A question of considerable importance which has arisen in two different towns during the past year is the relation of local boards of health to such public institutions as exist in the different cities and towns. Several circumstances in recent years have tended to bring the State and local boards of health into closer mutual relations to each other. (1) The enactment of statutes requiring annual returns of deaths to the State Board by local boards, and the immediate reporting of all infectious diseases by local boards. (2) The work undertaken by the State Board to assist local boards in the diagnosis of infectious diseases, and in the supply of antitoxin for the treatment of diphtheria. (3) The general supervision of water supplies and systems of sewerage, which was required of the State Board in 1886. Reference has already been made in previous reports of the Board to the organization of the Association of Boards of Health, at whose quarterly meetings the representatives of the State and local boards meet for the discussion of all questions which pertain to municipal as well as to general hygiene. This organization has proved very helpful to those local boards which have availed themselves of its privileges. The efficiency of the sanitary supervision of cities and towns may be in some measure shown by the vital statistics of the State for the past thirty years. It is one of the first principles of general hygiene that the death-rate increases with the density of population, other things being equal. Hygienic conditions, however, may be so greatly improved as to offset the harmful effects of increasing density. During the past thirty years the population of Massachusetts has doubled in number, and the density has increased in like proportion (that of 1865 was 152 inhabitants per square mile, and that of 1895, 300); yet the death-rate has remained about the same throughout these thirty years, when long periods of time are considered and not single years. The death-rates of the population of the three successive decades. since 1865 were as follows: These figures, when considered in connection with the doubling of the density, may be taken as an index of decidedly improved sanitary conditions. HEALTH OF Towns. A digest of the principal facts of importance published in the annual reports of local boards of health occupies the final pages of this report. The general character of these reports indicates a decided improvement in the work of local boards, especially in the direction of the management and control of infectious diseases. The table containing the number of cases and deaths from certain infectious diseases with the ratio of fatality which was formerly published in connection with this digest has been transferred from this portion of the report to that part which is entitled "Statistical Summaries of Disease and Mortality." ROUTINE WORK OF THE BOARD. During the year ending Sept. 30, 1896, the Board held meetings at least once in each month. Meetings of such of the standing committees as were necessary for the transaction of business were also held from time to time, as well as joint sessions with such other boards or commissions as were prescribed by the Legislature. The office of the Board has been open throughout the year, as prescribed by the Public Statutes, chapter 21, section 10,* for the transaction of its authorized business. Advice has been very frequently given at the office and by mail to local boards and to individuals in regard to sanitary matters, and many visits have been made by the secretary, the engineers and other experts to cities and towns for the purpose of making investigations and giving advice. The work of the office has become materially increased in consequence of being made a central station for the distribution of antitoxin to local boards of health, hospitals and physicians in private practice. To this has been added during the past year the work of examining the products of certain infectious diseases for the purpose of determining their character, notably diphtheria, tuberculosis and malarial fever. The statistics of mortality compiled from the weekly postal card returns from the registering authorities of cities and towns have been published weekly during the year in the form of a bulletin, which also contains, once in each month, a report of the work done in the Office hours, 9 A.M. to 5 P.M.; Saturdays, 9 A.M. to 2 P.M. line of food and drug inspection, together with the prosecutions made under the food and drug acts, and other important information relative to the work of this department. In addition to these items there is also published in the same bulletin a weekly report of the number of cases of infectious diseases reported by the local boards to the State Board of Health. The following table presents certain statistical data relative to the routine work of the Board: STATISTICAL TABLE FOR THE YEAR ENDING Sept. 30, 1896. 8,338 4,484 76,113 38,905 Number of packages of antitoxin issued to cities and towns,* 3,245 Number of bacterial cultures made for the diagnosis of diphtheria in Number of examinations made for diagnosis of tuberculosis,* Number of notices of cases of infectious diseases received and recorded Force employed in general work of Board at central office, State House: 1,469 124 57 21,315 2,340 86 Force employed at central office, State House, Boston, for food and drug inspection, chemists and assistants, At Amherst, Inspectors,. 2 11 1 احد Total, For the year ending March 31, 1897. Towns having a population of over 5,000 inhabitants in each. Force employed at laboratory (Bussey Institute): — UNDER THE PROVISIONS OF CHAPTER 375, ACTS OF 1888. Applications for advice from cities, towns and others: Relating to water supply, . Total, Number of samples of water examined chemically and microscopically at the Massachusetts Institute of Technology, Number of samples of sewage and effluent from sewage purification works examined chemically at the Massachusetts Institute of Technology,. Number of samples of sewage and water examined chemically and bac- Total number of samples examined, 2,200 199 2,929 211 115 6,500 12,154 Total ordinary force employed under chapter 375, Acts of 1888,. Not including the force employed upon the improvement of Charles, Concord, Sudbury and Neponset rivers, Salem and Peabody sewerage, or Marshfield investigation. The number of applications for advice under the provisions of chapter 375, Acts of 1888, received since July, 1886, when the act relating to water supply and sewerage first went into operation, is as follows: The following recommendation was made to the Legislature at the beginning of the session of 1897: The Board recommends the continuance of its investigations now being carried on as authorized by the provisions of chapter 375 of the Acts of 1888. For this purpose, and to make the necessary investigations in order to advise cities, towns, corporations and individuals in regard to the best methods of assuring the purity of intended or existing water supplies and the best method of disposing of sewage, and to carry out the other provisions of chapter 375 of the Acts of 1888, the Board estimates that the sum of $30,000 will be required. EXPENDITURES. The work of the Board is conducted under the provisions of several statutes, and for its different departments of work three appropriations are annually made, one for the general work of the Board, one for the inspection of food and drugs, and a third for carrying out the provisions of chapter 375 of the Acts of 1888, relating to the protection of the purity of inland waters. In addition to the foregoing, special appropriations have been made from time to time, as occasion has demanded, for the purpose of enabling the Board to conduct special lines of investigations. The appropriations for the different departments of work in 1896 were as follows: For carrying out the provisions of chapter 375, Acts of 1888, 30,000 Total, . $57,300 |