FOURTH ANNUAL REPORT OF THE BOARD OF HEALTH, LUNACY, AND CHARITY OF MASSACHUSETTS. INTRODUCTORY. The Board of Health, Lunacy, and Charity was established by law in 1879 under a statute (chap. 291 of the Acts of 1879), which, as revised by the Legislature of 1881, now makes a part of three chapters in the volume known as the Public Statutes; viz., the whole of chap. 79 and the beginning of chaps. 80 and 87. These laws, with the other statutes and decisions relating to the subjects considered by the Board, will be found in a Manual appended to this Report. By the authority of the original statute (given in sect. 2 of chap. 79 of the Public Statutes) the Board has performed its functions both directly and by its agents. The committees of the Board are as follows: Health. Dr. WALCOTT, Mr. TALBOT, Dr. DAVIS, Mr. FALLON, and Mr CARTER. - Lunacy. Dr. HITCHCOCK, Dr. WALCOTT, Dr. PARMENTER, and Mrs. LEONARD. Charities. Dr. PARMENTER, Mr. DONNELLY, Mr. FALLON, Mr. CARTER, and Mrs. LEONARD. The agents of the Board are the officers of its four Departments, acting under the direction of these committees. In the division of the many duties of the Board, these officers were appointed in its several departments in order to classify the work, and have it done more efficiently. Its Health STATE BOARD OF HEALTH, LUNACY, AND CHARITY. Officer is Dr. S. W. Abbott; its Inspector of Charities and Secretary, Mr. F. B. Sanborn; Mr. S. C. Wrightington is Superintendent of In-door Poor, and Dr. H. B. Wheelwright is Superintendent of Out-door Poor. The duties of these four officers will appear from the by-laws of the Board, which are printed in the Manual above-mentioned; but they will be more distinctly understood if stated somewhat in detail. It is to be remarked, however, that all these officers are called upon to perform duties which cannot be described in a brief space, since they relate to innumerable special cases, arising under the statutes of the Commonwealth and the orders of the Board. These officers in course of the year deal with many thousands of the dependent classes and with hundreds of citizens and official persons in this Commonwealth and in other States and countries, as they are called upon to represent the various sanitary, charitable, and reformatory interests which are entrusted to this Board and its officers. 1. THE HEALTH OFFICER. This official performs nearly all the duties formerly devolving on the Secretary of the State Board of Health, with such other work as may be assigned him by the Health Committee, or the Board. All questions relating to the drainage, water-supply and sewage distribution of cities and towns; the adulteration of food, beverages, drugs and other articles; and numerous other topics connected with the public health, are assigned to his department. During the present year, under the new law concerning the adulterations of food, drugs, etc., special analysts have been appointed, but the general oversight of their work depends on the Health Officer, who also has a sanitary supervision of the public institutions; attends to complaints concerning noxious and offensive trades; investigates the prevalence and causes of disease, and, in case of infectious or contagious diseases, notifies the local health boards, and other persons needing information, of what can be done to prevent the spread of disease. When special cases arise in this department of the Board, his duties are increased in this direction; at other DUTIES OF THE BOARD AND ITS OFFICERS. times he is more occupied with those general inquiries and communications which the sanitary oversight of a large and densely peopled Commonwealth requires. 2. THE INSPECTOR OF CHARITIES. This officer is in fact the Deputy Commissioner of Lunacy for the Board, attending to most of the duties which the law imposes on the Board with respect to the commitment and detention of the 5,000 insane persons who now appear yearly in the public establishments, the private asylums and hospitals, or the courts which commit the insane. The Board itself, however, and its Committee on Lunacy, also exercise a general power of visitation and inspection, and pass upon all matters reported to them by the Inspector; who, under their instructions, examines every commitment paper upon which the insane are held, receives and investigates all complaints by insane persons of improper commitment, detention or treatment, and visits each State hospital monthly for the purpose of receiving complaints, examining papers, and collecting the letters of patients. He also receives weekly returns from each hospital of patients committed and discharged, and keeps registers at the office of the Board, upon which these and other facts are recorded. The substance of the information thus obtained, and of the investigations made, is communicated each month to the Board, or its standing committee, and is made the subject of action or advice in regard to all matters as they arise, unless these have been disposed of under the general instructions given to the department officers in the by-laws of the Board. This same practice of reporting exists in the other three departments, and is an important feature in the Board's method of transacting its business, by which each officer is made responsible, and required to inform the Board at frequent intervals how its work is going on. The Inspector also keeps the Board informed of the general condition of the poor throughout the Commonwealth, by means of returns from city and town officers, and from the DEPARTMENT OF OUT-DOOR POOR. State establishments, and of reports and communications from other departments of the Board. The facts thus gathered during the year are tabulated, and appear in the annual report of the Board; this work of tabulation being mainly done in the Inspector's department under his direction, according to forms prepared by him. The Inspector visits all the State establishments frequently, and every year inspects personally or by deputy, about 200 city and town almshouses, reporting to the Board their general condition, and any special circumstances requiring attention. 3. THE OUT-DOOR POOR DEPARTMENT. The Superintendent of this Department has for his principal duties the care of the sick State poor, in the cities and towns of their residence; of the resident poor temporarily aided or removed from their place of residence; of the foundling and deserted infants, and of the cases of small-pox occurring among the State poor. In the care of the sick State poor the first duty of this department is to receive and record notice of each case from the overseers of the poor in the different cities and towns. The second step is visitation of the patient by an officer of the department, whose duty is to ascertain if the disease is correctly reported, if the patient is properly treated, and if removal to the State almshouse is safe or desirable; next, to investigate his personal history and civil status, that the responsibility for his expenses may be correctly placed; thirdly, to examine the sanitary condition of the tenement and locality; and finally, to return a full written report. If the case is protracted, he must repeat his visits till it is closed by recovery or death. The officer having reported, the next step, oftentimes at an interval of several months, is an audit by the Superintendent himself of the bill sent in by the overseers for the support of each case. This audit involves a careful study of the officer's report and the statement presented by the overseers. When both agree the case is settled at once on that basis; but when there DUTIES OF THE BOARD AND ITS OFFICERS. are discrepancies the rights of all parties compel delay till they are reconciled. The final step is to certify the allowances to the State Auditor and send a written statement thereof to the overseers. In course of the investigation of such cases, and of all that come under the notice of the two Departments of Out-door and of In-door poor, the question of pauper settlement is considered, and this requires a special acquaintance with the various statutes known as the Settlement Laws of Massachusetts. This system of laws, though complicated, and requiring patience and research in order to understand and comply with its requirements, will yet be found to have its basis in equity and good sense. Its actual operation is to bring each case of destitution, among the people of Massachusetts, under the observation of experienced persons, who decide whether the destitution is real, and whether it is temporary or likely to be permanent; and an essential part of this system is its administration by State officers in the manner above described. The effect of such administration in both these departments of the Board is to check imposture and fraud; to remove from the State thousands of paupers every year; to keep out many more than are removed, and, in general, to reduce pauperism to something like its mini mum. In the management of small-pox cases by the Superintendent of Out-door Poor he has the co-operation of the Health Officer, these two departments being in daily communication. If the Health Officer receives notice of a case of smallpox in any city or town, he immediately communicates it to the Superintendent of Out-door Poor, who does the same if he first receives notice; and the two departments thenceforward work together and in concert with the local boards of health, for the suppression of the disease. Medical officers are despatched without delay to the infected towns, with instructions to inspect at once the condition of the people in regard to vaccination, and, if necessary, to undertake a general vaccination at a small expense to the State; thus |