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GENERAL REPORT.

This twenty-eighth annual report of the State Board of Health contains a statement of the general work of the Board for the year ending Sept. 30, 1896, and of that which relates to water supply and sewerage for the calendar year 1896.

The first portion, the general report, paged in Roman numerals, includes a condensed statement of the work done under the statutes which define the work of the Board.

To this is appended the reports, in brief, which the Board has already presented to the Legislature upon the sewerage of Salem and Peabody and the improvement of the Neponset valley, also the joint report of the Board with the Metropolitan Park Commission on the improvement of the Charles River.

The second part of the report, paged in Arabic figures, contains the fuller details of the work of the Board, under the acts relating to water supply and sewerage, food and drug inspection, reporting of infectious diseases, and such papers upon special topics as the Board has deemed it desirable to publish. In the recent reports of the Board it has been customary to present a condensed annual statement of the vital statistics of the State. In the present report this statement is presented, with much greater fulness of detail, in the form of a forty-year summary, in which comparative statistics are quite fully presented of the earlier and later portions of the period (1856-95). This summary is presented in compliance with an increasing demand for information of this character.

The following members comprised the Board in 1896:

FRANK W. DRAPER.

HIRAM F. MILLS.

JAMES W. HULL.

HENRY P. WALCOTT, Chairman.

GERARD C. TOBEY.

CHARLES H. PORTER.
JULIAN A. MEAD.

No changes have taken place in the membership of the Board dur

ing the year.

INFECTIOUS DISEASES.

The group of diseases known as infectious, including tuberculosis, has diminished with a considerable degree of uniformity during the past half century in its incidence upon the population. Exceptions occur in the case of single years, as well as in the case of separate diseases or causes of death, but as a general rule the death-rate from such diseases appears to be steadily decreasing. This is more apparent when five-year periods are compared than when the comparison is applied to single years.

For example, the combined death-rate from small-pox, measles, scarlet-fever, diphtheria and croup, typhoid fever, cholera infantum, consumption, whooping-cough, dysentery and child-birth was as follows for the forty years (1856-95), in five-year periods:

Death-rate per 10,000 living from Certain Diseases.

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By the foregoing figures it will be seen that the decrease has been much more uniform in the second twenty years than it was in the first.

During the first twenty years the combined death-rate from these causes rose to more than 100 per 10,000 living in three years of the period (1863, 64 and 72), while in the second period at no time did it rise above 82.7 (in the first year, 1876) and fell to a minimum of 47.1 in 1895.

Small-pox.

Since the occurrence of the limited epidemic of small-pox of 1893 and 1894 there have been but very few cases reported in the State. The whole number of cases officially reported to the board in 1896 under the statute of 1883, chapter 138, was 5 and the details are as follows:

The explanation of the different incidents of child-birth embraced in this term may be found on page 804.

Cases of Small-pox reported to the State Board of Health in 1896, under the Provisions of Chapter 138 of the Acts of 1883.

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A sister of No. 5 was a rag cutter in a paper mill.

Nos. 3, 4 and 5 occurred in places where paper mills using rags are located.

No. 1 was a cook employed among laborers on the Cambridge water works.

Cases of small-pox occurring in other parts of the United States were reported to the Board in 1896, under the provisions of an interstate agreement made at Toronto, Ontario, in 1886.

In February, 2 in Connecticut, 1 each in Michigan and the Provinces of Quebec and Ontario.

In March, 2 in Alabama, and 1 each in Kansas and Indiana.

In April, 11 in Alabama and 3 in Pennsylvania.

In May, 1 each in Indiana and Washington (State).

In June, 1 in New York.

In August, 1 in Washington.

In November, 1 each in Indiana and Ohio.

In December, 1 in Pennsylvania.

These 30 cases, together with the 5 in Massachusetts, making 35 in all, are all that were officially reported in 1896 in a population of about seventy million people.

In addition to the foregoing, notice was received from the quarantine station at New York of the arrival at that port of the steamers "Massilia," "Victoria" and "Patria" on February 7, April 27 and May 9 with cases of small-pox on board. These steamers all hailed from Naples, and had immigrants on board destined for Massachusetts cities and towns, and in each instance the boards of health of these cities were notified of the fact. It is not known that the disease was communicated to inhabitants in any of these cities.

Typhoid Fever.

No disease or cause of death constitutes a better index or measure of the efficiency of sanitary work than typhoid fever. The number of deaths from this disease has diminished with considerable uniformity in proportion as public water supplies have been introduced in the cities and towns. A table and diagram in the portion of this report which is specially devoted to vital statistics illustrates this principle. The returns for 1896 are not all in at the date of writing this, but sufficient information is at hand to show that the past year proves no exception to the rule. The notifications of infectious diseases which are constantly received at the office of the Board give evidence of the fact as well as the diminished requests for the assistance of the Board in the investigation of epidemics.

The principal epidemic of this character which occurred during the time embraced in this report was that of North Adams. This epidemic was reported to the State Board of Health by the board of health of North Adams late in September, 1895, and Professor Sedgwick was instructed to proceed to North Adams and to investigate the cause and aid the local board in its inquiries.

It appears from the table which is given on page xiv that North Adams has had a persistently high death-rate from typhoid fever for several years.

Professor Sedgwick found that considerable apprehension existed at North Adams with reference to the condition of the water supply, which is taken from certain reservoirs made by impounding the water of brooks in comparatively uninhabited regions, and from driven wells near the centre of the city.

Although the water of these wells is hard and comparatively impure it did not appear that they could be charged with causing the unusual prevalence of typhoid fever, since the distribution of the cases would not warrant this inference. Most of the cases in 1895 occurred in the western and northern sections of the city and especially in the valley along the watershed of the north branch of the Hoosac River.

The deaths registered in the four months of June, July, August and September in the five years 1891-95 were as follows: 1891, 3, 1892, 3, 1893, 5, 1894, 10 and 1895, 11.

The cases which occurred in 1895 did not appear simultaneously or in large numbers, as is common in epidemics due to infected milk

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