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On the other hand, Lawrence, which for twenty years used the polluted water of the Merrimack River without filtration, had during that period an invariably high typhoid mortality. Since the introduction of thorough filtration, at the advice of the State Board, its rank in the columns of this table has fallen to a position quite near the bottom of the list, and a mortality of only 1.86 per 10,000 in 1896.

Holyoke has a comparatively good public water supply, but for the first three five-year periods stood at the top of the list, with the highest typhoid mortality. It then fell to the sixth place in the fourth and the eleventh place in the fifth period, and then to the thirtieth in the year 1896. Upon investigation by the State Board of Health in 1891 it was found that, notwithstanding the good quality of its water supply, much water was taken for drinking purposes from the three canals, either directly or but imperfectly filtered by means of defective filtering galleries in the bottom of the canals. The authorities were advised to discontinue this practice.

It may be added as a general statement, in regard to these tables, that the mean typhoid death-rate of the cities in the first or upper half of the list in 1896 is less than the mean typhoid death-rate of the cities in the lower half in the period 1871-75, and that some cities which have maintained a comparatively uniform rate through the whole time from 1871 to 1896 have apparently risen in this table to a higher relative position, for the reason that this very marked improvement has taken place in many other cities.

In 1896, for the first time, there are three cities having a combined population of over 70,000 in which the typhoid death-rate was less than 1 per 10,000, and in one of them (Woburn) there were no deaths from this cause.

Consumption.

In the last annual report of the Board a copy of the circular issued by the Board in the preceding year was published. Soon after the publication of the circular, the attention of the Board was called to a monograph by Dr. J. B. Russell, the Senior Medical Officer of Health of Glasgow, which had recently been published in that city, entitled "The Prevention of Tuberculosis."

The practical tone of the book, and its clear and intelligent presentation of the subject, led the Board to reprint it for distribution in Massachusetts, with the consent of the author. An edition of five

thousand was published and distributed throughout the State. No publication of the Board has been received and read with greater interest, and it is hoped that much benefit will be derived from its free circulation. Copies may be had on application to the Board.

Diphtheria.

No disease or cause of death has received greater attention in recent years than diphtheria, and it is hoped that the vigorous action of health authorities now being conducted against this disease will be followed by similar results as appear to be taking place in the deathrate from tuberculosis. The efforts at prevention and restriction of disease now going on in all civilized countries may well receive the title usually given to them in German cities, "a campaign against infection."

In the interest of the health of the people the Board has therefore believed it proper to offer every possible facility to the different municipalities both for the diagnosis and for the preventive treatment of diphtheria.

For the first of these objects, the diagnosis of diphtheria, a system of examination of throat cultures has been established, whereby such cultures may be forwarded to the Board for examination from any city or town in the State, sets of tubes containing the culture material being deposited with boards of health and druggists in convenient locations. An account of the first year's work in this direction may be found in this report.

For the second object, the furnishing of antitoxine, the methods adopted by the Board have already been described in the report of last and a continuation of the subject is presented in this report.

year,

Malarial Fever.

In 1885 malarial fever appeared for the first time as a serious epidemic in eastern Massachusetts at South Framingham, and was made the subject of a report by Dr. Z. B. Adams in the seventh annual report of the Board of Health, Lunacy and Charity, Supplement on Public Health.

From that time it appeared successively in other towns in the eastern part of the State, and reports have been made upon its operations by different writers.

The reports which have been published by the State Board of Health are as follows:

Report of 1880, by Dr. J. F. A. Adams of Pittsfield.
Report of 1885, by Dr. Z. B. Adams of Framingham.
Report of 1889, by Dr. C. H. Cook of Natick.

Brief statement in report of 1888 of its prevalence in Deerfield.

In addition to these, special examinations have been made of the territory along the banks of the Charles River from Dedham to tidewater. This examination was made by the Board, acting conjointly with the Metropolitan Park Commission, first of the region from Waltham to the sea, and secondly, of the region immediately above Waltham.

Investigations have also been made at Uxbridge, North Saugus and at Woburn, in each of which places there have been serious outbreaks of malarial fever. In a small district in Woburn, mostly upon the shores and territory contiguous to Horn Pond, a house-tohouse inquiry revealed the fact that over 1,900 cases of malarial disease had existed in this district during the years 1894, 1895 and 1896 in a somewhat densely settled district covering an area of about onehalf square mile.

OFFENSIVE TRADES.

No complaints were made directly to the Board during the year with regard to offensive trades, and consequently no hearings upon the subject were held. In consequence of the more efficient organization of local boards of health in the cities and large towns such matters have in the past two years been settled by the local boards.

In one instance the advice of the Board was asked as to the mode of dealing with a nuisance of this character located in the town of Mansfield, where an establishment existed for the purpose of conducting the business of making fertilizers in a very crude manner, the carcasses of animals being treated with acids out-of-doors and then covered with a light coating of soil, the effect being to produce a very foul odor in the neighborhood.

MANUAL OF HEALTH LAWS.

The Board has published at intervals of about four years, since 1882, an edition of the health laws of the State, each edition containing the health statutes in force up to the time of its publication.

An edition was published in 1894 which soon became exhausted, although a larger edition was printed than usual.

In 1896 a new edition was prepared, and was revised with unusual care by E. M. Parker, Esq., of Cambridge, the health laws in force up to January, 1897, being included. A new feature of the manual is the complete index of all the laws in force which precedes the text, each law being referred to by chapter and page of the manual. A very complete index is added at the end of the book.

As an aid to local health boards, physicians and court officers it will be found indispensable. The following partial list of its contents conveys an idea of its comprehensive character: general powers and duties of the State Board of Health, local boards, nuisances, infectious diseases, vaccination, protection of infants, quarantine, offensive trades, water supply and sewerage, public baths, cemeteries and burials, cremation, cattle diseases, medical societies, color blindness, instruction in physiology, etc., sanitary work of district police, plumbing, stables, bakeries, food and drug inspection, registration of vital statistics, inquests.

LEAD POISONING.

This subject was mentioned in the last report of the Board, with special reference to the occurrence of an unusual number of cases of illness in the town of Kingston, which upon investigation by the Board was shown conclusively to have been caused by the presence of lead in the water of the public water supply, and which could only be accounted for by the free use of lead for service pipes in the town. The Board at that time, Sept. 23, 1895, wrote to the water board of Kingston, recommending the "immediate removal of all lead pipes in the town, wherever they are used for conveying water for domestic use, either as service pipes or as street mains."

Since that time other cases of similar character have been reported from other parts of the State, notably from Fairhaven, New Bedford and Milford, and further investigations are being conducted with reference to the action of the public water supplies upon lead pipe. The results of these investigations will be made known in a future report.

INSPECTION OF SUMMER RESORTS.

There has been for many years a limited number of places, at different points in the State, at which large numbers of people congregate during the summer months for longer or shorter periods of time. These were in some instances owned and controlled by relig

ious or other organizations. They were usually located either on the seashore or upon the banks of a river or lake or pond. At some places cottages were built and quite a summer village was maintained, as in the case of Cottage City, Onset Bay, Brant Rock, Salisbury Beach, Pleasant Lake in Franklin County, etc. In other cases the camp or picnic ground was of a more temporary character, where people gathered in large numbers for a single day. The latter class of resorts has very greatly multiplied within the past ten years, their rapid increase being due largely to the development of electric railways in the neighborhood of the populous towns, and the desire of such corporations to provide amusement for their patrons.

In one instance, eight such resorts of different size and character have been established upon the shores of a single lake or pond, three upon another lake, and so on, and in some instances such places have been located upon the watersheds of public water supplies. In the case already noted, where eight places of this character exist upon one lake or pond, the water of the pond is the water of the public supply of the neighboring town. It is, however, filtered through the gravel and drawn from wells or galleries upon the shore of the lake.

It was, therefore, decided by the Board that an investigation of the sanitary condition of these places should be made, with several points in view, and with the intention of advising or recommending such changes as were deemed necessary to remedy defects and to improve existing unsanitary conditions. The special points which were kept in mind in the investigation were: First, the possibility of such places proving dangerous to public water supplies, in consequence of their location upon the watersheds. Second, as to the water supplies furnished to the patrons of these resorts. Third, the drainage and sewerage of the buildings. Fourth, their general sanitary condition, and especially that of the restaurants, kitchens, water-closets and the disposal of the garbage and other waste

matters.

The investigation was under the management of Prof. W. T. Sedgwick and a corps of inspectors, and many places were also visited by the secretary.

The whole number of such places which existed in the State so far as was known at the time of the inspection was 130, and nearly all of these were visited personally and during the season of patron

age.

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