COMMONWEALTH OF MASSACHUSETTS. STATE BOARD OF HEALTH, 13 BEACON STREET, BOSTON, July, 1886. To all persons interested in the Preservation of the Public Health in the Commonwealth of Massachusetts: In compliance with the provisions of the Acts of 1886, chapter 101, the undersigned have been appointed by the Governor and Council as a State Board of Health. The present Board enters upon its work with a much broader field before it than that of its predecessors, powers of a more decidedly executive character have been conferred upon it, and its duties have been made more exacting and more comprehensive. We desire at the outset to establish such relations and communications with the local Boards of Health that all may work together for the common advantage of the people, for the prevention of disease, and for the prolongation of life. The rights of the people to pure air, soil, water and food are recognized by the laws of the Commonwealth; and various statutes have been passed to secure the enjoyment of these rights, and to prevent their infringement by any individuals, corporations or municipalities, either from ignorance, carelessness or selfishness. This Board is charged to some extent with the duty of enforcing these rights and preventing and punishing any violation of them; having for this purpose powers co-ordinate with those of the local Boards of Health. The business of investigating and gathering information as to any matter pertaining to the public health and of diffusing such information among the people is also included in its functions. Among the matters of which it thus takes cognizance are: 1. The causes and prevention of infectious diseases. For this purpose the State Board is given co-ordinate powers with local Boards of Health. (See chap. 80, sects. 1 and 2, Public Statutes.) The rapid advance in the knowledge of the nature and causes of infectious diseases in recent years has an important bearing upon the legitimate work of Boards of Health. Greater familiarity with this subject is therefore essential to the successful operation of such boards. 2. The suppression of nuisances, including the regulation of noxious and offensive trades. (Chap. 80, sect. 93, Public Statutes; chap. 107, sect. 2, Public Statutes.) 3. The collection and diffusion of information relative to industrial hygiene, or the effects of different occupations, industries and domestic pursuits upon people at various ages, and under various conditions of life. 4. The hygiene of schools, school-buildings and public institutions. 5. The examination and investigation of public water-supplies and public ice-supplies, and the prevention of their pollution. (Chap. 80, sects. 103, 104, 105, Public Statutes; chap. 274, Acts of 1886; chap. 287, Acts of 1886.) 6. The investigation of drainage and sewerage systems or plans, so far as they relate to the public health. (Chap. 274, Acts of 1886.) 7. The disposal and transportation of the dead. 8. The inspection of food, drugs, and other articles affecting the public health. (Chap. 263, Acts of 1882; chap. 289, Acts of 1884.) 9. Inquiries into the causes and means of prevention of insanity. 10. Inquiries relative to the amount of intemperance from the use of stimulants and narcotics, and the remedies therefor. 11. The protection of human life. 12. Investigations as to the infectious diseases of animals, so far as they affect the public health, e. g., hydrophobia, trichinosis, glanders, anthrax, etc. Your attention is hereby respectfully called to the enclosed copy of the very important statute entitled "An Act to protect the purity of inland waters." (Chap. 274, Acts of 1886.)* Communications should be addressed to the Secretary, Dr. Samuel W. Abbott, 13 Beacon Street, Boston. Respectfully, HENRY P. WALCOTT, ELIJAH U. JONES, JULIUS H. APPLETON, THORNTON K. LOTHROP, FRANK W. DRAPER, HIRAM F. MILLS, JAMES WHITE, State Board of Health SAMUEL W. ABBOTT, Secretary. The standing committees of the Board appointed under the third article of the by-laws were as follows: Publications Messrs. WALCOTT and APPLETON. Water Supplies and Drainage - Messrs. WALCOTT, MILLS and Lo THROP. * See p. xix. Fublic Institutions Messrs. MILLS, JONES and WALCOTT. Food and Drugs-Messrs. WALCOTT, JONES and DRAPER. Legislation and Legal Proceedings-Messrs. LOTHROP, APPLETON and WHITE. Health of Towns and Correspondence with Local Boards of Health — Messrs. DRAPER and MILLS. Contagious Diseases - Messrs. JONES, WALCOTT and DRAPER. THE RELATION OF RAGS AND PAPER MANUFACTURE TO PUBLIC HEALTH. Among the important industries of Massachusetts is that of paper-making. All grades of this article are manufactured in the State, including the finest qualities of book and writing papers, as well as the coarser grades of sheathing and manila papers. For such manufacture various sorts of materials are used, such as wood-pulp, oakum, jute, manila straw and rags. Of the latter, very large quantities are employed, the rags being collected for this purpose in all parts of the world. In consequence of the immense quantity of rags consumed in such processes in Massachusetts, this State having for many years taken the lead in such manufacture, an opportunity is offered for observing the effects of such rags upon such persons as are engaged in handling them, from the time when they leave the ship at the port of entry, or the hospital, the tenement house and the junk shop, through the various processes of unbaling, dusting, sorting, cutting, boiling and conversion into paper. During the great epidemic of small-pox of 1872 and 1873 attention was directed to the prevalence of small-pox in towns where paper manufacture was conducted, and since the prevalence of cholera during the past four years on the shores of the Mediterranean, from which districts considerable quantities of rags are imported to the United States, attention has again been called to the possibility of infection from this source, and stringent measures for disinfection. of rags have been adopted at several of the principal Atlantic ports. Dr. Charles F. Withington has carefully investigated the subject of the relation of rags and paper manufacture to the public health, and has reported to the Board upon the subject. This subject has received considerable attention from sanitary authorities in this as well as in other countries, and the American Public Health Association at one of its recent sessions appointed a committee to consider the subject and report upon it. The report was made at the last meeting of the association, which was held at Toronto in October, 1886. The following resolutions were adopted at that meeting: Whereas, It is an admitted fact that the importation of rags is a prolific source of the spread of infectious disease, and that the seaboard cities which are ports of entry are the gateways through which this infection enters, and is distributed throughout various sections of the country; and Whereas, There are grave doubts as to the efficacy of the methods of disinfection used abroad; therefore, Resolved, That it is the judgment of the American Public Health Association that all health authorities having jurisdiction over matters connected with maritime sanitation owe it as a duty to the general public to adopt such systems of disinfection as will thoroughly destroy all disease-bearing germs before the rags are permitted to be distributed for manufacturing purposes. If it proves to be impracticable to disinfect them, it is recommended the disinfection may be commenced in quarantine, sufficient to insure safety in transportation, to be completed in the manufacturing establishment by such methods as the health authorities may prescribe. The conclusions of this preliminary report are substantially in accord with those expressed by Dr. Withington, with the exception of the statement in the first line of the former that the importation of rags is a prolific source of the spread of infectious disease." In Massachusetts, on the contrary, a State which uses one-third of all the rags imported into the United States, no infectious disease has ever been traced directly to the medium of imported rags, except small-pox, and that disease in a very few instances only. Not a single case of scarlet fever, typhoid fever, typhus fever, diphtheria, cholera or anthrax has ever been shown conclusively to have been transmitted by rags imported as such from countries outside of the United States. So far as Massachusetts is concerned the term "prolific" cannot be properly applied to a source which has been proved to have transmitted one disease only, and that in a very limited manner, this disease (small-pox) having the most certain and definite means of prevention. Dr. George M. Sternberg, the eminent authority upon disinfectants, having been quoted frequently in the report of the Public Health Association, the following extracts are made from a recent letter written by him, dated Dec. 22, 1886: I think it proper that I should state my present views, as I am not by any means as positive with reference to the necessity for disinfecting all rags as I was two years ago. I have since had an opportunity to make a personal inspection of the large establishments in several European cities where rags are baled and shipped to this country. At the request of Dr. William Smith, health officer of New York, I made inspections at Ghent, Brussels, Berlin and Stettin. I also obtained reliable information as to the methods pursued in Hamburg and other German ports from which rags are shipped to this country. I had previously supposed that rags from ports in southern Europe, where cholera was prevalent, were liable to be shipped from any of these ports. But all of the merchants with whom I conversed assured me that this could never occur, on account of the low price of rags as compared with the cost of land transportation. As a matter of. fact, rags sent to each shipping port can only be collected within a limited area, the boundaries of which depend upon cheap transportation facilities, by canals, rivers, etc. Again I learned that all rags shipped to this country are first sent to large warehouses in the shipping ports, where they remain for a longer or shorter time, often for many months, usually loosely piled up in open bins. These warehouses of the rag merchants are in populous cities, and it is evident that the first danger of infection is incurred by those who handle the rags for the purpose of sorting and baling them, and by the citizens of the cities in which the warehouses are located. These cities have their health officials, who naturally have an eye on the warehouses in question, and we would expect to see some restrictions placed upon the business of these rag merchants if experience had demonstrated that their establishments were dangerous to the public health. I could not learn that, under ordinary circumstances and in the absence of |