PUBLIC HEALTH. PART FIRST. PUBLIC HEALTH. PREVALENT DISEASES. SMALL-POX. In speaking of the health of the people of Massachusetts during the year 1882, the matter which has been of most interest to the general public may be first mentioned; viz., the exposure of Massachusetts to small-pox. The subject was treated at some length in the Third Annual Report, in which, also, the correspondence between our National government and the Canadian government in regard to the practice of vaccination in Canada was printed. This correspondence secured little or nothing in the way of protection to our people from small-pox introduced by way of Canada. It is still a fact, as was then stated, that, of the large number of immigrants from the Dominion of Canada resident in the State, a much greater proportion is unvaccinated than of any other nationality. The records of the Department of Outdoor Poor prove this fact beyond question. From this and other causes, hereafter to be mentioned, the people of Massachusetts are probably more exposed to small-pox than those of any State in the Union. This was shown by our experience in 1872 and 1873; and it was then predicted that a similar epidemic might be expected again whenever the number of strangers and infants not vaccinated had sufficiently increased, in process of time, to furnish food for contagion. Such an outbreak of small-pox did show itself in 1881-2, the disease appearing almost simultaneously in a dozen cities and towns. When overcome there it broke out THE SMALL-POX IN 1881-2. sporadically in other places, till 30 cities and towns, at least, were visited. But the powers conferred on this Board by the Act of 1879, which established it, enabled its medical officers and the local boards of health to deal effectively with the disease wherever it occurred. As soon as the telegraph brought news of an apparent case of small-pox in any part of the State, an officer of the Board was despatched by the next train, provided with a supply of the best vaccine virus. These officers vaccinated, in all, more than 6,000 persons, among them more than 3,000 employees of the post-office department and the railroad companies, whose business particularly exposed them to contagion. In consequence of these precautions, and the activity of the local boards, no extensive mischief followed these numerous single cases of disease; the total number of deaths from small-pox in Massachusetts during the whole year of 1882 being less than the small-pox deaths in Chicago for a single week. No appropriation for the treatment of small-pox cases was made or needed in 1880, the first year in which this Board acted under the useful powers conferred in 1879; the unexpended balance of previous years being found sufficient. Early in 1881, the disease increased, and $6,000 was appropriated by the Legislature of that year; in 1882 the appropriation was increased to $10,000, and from these two appropriations the sum of $5,165.49 has been already expended in the two years 1881 and 1882. An appropriation not exceeding $10,000 will be needed for 1883. The presence of small-pox in Massachusetts is due to three distinct causes, contagion from immigrants at our ports, paper rags, and the Canadian immigration by land. The large immigration and numerous births of the last nine years have renewed the supply of non-vaccinated persons, and there is constant danger of another outbreak should vigilance be relaxed by the State Board and the local boards of health. During the past year we know of its appearance in thirty cities and towns, having a population of more than 600,000; but in three places only did it make a serious headway, and even THE SMALL-POX IN 1881-2. there it was checked after fifty or sixty people had been attacked. The Board of Health in Boston secludes, vaccinates, and disinfects so promptly as to leave the disease little foothold; but in cities like Holyoke, in railroad centres like Adams, and towns where the paper manufacture is carried on, the people are much exposed; the chief risk being where there are paper mills, or where the Canadian population is large; since, for reasons already stated, it is among this population that the disease is most likely to occur. The present situation of Canada is a constant menace to the New England States, and especially to Massachusetts. The disease propagated from the paper mills is more within our own control. The sum paid or due by the State for the cases originating from this source alone for the past year will not fall short of $9,000, and may exceed that sum. The operatives in paper mills live in scattered villages and there is constant danger of the spread of contagion. A conference with the mill-owners might devise some means of disinfecting their rags when the bales are opened, and induce them to give work to no operatives who cannot show that themselves and their families have been recently vaccinated. It is still difficult for this Board to obtain immediate notice in cases of small-pox, except when the patient is supposed to be a State pauper, for whom the city or town where he is treated claims re-imbursement. We would therefore suggest the passage of a law refusing re-imbursement to such towns as fail to give immediate notice of small-pox cases, whether the patient be a State pauper or otherwise; in other words, that notice from the cities and towns to the State Board shall be compulsory under penalty. Few outbreaks of small-pox pass away in any town without affecting one or more State cases, and therefore the penalty proposed is likely to be effective. Notices of small-pox cases, 116 in number, but involving 236 different persons among the State poor, were sent from 21 cities and towns, of which the following is a list, with the number of notices from each town: These were by no means all the small-pox cases in the State, and not even all the State cases were properly returned to this Board. The whole number of cases, including the 236 named above, was probably 400, of which 150 were of persons having a local settlement or who paid their own expenses. The number of deaths reported in the whole State was about 35, and the number of cities and towns in which cases occurred was more than 30. It will be seen that, of the 21 places above-named, ten had but one case each, and four had but two cases each. In the other seven cities and towns many more cases occurred than are abovementioned. Notwithstanding this slight increase of small-pox during the year, and a considerable increase of typhoid fever and diphtheria in certain localities, the year 1882 was one of average health, and no disease can be said to have prevailed excessively. Typhoid fever indeed prevailed more extensively than for the two preceding years, and the mortality has been steadily increasing from the unusually low figures of 1878 and 1879. While the greater prevalence of this disease this year, so far as the eastern part of the State is concerned, may afford some apparent support to the belief that malarial fever and typhoid do not generally prevail at the same time, it should be noted that this experience is not invariable. Malarial fever has not appeared in so many towns east of the Connecticut as in the previous year, but in the western part of the State seems to have been more prevalent than ever. In January, by agreement with the National Board of PREVALENT DISEASES MALARIAL FEVER. Health and the State Boards of New York, Connecticut and Rhode Island, this Board took steps for a combined investigation of the subject of malarial fever. The following circular exhibits the scope of the inquiry. A large number of answers have been received, furnishing a mass of valuable information; but the laboratory work on this subject, by reason of the failure of the National Board to obtain the usual appropriation, was unfortunately suspended in July and has not been resumed. COMMONWEALTH OF MASSACHUSETTS. STATE BOARD OF HEALTH, LUNACY AND CHARITY. STATE HOUSE, BOSTON, 20th June, 1882. DEAR SIR: The National Board of Health has decided to undertake certain investigations upon the nature of the malarial poison, and more especially to attempt to determine the correctness of the observations published in Europe, within the last two years, with regard to the existence of a definite germ or parasite connected with the disease. It is proposed to repeat the experiments of Klebs and TommasiCrudelli, as well as those of Sternberg as to the effects upon animals of materials collected from or near malarial localities, and to compare these with similar material collected from localities as yet free from malarial diseases. It is also desired to investigate blood, with a view to prove or disprove the results announced by Eklund and Laveran. The National Board proposes to undertake the laboratory work of the investigation, including culture experiments, and experiments upon animals. This work will, for the present at least, be carried on at Boston, in the laboratory of Dr. W. S. Bigelow, by W. F. Whitney, M. D., Curator of the Warren Anatomical Mu seum. The State Boards of Health of Connecticut, Massachusetts, Rhode Island and New York, have agreed to furnish the materials for this research, and to collect information in their respective States, as to the conditions appearing to influence local outbreaks of the disease. It is especially desired that early notice of the appearance of malarial fever in districts where it was previously unknown may be at once given to this Board. |