HEALTH OF TOWNS.

The information given under this head is, for the most part, contributed by regular correspondents of the Board, in the various towns and cities. It is the wish of the Board to be informed at all times of the occurrence of epidemics in any part of the State, of the existence of any exceptional forms of disease, of unusual sickness or mortality, and especially to stimulate inquiry concerning the preventable causes of disease. Another purpose constantly kept in mind is, to persuade the people in the various towns to organize efficient health boards, of which one member at least should be an intelligent physician, and to support these boards in the fearless exercise of the great powers which are given them under General Statutes.

With these views, an extensive correspondence has been kept up with the towns and cities. We are very far, as yet, from being made acquainted with the condition of public health in all parts of the State, but each year adds to the amount of this knowledge.

In some instances, when it was made known to us that unusual forms of sickness were prevailing in certain localities, a special investigation has been made. The results of two such inquiries are given in the following pages, under the heads of "Medford" and "Spencer." Others were also undertaken, which led to no results worthy of present record. The investigation by Dr. Draper, in the town of Spencer, is referred to in the General Report.

The Board having heard rumors that an epidemic of typhoid fever was prevailing at Medford, and that it had been caused by the typhoid contagion conveyed in milk from a dairyman's premises, requested Dr. A. H. Nichols to visit the place, collect the facts, and report thereupon. As such epidemics

have recently occurred in England, it was thought desirable to decide whether the Medford epidemic originated in this way. The thorough manner with which Dr. Nichols has performed the task, shows that it has been owing rather to the filth surrounding the houses, and possible contamination of the water. There is no sufficient proof that it originated from milk. Possibly the whole epidemic might have been prevented if the simplest sanitary precautions had been taken in the various houses. There are many such homesteads in Massachusetts, and those who occupy them may find a warning in this investigation.

It will be seen that some of our correspondents have given very complete and instructive accounts of the state of public health in the towns of their residence.

A circular was issued in November, in which the following questions were asked:

1. Whether any forms of disease have been specially prevalent.

2. Whether you can discover any cause for such prevalent forms of disease.

3. Whether such causes are, in your opinion, in any degree preventable or removable.

4. Are the local health authorities intelligent, vigilant and efficient?

In reply to these inquiries, letters have been received from 154 towns. Of this number, 62 are to the effect that no forms of disease have been specially prevalent. This single statement answers the 1st, 2d and 3d questions. About half of this number reply to the 4th question, but as they are generally from small towns, where the selectmen are the board of health, and seldom concern themselves about health affairs unless small-pox makes its appearance, the information conveyed is not of much value.

The remaining 90 correspondents speak of the boards of health of their cities and towns very freely, and for the most part we forbear to quote their remarks. More than half of the number are very uncomplimentary to the health authorities. No doubt can be left on the mind of any one who ex

amines these letters that the boards of health of most of the cities and towns of Massachusetts have no idea of the responsibility which belongs to their office.

Amesbury.—“ Small-pox to a moderate degree, measles in a severe form, and enteric diseases during a few weeks in midsummer, were the prevalent diseases. The causes of the severity of the measles are represented as excessive heat and moisture, with sudden changes, affecting bottle-fed babies more especially. Lack of vaccination and re-vaccination promoted the spread of the small-pox."

Amherst.-"Typhoid fever has been quite prevalent; next, diseases of the respiratory organs and enteric diseases. In the spring of the year many children took on a condition of great depression, with slow pulse, great restlessness, sighing respiration, etc., resembling that of epidemic cerebrospinal meningitis, of which disease there were several cases in this vicinity at that time. The pulse, in one case of undoubted pneumonia, with no other complication save this depression, remained for several days at 58. The typhoid and enteric diseases have been accompanied with a tendency to functional disturbance of the liver.

"The causes of typhoid fever are mostly local and preventable. There is too much indifference to drainage, the care of sink-drains, privies, etc. Yet cases have occurred where no fault whatever could be found with the surroundings, and the causes have been unknown. Several cases can only be accounted for on the theory of contagion or infection."

Ashburnham.—"Typhoid fever has been specially prevalent. In most cases improper drainage or a privy near the supply of water is the cause. These causes would be preventable if the health-laws could be enforced."

Athol.-"We have had a remarkable degree of good health. There has been no prevalent disorder; that is, nothing more than is usual in country towns.

"Our population is to some extent transient, 'floating,' and now numbers nearly 5,000. Among so great a number, comparatively speaking (for our growth is wonderful), we naturally look for various forms of disease.

"We need a board of health, and I would recommend the suggestion of legislative action in this respect. There are times when such a board could accomplish great good, and I thoroughly advise the legal establishment of such in every city and large town.

"Our board of selectmen are 'intelligent, vigilant, and efficient,' but at the same time they are bounded by the appropriations, and none such have been made as yet for the benefit of health and sanitary influences.

"If the legislature compelled towns to establish boards of health, under pay, every town could be accommodated, and the average health would be increased above the present figures. I trust you will thoroughly agitate this subject vigorously, and be successful."

Attleborough.—“ In 1871 and 1872, typhoid fever was rife. Four cases and two deaths occurred in one house where the well was apparently contaminated. No analysis was made, and no direct source of impurity was detected. Whether such causes are in any degree preventable or removable, I can

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make no practical suggestions, except the application of the general principles of hygiene."

Ayer.-"We have had very little sickness of any kind during the year; hardly a case of cholera infantum, which was very common last year; one or two cases of typhoid, which also last year was very prevalent. Pneumonia prevails to a greater extent than any other disease requiring mention, but less this than in former years. Severe colds are common, and both these and pneumonia are caused in no small degree by poor ventilation, in sleeping apartments especially. Whether sudden changes from a small room, the air of which is charged with foul gases, into cool air with abundance of oxygen, prepares the way for congestion and inflammation or not, I am fully persuaded that poor ventilation acts as an exciting cause, and if so, it is preventable."

Boston. The death-rate of the city of Boston is so high as to make the discovery of its causes a matter of the deepest interest to every citizen. 7,869 persons died in 1873. The mortality of the past three years will be made evident by the following table:

Brimfield.-"Typhoid fever has been specially prevalent.

In years past

I have thought I could discover the cause of this disease; but this year, I cannot, it prevails everywhere, in new houses as well as in old ones, in healthy as well as unhealthy locations. My impression, however, is, that dirty-smelling sink-drains occasion more typhoid than all other causes combined."

Beverly." Scarlet fever prevailed from January to July. Ten cases occurred in October and November. There were none in August and September. I do not know any way of protection against any epidemic of scarlatina."

Berkley." Measles and scarlatina, quite malignant, prevailed. The scarlatina originated from one family who had had no communication with any other person or persons who were previously diseased, but who used the water from a spring on the bank of the Taunton River which was overflowed by the tide, receiving 'putrid blood' or anything else that the water might hold in solution. Such causes are in some degree preventable or removable."

Brookfield.-"Last spring we had scarlatina and rubeola, and this fall have had some typhoid fever, but not a great amount. I can discover as a cause nothing more than what is generally observed. In some of the cases of typhoid fever, I thought they might be traced to the use of bad water for drinking and cooking purposes.

"We have no health authorities except a board of selectmen, which serves us very well in case of small-pox appearing among us. Farther than this, I have never known them to act. It appears to me that a board of health should be chosen in every town as much as a board of selectmen, that the health of the towns should be carefully looked after, and all causes of disease, as far as possible, removed."

Belchertown." There has been less sickness in this town and immediate section than for many years past. In a few cases of typhoid fever I have had, I have almost always found damp, dirty cellars or defective drains, and in one well-water contaminated by offal being thrown around it. Such causes are to a great extent preventable."

Cambridge.-"Small-pox and cerebro-spinal meningitis were prevalent in the early part of the year. No other diseases have specially prevailed. I cannot discover any cause for the diseases mentioned."

Chelsea." In the early part of the present year, we had, commencing in the latter part of April, something of an epidemic of cerebro-spinal meningitis, which suddenly subsided as the dry weather of early summer came on. We have had in our city, the usual number of typhoid fever cases during the fall months.

I think many of these cases were traceable to bad location, cesspools, privy-vaults, or cellars poorly ventilated, or some deficient drainage about the premises.

"In many cases, the local cause of trouble could be removed, and then a general or more extended system of sewerage adopted throughout the city would be an improvement to health.

"In our city, we have no 'health officer'; but our mayor and the board of aldermen attend to matters supposed to affect the health of our city. Perhaps a committee of two made up from this board, and more independent of political influences, would accomplish more."

Cheshire.-"Typhoid fever and dysentery have been prevalent. Low water in ponds is the cause, and it is not preventable or removable. The health authorities are intelligent, vigilant and efficient."

Chicopee." During the spring months, a large number of cases of rheumatic disease occurred, some of great severity. The causes assigned by physicians here, were: wet weather, living in damp basements, and insufficient clothing; all of which, of course, might have been obviated by change of residence, warm clothing, and more intelligent care in preventing exposure. “During June and July spinal-meningitis prevailed, apparently epidemic, in one section of this village. This was alluded to in a reply to a previous circular.

"This disease appeared to me to have some connection, as a probable consequence, with foul vapors, arising from a stagnant pool of water from the sewage of several houses crowded with tenants, although some isolated cases