water
Russell, water supply ....
Rutland, water supply
Rutland State Sanatorium .
Report of superintendent of .
Report of treasurer of .
Special report of .
Statistical tables of . . .
Valuation of ....
Sacket Brook, analysis of water
Salem, water supply ....
Salisbury, water supply
Sandy Pond, analysis of water
Sanitary Engineering, Division of .
Appropriations and expenditures of
Report of .
Scarlet fever . . 225,233.236,240,241,249,251
Schick outfits .....
Scituate, water supply
Scott Reservoir, analysis of water
Septic sore throat ....
Sewerage and sewage disposal works, examination of
Sewerage facilities, difficulties of providing, in certain
Sharon, water supply ....
Shaw Pond, analysis of water
Sheffield, water supply
Shelburne (Shelburne Falls), water supply
Shelburne, water supply
Shellfish, studies of ... .
Shirley, water supply ....
Shrewsbury, water supply
Silver Lake, analysis of water
Smallpox ......
Smallpox vaccine ....
Snake Brook Reservoir, analysis of water
Social service .....
Southbridge, water supply .
South Egremont (Egremont), water supply
South Hadley, water supply
Spencer, water supply
Spot Pond, analysis of water
Springfield, water supply
Spring Pond, analysis of water
Sterilization of water by means of liquid chlorine or
perature upon
Stockbridge, water supply
Stony Brook Reservoir, analysis of water
Stoughton, water supply
Sudbury Reservoir, analysis of water
Sudbury River:
Condition of ....
Flow of .... .
Rainfall of drainage area
districts
253,
255,
bleach, the
57, 259, 261
234, 244, 261
effect
244
60,
of low tern
PAGE
57,68
60,70
58, 68
00,70
60,70
350
350
354
360
361
359
60,70
60,71
64, 74
58,69
20
41
49
, 262, 264
268
64,74
57, 68
, 262, 264
100
53
64.74
60,71
64,74
60,71
60,71
123
64,74
64,74
56, 67
, 262, 264
268
60, 71
214
60,71
57,68
64, 71, 74
60,71
56, 67
60,71
59, 70
133
60, 71
56,67
60, 71
56,67
112
91, 99, 100
92
INDEX.
391
PAGE
Suntaug Lake, analysis of water . . . . . . . . . 59, 70
Supplement ............ 47
Swan Pond, analysis of water ......... 57
Swimming pools, B. coli in the water of ....... 125
Syphilis 219, 242, 249, 251, 253, 255, 257, 259, 261, 262, 264
. 227, 249, 251, 253, 255, 257, 259, 261,
226, 228, 238, 240, 241, 249, 251, 253, 255, 257, 259,
Taunton, water supply
Taunton River, condition of
Tetanus ......
Thunder Brook, analysis of water
Tillotson Brook Reservoir, analysis of water
Tisbury, water supply ....
Trachoma ......
Trichinosis .....
Trickling filters, operation of
Tuberculosis
Other forms
Pulmonary .
Tuberculosis sanatoria:
Appropriations of, special
Expenditures of .
Tuberculosis (Sanatoria), Division of
Appropriations and expenditures of
Report of .
Consultants
Consultation clinics
Examination clinics .
Examination of prisoners
Follow-up work
Lakeville State Sanatorium, report of
Massachusetts Hospital for Consumptives and T
act to establish ....
North Reading State Sanatorium, report of
Observation hospital ....
Public health nurses ....
Rutland State Sanatorium, report of .
Subsidy ......
Westfield State Sanatorium, report of .
Typhoid fever . . 211, 234, 239, 240, 241, 249, 251
Typhoid paratyphoid vaccine
Typhus fever ......
Upper Hobbs Brook Reservoir, analysis of water
Upper Holden Reservoir, analysis of water
Upper Naukeag Lake, analysis of water
Uxbridge, water supply
Venereal diseases ....
Infection, sources of . . .
Lapsed cases ....
Statistics .....
Venereal Diseases, Subdivision of:
Appropriations and expenditures of
Report of .... .
Advertising ....
Arsphenamine ....
244,
244,
244,
ubercular Patients, an
253,
255, 257, 259, 261
60,71
114
262, 264
57,68
60,71
64,74
262, 264
262, 264
126
10
262, 264
261, 264
46
45
28
42
289
297
294
295
296
297
330
289
298
296
296
350
296
314
262, 264
268
244
56
61,71
56,67
64,74
15
217
214
211
38
211
215
214
392
INDEX.
Venereal Diseases, Subdivision of — Concluded.
Report of — Concluded.
Clinics
Meeting of directors of
Courts
Educational
Industrial
Infection, sources of .
Jails and houses of correction, inspection of
Keeping fit campaign
Lapsed cases
Police departments
Social service
Statistics ....
Wachusett Lake, analysis of water
Wachusett Reservoir, analj^sis of water
Wakefield, water supply
Walden Reservoir, analysis of water
Wallace Reservoir, analysis of water
Walpole, water supply
Waltham, water supply
Wannacomet Pond, analysis of water
Ware, water supply
Wareham, water supply
Wareham (Onset), water supply .
Wassermann Laboratory, report of
Complement fixation tests in gonococcal infections
Complement fixation tests in tuberculosis
Costs .....
Routine tests ....
Water, consumption of, in cities and towns
Water and Sewage Laboratories, Division of
Report of .
Water and sewerage facilities, difficulties of providing, in certain districts
Water supplies:
Analyses of ground-water sources .
Analyses of surface-water sources .
Comparison of, by chemical analysis
Sanitary protection of public .
Water supply investigation, special
Water supply statistics
Wayland, water supply
Webster, water supply
Wellesley, water supply
Wells, examination of, private
Wenham Lake, analysis of water
Westborough, water supply .
West Brookfield, water supplj'
Westfield, water supply
Westfield Little River, analysis of filtered water
Westfield State Sanatorium .
Report of superintendent of
Report of treasurer of .
Special report of .
Statistical tables of
Valuation of
PAGE
212
216
217
215
215
217
216
217
214
216
214
211
57,68
56,67
60,71
58,69
57,68
64,74
64, 74, 75
59, 70
64,75
64,75
60,71
271
272
271
272
271
88
21
117
53
61,72
56,67
65
55
12
75
60, 71
64,75
64,75
52
60, 71
64, 75
64,75
60,71
60, 71
314
314
318
324
325
323
INDEX.
393
Westford, water supply
West Groton (Groton) , water supply
Weston, water supply .
Weston Reservoir, analysis of water
West Springfield, water supply
Weymouth, water supply
White Pond, analysis of water
White Reservoir, analysis of water
Whiting Street Reservoir, analysis of water
Whooping cough 223, 228, 233, 235, 240, 241. 249
Williamsburg, water supply .
Williamstown, water supply
Winchendon, water supply .
Winchester, water supply
Windsor Reservoir, analysis of water
Woburn, water supply
Worcester, water supply
Worthington, water supply .
Wrentham, water supply
Wright and Ashley Pond, analysis of water
251,
253, 255, 257, 259, 261
PAGE
64, 75
62,73
65,75
56,67
60,71
60,71
59,69
58,69
58,69
262, 264
60, 71
61,71
65,75
61,71
57
65,75
61,71
65,75
65,75
58, 69
a P'l
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