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It is nearly ten years since the state board of health of Vermont was created by the legislature. This therefore is the ninth annual report, for the year ending August 31st, 1895.
The board at the beginning of its work was given general supervision of the public sanitation of the state. It was made the duty of the board to make, or cause to be made, sanitary investigations and inquiries respecting the causes of diseases, especially when existing in epidemics, and the means of their prevention ; also respecting the sources of mortality, the effects of localities, employments, habits, and circumstances of life upon public health.
The board was authorized, whenever requested, or whenever in the opinion of the members the sanitary interest of localities demanded, to advise with municipal authorities regarding the location, drainage, water supply, heating and ventilation of public buildings, and the water supply and drainage of towns and cities.
The duties of the board remain the same as at its creation, although much greater power and authority has been conferred by each legislature since its organization. The responsibilities have increased in proportion to this greater authority.
As far as possible the board has performed the duties as outlined by the act creating it.
Many calls have been made for advice respecting complaints of nuisances, bad sewerage and bad drainage ; also in regard to new plumbing
Complaints have been made of the contamination by sewage from houses, towns and cities, of brook and river water used for drinking purposes, while the complaints of slaughter houses, pig pens, privies, etc., are continually brought to the notice of the board. The circumstances connected with all these demands have been varied, each case requiring to be settled upon its own merits-no general rules can be promulgated to cover all points. The board has attended promptly to all demands made upon it, and fair and usually satisfactory adjustments have been made.
It is gratifying to be able to report a large falling off in the death rate from infectious and contagious diseases, and that our state stands first in the list of New England states in reference to mortality with the exception of Maine, which in 1892 had a mortality of 18.3 to each 1,000 of population, while that of Vermont was 18.6.
The reports that come to this office have not been complete in all details, nor have they been complete in statistics. This is due in a great measure to the unwillingness on the part of physicians to report to health officers.
All interested should be willing to conform to the law as nearly as possible and thus enable the secretary to make a report that would be interesting to the people and valuable from a sanitary standpoint.
There has been quite a falling off in the number of cases from
In 1894 reports of 181 cases were received, with 128 cases for 1895. The mortality among those stricken with the disease in 1894 was about 23 per cent, and in 1895, 12 per cent.
This favorable showing cannot be attributed to the use of antitoxine, as this treatment has been used but very little, yet in the few instances reported, very satisfactory results have followed. No doubt now remains that the experimental stage has long since passed and that the remedy has proved its claim to be far superior to all others for the treatment of diphtheria, and that no physician would be justified in neglecting to resort to this treatment in any case of the disease he might be called upon to treat.
Scarlet fever has been quite prevalent, but it has assumed such a mild form that it has been impossible to obtain statistics, as many cases did not require the attendance of a physician. The total number of cases reported was 440 with 41 deaths, while in 1894 there were 525 cases with 24 deaths. This shows an increase in the mortality of 1895 over that of 1894 of 43 per cent, or that according to the reports received the mortality has nearly doubled. (This point shows more positively than any other that our statistics as received is not all that can be desired.)
Typhoid fever has not been so prevalent as in 1894, when 324 cases with 43 deaths were reported as compared with 1895, which gives 205 cases with 14 deaths. The percentage of mortality has diminished therefore from 13 to 6.
The falling off in typhoid fever and the lowering of the death rate from this disease is due mainly to the improvement in water supply. Many changes have been made during the year, notably in Burlington or Windsor.
In Burlington since the intake has been extended to such a distance beyond the breakwater that there is no danger of contamination by sewage, only six cases of typhoid fever occurred as pared with eight in 1894.
Four of the cases reported this year were due, I believe, to the use of well water for drinking purposes, as they lived in neighborhoods so supplied, some using the water from the same source as the specimen designated as No. 1, in the report of the health officer of Burlington, which is included in this volume.
Since the entire change of the water supply of Windsor, typhoid fever there is nearly extinct.
There have been three outbreaks of small pox in the state during the year; thirty cases with four deaths. In the town of Charlotte, Chitteuden county, in one house of two families—twenty-seven persons—there were twenty-five cases and three deaths. The work of the health officer in this instance was most commendable, as the disease was not allowed to extend beyond the limits of the original ontbreak. The local board called the state board to their assistance in the final work of cieaning and disinfecting the house and surroundings.
It is estimated by good authorities that one-tenth of all the inhabitants of the temperate zone die of consumption. The question now is, what can be done to circumvent this universal scourge and prevent its inroads upon mankind ?
Practically our state is doing nothing to prevent consumption. I believe, however, that the time has come when something can and should be done in this direction. True, the state board of health has issued a circular regarding the nature and prevention of consumption, which has been distributed to health officers and physicians throughout the state, but thus far it has succeeded in awakening but little interest in the matter.
Public sentiment does not as yet admit of isolation of phthisical subjects, hence our efforts must be mainly of an advisory and educational nature. Every individual should understand that a person suffering from consumption is a dangerous factor in the family and community. This is not the proper place to discuss the various means that may be used in the prevention of phthisis, but in the language of another : “ It may be summed up in these five words, keep water in the spittoon."
It will be seen from the annual reports of health officers that the water supply of towns is regarded as a very important factor in securing good health to the inhabitants. It certainly may become a most dangerous element when contaminated by sewage or other filth. Therefore, too great vigilance cannot be exercised in guarding the pnblic from this source of danger.
In no year since the creation of the state board of health have greater changes and improvements been made in the water supplies of towns and villages than in the last. Even many of the smaller villages are getting a public supply, especially where typhoid fever has prevailed, caused as it was thought by the use of well-water for drinking purposes.
SEWERAGE AND DRAINAGE.
There is a growing interest in the state in the matter of sewerage and drainage. This is manifest hy the great number of requests received by the state board to settle complicated questions connected with this work.
The plumbing of dwellings and public buildings is receiving more than the usual degree of attention. The rules and regulations promulgated by the state board in a supplemental circular are generally adopted. Some law should be enacted by the legislature requiring an inspection of all plans of plumbing work it is not already provided for by powers conferred upon the state board of health. At the present time there are as many ideas of plumbing as there are plumbers in the state.
VITAL STATISTICS. Vital statistics is the basis or ground work of public hygiene, therefore the two departments should be united, which is the case in nearly all the states where registration of vital statistics is required. I believe our own state should adopt this method. A summary of the vital statistics of the New England states has been issued for 1892, compiled under the direction of the secretaries of the state boards of health of the six New England states. It is proposed to publish one of these summaries every five years. “ The objects to be secured by such a publication may be stated briefly as follows:
1. The securing of better and more uniform methods of the presentation of material collected in the registration returns.
2. The stimulation of attention to this important branch of public work in other states where registration has hitherto been neglected.
These are the objects as stated by Dr. Abbott, secretary of the state board of health of Massachusetts, who has the matter in charge.
The registration returns of the state should show the comparative healthfulness of towns. Information upon this point is frequently asked of the state board of health, the statistics of which only show, and that imperfectly, the condition of the state in reference to some of the infectious diseases.
These facts should all be made to appear in the state registration reports.
SMALL POX CASES REPORTED.
The following is a list of small pox cases as reported to this office in accordance with inter-state regulations, from September 1, 1894, to August 31, 1895: Maine, 1; New Hampshire, 20 ; Vermont, 30 ; Massachusetts, 1; Illinois, 30 ; Iowa, 10; Maryland, 45 ; Minnesota, 11 ; Pennsylvania, 109; Wisconsin, 262; Michigan, 199; New York, 1; Ohio, 238. Total, 957.