1-.957

MASSACHUSETT~ ~ DEPARTMENT ·OF PUBLIC HEALTH ~ -- --- 1- J e (0, 1957 Commissioner of Public Health, Samuel B. Kirkwood, M.D. PUBLIC HEALTH COUNCIL Samuel B. Kirkwood, M.D.,.... Chairman Gordon M. Fair, B.So,Dr.Ing., 1956-62 Raymond L. Mutter, 1947-59 William H. Griffin, D.M.D., 1945-57 Conrad Wesselhoeft, M.D., 1953-60 Paul J. Jakmauh, MoD., 1949-61 Charles F. Wilinsky, M.D., 1946-58 Florence L. Wall, Secretary

BUREAU OF ADMINISTRATION Division of Administration Worthen H. Taylor, B.S., Director Division of Health Information Anthony V. Caramello, M.P.H., Director

BUREAU OF HEALTH SERVICES Robert E. Archibald, MoD., M.PoH., Bureau Chief Division of Local Health Robert E. Archibald, M.D., M.P.H. Services Director and Deputy Commissioner

Division of Maternal and Child Sallie Saunders, M.D o , Director Health Services

BUREAU OF HOSPITAL FACILITIES A. Daniel Rubenstein, M.D~, M.P.H., Bureau Chief Division of Hospital Facili ties ·:A .. .Daniel Rub'enflt.ein, M.D., M. P.H • . Director ' . " BUREAU OF PREVEN'rIVEDISEkSE CONTROL Herbert L. Lombard, :-M.B; s ' M' P':H :; BtlreaLi 'Chief ... :...... : . . Division of Cancer and Chronic Herbert L. Lombard, M.D., M.P.H. Diseases Director Division of Communicable Roy F. Feemster,_ M.Do, Dr.P.H. Diseases Director Division of Venereal Diseases Nicholas J. Fiumara, M.D., M.P.H. Director Division of Dental Health William D. Wellock, D.M.D., M.P.H. Director Division of Alcoholism James B. Moloney, M.Do, Director 1-,r "'I~M 3 Srrq.,... ICf5fc-.5'1 BUREAU OF ENVIRONMENTAL SANITATION Clarence I. Sterling, Jr., C.E., Bureau Chie£ Division o£ Sanitary Engineering Clarence I. Sterling, Jr., C.E., Director Division of Food and Drugs George A. Michael, B.S., Director BUREAU OF TUBERCULOSIS CONTROL William H. Weidman, M.D., Bureau Chie£ Division o£ Sanatoria and William H. Weidman, M.D., Director Tuberculosis

BUREAU OF INSTITUTE OF LABORATORIES Johannes Ipsen, M.D., M.P.H., Bureau Chie£ Division o£ Biologic Laboratories James A. McComb, D.V.M., Director Division of Diagnostic Robert A. MacCready, M.D., Director Laboratories

District Health O£ficers under Division of Local Health Services Southeastern District Grace E. Lutman, M.D. Lakeville State Sanatorium Middleboro Northeastern District Frederick A. Dunham, M.D. North Reading State Sanatorium North Wilmington Central District Arthur E. Burke, M.Do Rutland State Sanatorium Rutland Western District Walter W. Lee, M.D. University of Amherst and 246 North Street, Pittsfield

Institutions under Division o£ Sanatoria and Tuberculosis Lakeville State Sanatorium Harry A. Clark, M.D., Superintendent North Reading State Sanatorium Clair W. Twinam, M.D., Superintendent Rutland State Sanatorium Paul Dufault, MoD., Superintendent Westfield State Sanatorium Wilson W. Knowlton, MoD.,M.P.H., Supt. Pondville Hospital George L. Parker, M.D., Superintendent William H. H. Turville, M.D., Supt. Massachusetts Hospital School John J. Carroll, M.D., Superintendent ANNUAL REPORT OF PUBLIC HEALTH COUNCIL Samuel B. Kirkwood, M.D., Chairman

Herewith is submitted the annual report of the Public Health Council for the fiscal year ending June 30, 1957.

Meetings Regular monthly meetings were held in accordance with General Laws, Chapter 17, Section 3. In addition, because of the great number of matters for consideration, some of which required lengthy deliberation, it was found necessary to hold two meetings in April, 1957. The regular July, 1956, meeting was held at Lakeville State Sanatorium where the Council was conducted on a tour of the various activities carried on, including the patients' quarters, the surgical and x-ray departments, the physical therapy and occupational therapy departments, and the facilities for evacuation of patients in case of emergency_ The Council then visited the Southeastern District Health Office, located in a separate building on the Sanatorium grounds, and viewed the facilities available for the functioning of this office. Four special meetings were held during the year, as follows: In July, 1956, to meet with the Barnstable County Health Officer at his office in Barnstable to discuss various programs and problems in his area; on October 30, 1956, to consider applications for assistance under the Hospital and Medical Facilities Survey and Construction Act of the Federal Government; on March 19, 1957, to hold a public hearing on the appeal of a boarding home from the Department's refusal to issue a renewal license; and on June 14, 1957, to follow the annual custom of meeting at Amherst with representatives of local boards of health to familiarize them with various programs of the Department. The Committee on Environmental Sanitation, composed of Dr. Jakmauh, Chairman, Mr. Mutter and the Commissioner, has met regularly during the year prior to the regular Council meetings to study matters of sanitary significance and prepare recommendations on them for presentation to the full meeting of the Council.

General Duties The regular duties imposed upon the Council by General Laws, Chapter 111, Section 3, and other statutes have been carried out. These include the approval and licensing of hospitals, hospital blood banks, convalescent and nursing homes, boarding homes for the aged, public medical institutions, city and town infirmaries, dispensaries, and dental clinics which have been found upon inspec­ tion by Department representatives to comply with the Department's minimum standards for licensure of each class of facility; the •

certi£ication o£ laboratories which have taken part in the annual evaluations carried on by the Institute of Laboratories and have demonstrated their ability to perform satis£actorily certain tests; approval of professional personnel in the Department and at state and county sanatoria; approval of professional personnel at clinics for alcoholism; approval of contracts between Medical Milk Commissions and dairies £or the production and sale o£ certified milk; approval of food regulations of local communities which submit them under General Laws, Chapter 94, Section 146; advice to cities and towns and official agencies on sanitary problems of water supply, sewage disposal, nuisanees and offensive trades, and prevention of pollution of inland and tidal waters; and approval of out-of-state shellfish dealers which have been approved by their respective state authorities. Contracts were approved and signed on behalf of the Commonwealth with the town of Lakeville for the conveyanceto said town o£ Clear Pond and land surrounding it, this pond no longer being needed as a source of water supply of Lakeville state Sanatorium; and with the Geological Survey, Department of the Interior, for investigation of water resources and stream gaging work. Because of funds made available by the Children's Bureau of the Department of Health, Education, and Welfare of the Federal Government, it was possible to make agreements between the Common­ wealth and other agencies as follows: With the Children's Medical Center tor assisting in the financing of the Poison Information Center; with Boston Uhiversity School of Nursing for the development of a program in Nursery School Education; with Harvard University School of Dental Medicine for assistance ot its Public Health Unit; with Boston University School of Nursing for expenses in connection with a Work Conference on Nursing of the Mentally Retarded Preschool Age Child; with Tufts University School ot Dental Medicine £or the development and administrative support of an Institute for Clett Palate and Dentotacial Deformities; and with the city o£ Cambridge for a Community Project on Mental Retardation.

A three-year contract between the counties of Be~kshire, Frankli~ and Hampshire for the joint use of Hampshire County Sanatorium for the care of tuberculosis patients, was approved.

Special Activities The matter of the importation of £oreign shellfish, which was reported last year, was given £urther attention this year. On August 3, 1956, after consideration o£ reports of tests made on imported clams the Council voted to continue its policy of restric­ tion adopted on February 14, 1956. The advisability of this policy was further strengthened by the report of the Committee on Environmental Sanitation to the Public Health Council on September 11, 1956, that about 61 per cent of samples of imported £rozen shellfish had to be rejected after testing because of decomposition of the clams in the middle of frozen blocks of clams which were apparently decomposed before they were effectively frozen. As a result of the recommendation of the Special Recess Commission relative to High Blood Pressure and Its Control, the Public Health Council on October 2, 1956, established the follow­ ing program for the study and control of arterial hypertension at the Lemuel Shattuck Hospital: (1) The establishment of a Hypertension Research Laboratory (2) The purchase and installation of necessary equipment and supplies for the Laboratory, amounting to over $16,950. (3) The purchase and installation of a suitable plaque designating the Paul A. McCarthy Memorial. (This was unveiled on May 17, 1957.) The report of an investigation and study made by the Department under Chapter 67 of the Resolves of 1954, relative to the preserva­ tion of the purity of certain water supplies was approved and signed on December 11, 1956, and filed with the Clerk of the Senate. A report of an investigation made by the Department under authority of Chapter 92 of the Resolves of 1956, relative to buildings in which to establish Department laboratories for the purpose of studying certain disease-producing agents, was approved and signed on November 20, 1956, and filed with the Clerk o~ the HOllse. Proposed regulations for the control of fluoroscopic shoe­ fitting machines, made under Chapter 595 of the Acts of 1956, were tentatively approved on May 14, 1957, and a public hearing relative to them was planned for early in the next fiscal year. In May, 1957, the local boards of health were warned of the dangers accompanying the installation of heat exchangers on oil and coal fired boilers and the prohibition of their use on gas-fired boilers, and advised of the local boards' responsibility of frequent inspection. In view of thj increasing demand from industry for approval of the use of certain chemicals and other products as additives in the preservation of foods, the Committee on Environmental Sanita­ tion of the Public Health Council studied this matter intensively, and recommended that a broad policy determination be made on the general subject of the addition of preservatives to tood during the processing period. Therefore, on October 2, 1956, the following policy was adopted: The following criteria are to be used before any SUbstance is approved as a preservative: (1) The preservative is non-toxic in the dosages used, and either (2) The preservative prevents the transmission of diseases or eliminates a public health hazard, or (3) The preservative is useful in preserving a tood which otherwise is subject to excessive spoilage. The results of work done on the use of aureomycin in the wash water of freshly slaughtered poultry to increase its keeping quality was given careful consideration for several months. After review of the work done in this field and of the op1nions of the medical profession that there are definite hazards involved and that material which might be used for medicine should not be used as food, the use of aureomycin in the wash water of freshly slaughtered poultry was disapproved on December 11, 1956, as it was felt that the alleged benefits did not appear to compensate for the potential hazards that might occur from its use. Throughout the year much attention was devoted to study of the use of biphenyl and certain combinations of chemicals to be used in the spraying of citrus fruits to produce a fungistatic condition. On December 11, 1956, the use of a combination of chemicals producing small quantities of ammonia gas in conjunction with the preservation of or'lnges was approved. On February 12, 1957, the use of sodium o-phenylphenol with a tolerance of 5 parts per million for residues of sodium o-phenylphenate calculated as o-phenylphenol, by a process approved by the Director of the Division of Food and Drugs of this Department, was approved as a preservative on citrus fruits, pears and applies. The use of biphenyl as a preservative on citrus fruits was disapproved on December 11, 1956. This action was appealed by the fruit industry and the investigation by the Department was continued. Representatives of the citrus fruit industry were given an opportunity to be heard on April 2, 1957. After lengthy deliberation of the information available concerning the possible toxic action or carcinogenic action, the results of experimental work on animals, the information presented at the hearing and obtained from the Cancer Division of the National Institute of Health and the Federal Food and Drug Administration, on June 11, 1957, the Department voted to sustain its earlier action in disapproving the use of biphenyl as a preservative on citrus fruits.

Public Hearings The Council held three public hearings relative to a hospital, a nursing home and a boarding home for the aged which had appealed from refusals of the Department to issue renewal licenses because of failure to comply with the st~ndards for licensure. The hospital license was subsequently restored; the nursing home was sold and the action therefore dismissed; and the Department's decision to close the boarding home was upheld. Representatives of a new hospital were given an opportunity to informally present their case and to hear the Department's reasons for certain standards, after which the owners of the hospital agreed to meet the standards, and a license was subsequently given. On April 2, 1957, the Council granted representatives of the citrus fruit industry an opportunity to present information relative to the use of biphenyl as a preservative on citrus fruits. Under authority of Chapter 152 of the Acts of 1946, the Director of the Division of Sanitary Engineering was delegated to conduct public hearings on the acquisition of land for the protection of the water supply of West Springfield, the acquisition of land for sewage disposal purposes in Russell, and relative to the assignment of an area in Beverly as a municipal dump. The Director of the Division of Hospital Facilities was authorized to conduct a public hearing on October 4, 1956, relative to proposed revisions of the rules and regulations pertaining to the licensing of convalescent and nursing homes.

Regulations At a meeting on July 10, 1956, regulations relative to the following foods were approved and adopted: Fortified Nonfat Milk and Half-and-Half; Standardized Milk; Cottage Cheese; Mayonnaise, Mayonnaise Dressing, Mayonnaise Salad Dressing, Salad Dressing, and French Dressing; Fruit Butter, Fruit Jelly" and Preserves and Jams. On December 11, 1956, the following definitions and standards were approved under authority of Chapter 615 of the Acts of 1956: Definition of Active Tuberculosis and Methods of Determining it in Certifications made by Boards of Health and Physicians; and Minimum Standards for the Treatment of Active Tuberculosis Outside the Hospital. A regulation relative to the Responsibility of the Super­ intendent or Director of a Tuberculosis Sanatorium was adopted on May 14, 1957; this pertains to the superintendent's responsibility whenever a patient intends to leave a sanatorium or hospital against medical advice. In accordance with the State Administrative Procedure Act, General Laws, Chapter 30A, Section 4, the following Department internal regulation was adopted by the Council on May 14, 1957: Any interested person may petition the Department of Public Health requesting the adoption, amendment or repeal of any regulation. The petitioner will submit the views, data and argument on typewritten pages, in triplicate, to the office of the Commissioner of Public Health. Hospital Survey and Construction During the fiscal year approval was given to applications from the following hospitals for financial assistance from Federal funds allotted to the Commonwealth by the Surgeon General under the Federal Hospital and Medical Facilities Survey and Construction Act, each of these projects having been approved by the State Advisory Council for the Administration of this Act: Noble Hospital, Westfield, for a complete new hospital of 100 beds to replace an existing facility of 70 beds; Pittsfield General Hospital, Pittsfield, for additions and alterations to provide a two-story fire-proof service building, a new maternity section with necessary services, relocation of clinics and emergency rooms, and expansion of nursing areas; Addison Gilbert Hospital, Gloucester, for additions and alterations so that on completion the hospital will have 89 medical and surgical, 20 obstetrical, and 18 pediatric beds; Allerton Hospital, Brookline, for a new 60-bed general hospital of fire-proof construction to replace an existing facility of 50 beds; Whidden Memorial Hospital, Everett, for a three-story addition to provide a teaching laboratory for school of nursing, a new obstetrical department, out-patient depart­ ment and other facilities, so that upon completion the hospital will have 18 pediatric, 35 maternity, and 101 medical and surgical beds; , Fall River, for additions and alterations to provide 71 beds in a new fire-proof building and the elimination of 49 beds in non-fire-proof buildings, making a total upon completion of 168 beds; Springfield Hospital, Springfield, for an eight-story addition to provide 180 beds, a central sterile supply unit, a pharmacy, and x-ray department; Quincy City Hospital, Quincy, for addition to provide 105 beds with related services, and alterations, including a new elevator, modernization of ward kitchens, extension of x-ray department, new laboratories, and modernization of nurseries; Newton-Wellesley Hospital, Newton, for alterations to existing building and completion of fifth and sixth floors, so that on completion the hospital will have 199 medical and surgical, 27 pediatric, 50 obstetrical, and 17 accident beds; Hale Hospital, Haverhill, for additions and alterations to increase the bed capacity from 161 to 222 beds. ..

Kennedy Memorial Hospital, Boston, for an addition to exist­ ing facility to provide space for laboratory and clinical facilities for the study of cerebral palsy and other chronic diseases of children; Noble Hospital, Westfield, for the development of diagnostic and treatment areas within a new facility; , for a one-story addition to present facility to provide out-patient and laboratory space. Because of extraordinary expenses encountered by the Cottage Hospital in shipping materials from the mainland, an additional grant of $25,000 was made to this hospital. In view of the fact that the original grant to St. Margaret's Hospital, Dorchester, was only slightly in excess of $102,000, an additional grant of $10,200 was made to this hospital. IThe annual revision of the Massachusetts state Plan for the Administration of the Hospital and Medical Facilities Survey and Construction Act was approved by the Council on October 2, 1956. Because of the Wolverton Amendment, Part G of the Hospital and Medical Facilities Survey and Construction Act, (Public Law 482, 83rd Congress), which was approved as part of the Massachusetts State Plan on October 2, 1956, it is now possible to approve allotments to nursing homes and boarding homes for the aged. Consequently, the following applications for Federal funds were approved: Stephen Caldwell Memorial Home, Ipswich, for a new nursing home to provide 20 beds and necessary facilities, and alterations to existing facility; Hebrew Home for the Aged, Boston, for a new fireproof building of 440 beds to replace an existing facility of 264 beds.

Personnel There were no changes in the membership of the Council during the fiscal year. On June 30, 1957, the membership of the Public Health Council was as follows: Samuel B. Kirkwood, M.D., Chairman William H. Griffin, D.M.D., 1945-57 Charles F. Wilinsky, M.D., 1946-58 Raymond L. Mutter, 1947-59 Conrad Wesselhoeft, M.D., 1953-60 Paul J. Jakmauh, M.D., 1949-61 Gordon M. Fair, B.S., Dr. 108., 1956-62 On September 19, 1956, Dr. Charles F. Wilinsky was selected by the American Hospital Association to receive the 1956 Distinguished Service Award, the highest honor conferred by the Association. At its meeting on September 11, 1956, the Council voted as follows: That the Public Health Council record its recognition of the honor given to one of its members, Dr. Charles F. Wilinsky, by the American Hospital Association in awarding to him the 1956 Distinguished Service Award for his outstanding work in hospital administration and public health.

Acceptance of Report At a meeting of the Department on December 3, 1957, the Com­ missioner presented to the Counoil a report of the Department of Public Health for the fiscal year 1957, and it was voted that the report, together with the foregoing brief summary of the activities of the Public Health Council, be approved and adopted as the report of the Department of Public Health for the fiscal year 1957. FORTY-THIRD ANNUAL REPORT OF THE COMMISSIONER OF PUBLIC HEALTH

To the Public Health Council: Gentlemen: I have the honor to submit the forty-third annual report of the Department of Public Health, for the fiscal year ending June 30, 1957.

BUREAU OF ADMINISTRATION Regular staff conferences were held by the Commissioner with the Bureau Chiefs weekly. On the first Monday of each month all Division Directors were included in these conferences at which Departmental policies were planned and the carrying out of admin­ istrative procedures formulated by the Commission on Administration and Finance discussed. Early in each calendar quarter, conferences were held by the Commissioner with Division Directors, Section Heads, District Health Officers, Institution Superintendents, and other key per­ sonnel of the Department. The Commissioner attended the Annual Conference of State and Provincial Health Officers held in conjunction with the Annual Meeting of the American Public Health Association in Atlantic City in November, 1956. He also attended the Annual Conference of State Health Officers with the Surgeon General of the Public Health Ser­ vice and with the Chief of the Children's Bureau in Washington. The Commissioner is a member of the Civil Defense Committee and the Maternal and Child Health Committees of this Conference. As a member of the Executive Committee of the Conference of State and Provincial Health Authorities, the Commissioner attended a joint meeting with the Canadian Public Health Association in May, 1957. ..

Recommendations for 1958 Legislation Following is the legislation to be submitted to the General Court by the Department for the next fiscal year:

1 . AN ACT ROVIDING FOR THE ADMISSION OF PATIENTS WITH CHRONIC DISEASE TO COUNTY TUBERCULOSIS HOSPITALS UNDER CERTAIN CONDITIONS o This bill provides for the admission of patients with chronic disease to county tuberculosis sanatoria under the following conditions: That the trustees of the sanatoria decide whether patients with chronic disease may be admitted to the district tuberculosis sanatorium: that sufficient beds be available at all times for tuberculosis patients in the district : that t he sanatoria be licensed by the Department of Public Health for the treatment of chronic disease : and that the trustees determine the rates to be charged for the care of these patients. This bill is introduced because there is a great and urgent need for hospital beds for patients requiring long-term, expert nursing care . The occupancy rate in tuberculosis sanatoria is constantly decreasing, and the per capita cost is rapidly in­ creasing. The proposed mgislation, which has wide support, is one method of attacking these problems . 2. AN ACT PROVIDING FOR THE ADlVlISSION OF CHILDREN WITH RHEUMATIC HEART DISEASE AND CHILDREN VIITH CHRa-JIC DISEASES TO NORTH READING ST TE SAL'IATORIUM . It is proposed to amend Section 65B of Chapter III of the General Laws, which provides for the admission of children with rheumatic fever to North Reading State Sanatorium, so that children with chronic diseases may also be admitted to that institution for treatment. In certain instances chi ldren with long-term illness who are unsl1 i table for care in general hospitals require prolonged periods of care which cannot be p rovided in the home . Among these groups which require long-term supervision and therapy are children with chronic asthma conditions and cystic fibrosis . Permission is being requested to establish a treatment center for this type of case at the North Reading State Sanatoriumo 3. AN ACT UTHORIZING THE DEP RTllENT OF fUBLIC HEAL'rH TO HAKE CONTRACTS FOR THE OPERATION OF CONCESSIONS IN ITS INSTITUTIONS o This bill will amend Chapter 497 of the Acts of 1956 so that all the Departmental institutions will be permitted to make contracts for the operation and control of conc~ssions . This request has been made necessary because of the constantly increasing volume of patients seen in the outpatient clinics in the various institutions . For example , at Pondville Hospital approximately 15,000 outpatients are seen every year.

4. N CT PROHIBITING THE N1PLOTI~NT IN SCHOOLS OF PERSONS SUFFER­ ING FROl1 TUBERCULOSIS IN CC !'Jl}1UNICABIE FORl'1 1TD PROVIDING FOR PERIODIC

EXAHINATIONS OF SCHOOL EMP LOYEES. ° This proposed legislation will amend Section 55B of Chapter 71 of the General Laws, so that a negative intradermal tuberculin test could be submitted in lieu of an X-ray to show that a school employee does not have tuberculosis in a communicable form. Those individuals ~f~~~§yap~g~i~~~ef~¥b!~c£fi~nb~!!~ti~~t~O~t~ l~~~~~~e~ ~~~~t~-~~ as c

excessive X-ray radiation every effort must be made by public health officials to reduce the total amount of X-ray exposure to any individual.

5. CT REGUL TI NG THE USE O ~ CERTAIN MACHINES. The purpose of this bill is to provide protecti on f or the people of this Commonwealth from indiscriminate, unnecessary , and potentially harmful exposure to radiation. The use of fluoroscopic shoe- fitting machines for the fitting of shoes is unnecessary and the use of such machines for other than diagnostic or therapeutic purposes should be prohibited. In the opinion of public health workers and the National Committee on Radiation Frotection every eftbrt should be made to minimize exposure of the population to any and all types of ionizi. ng radiation both for the protection of the individual m. d the present and future population. lthough the Department has recently prescribed rules sad regula­ tions for the control of fluoroscopic shoe- fitting machines as directed under the provisions of Chapter 595 of the cts of 1956, in view of the fact that the use of such machines is unnecessary, the Department is still of the opinion that the use of such machines should be pro­ hibited rather than regulated .

6 . CT RELl TIVE TO THE ADHISSIBILITY Of? RECORDS OF HOS PITALS , DISPENSARI ES OR CLINICS, AND SAN TORIA . This legislation is proposed to extend to dispensaries or cli nics and sanatoria the privilege now enjoyed by hospitals of certifying records of treatment and medical history, and delivering them to clerks of court for ~production at trial or hearing o

7. AN ACT REIA TIVE TO THE APFHOVAL OF CERT I N PHOPOSED CORPOR TIONS. This legislation is proposed to coordinate the actions of the Department of Fublic Health and the Commissioner of Corporations and Taxation in the specialized instances where a corporation will recpire a license from the Department of -Public Health .

8. ACT PROVIDING FOR EYJDHN I.TION AND REGISTRATION OF GRADU .TES OF F OREIGN MEDIC L SCHOOLS WHO RE APPLICANTS FOR REGISTRATION AS PHYSICIANS. The purpose of this legislation is to provide screening of graduates of certain foreign medical schools who desire to be licensed to practice in Massachusetts o Legislation The following legislation of particular interest to public health was passed by the 1956 and 1957 Legislatures and enacted into law: Acts of 1956 (July 1 - October 11, 1956) Chapter

520 - An act authorizing and directing the Department of Public Health to establish and maintain an alcoholic clinic in the city of Boston. 527 - An act relative to the control and eradication of brucel­ losis in bovine animals. This act provides for regulating the importation of cattle into the Commonwealth. This work is under the direction of the Director of Livestock Disease Control. 542 - An act authorizing and directing the Department of Public Health to establish an alcoholic clinic in the city of Brockton.

570 - An act providing for the use by school committees in cities and towns of audio-equipment for the instruction of physi­ cally handicapped children and for the reimbursement by the Comm.onwealth in connection therewith. This legislation adds audio-equipment to the material that may be supplied by local school departments, with the approval of the Department of Education, to children so physically handi­ capped as to make attendance in school not feasible.

595 - An act to regulate certain uses of fluoroscopic shoe-fitting machines. This law will control the indiscriminate use of fluoroscopic shoe-fitting machines to prevent persons being fitted from receiving excessive dosages of radiation, par­ ticularly those which may result in damage to the reproduc­ tive organs of children. Provision is made for the Department of Public Health, after a public hearing, to establish rules and regulations to control the maintenance and operation of all fluoroscopic shoe-fitting machines. Under the act the Department of Labor and Industries is still authorized to establish rules for the protection of employees against radiation. 602 - An act establishing the Massachusetts Rehabilitation Com­ mission. This Commission will have a Commissioner of Rehabilitation and an advisory council of 11 members, one of whom is the COmmissioner of Public Health. The Commis­ sion will cooperate with the various State departments concerned with the problems of rehabilitation. 608 - An act authorizing the Commonwealth to enter into a compact with the State of New Hampshire relative to flood control and water resources utilization in the basin of the Merri­ mack River and its tributaries. • / \ ~

615 - An act regulating the hospitalization of certain tuberculo­ sis patients and to the establishment of a state sanatorium treatment center for such patients. This act will remedy the situation in Massachusetts in regard to uncooperative tuberculosis patients. A study showed that 45.3 per cent of known tuberculosis cases in this State which should have intensive public health supervision wer& being treated at home; of these, 90 per cent were in the advanced stages of the disease, and about 40 per cent had left sanatoria against advice. These persons, who are a menace to public health, can now be hospitalized if they are not already receiving such treatment, or detained in hospitals if already there. The rights of such patients are protected by the establishment of a court review, certification of all such hospitalizations, and the appointment of legal counsel to protect a patient's interests. It also establishes a special treatment center at one of the State sanatoria for these patients. As soon as patients give evidence that they are willing to cooperate, they may be transferred to open wards at State, county or municipal sanatoria. 645 - An act establishing the Massachusetts Commission on Atomic Energy and defining its powers and duties. The Department of Public Health, as well as other State departments, is directed to continue its studies as to necessary changes in laws or regulations because of the presence of special nuclear materials and by-products, and to keep the Co­ ordinator of AtomiC Development (a position created by this act) advised of current activities. 663 - An act providing for the registration of persons engaged in the processing of food. This law requires that persons who prepare, manufacture, bottle, store, handle or distri­ bute food for sale in the Commonwealth must register with the Department. Certain exceptions are made, including licensed common Victuallers, purveyors of fresh fruit and vegetables, farmers who produce and sell raw farm products, persons who operate a Federally inspected meat establish­ ment, retailers who do not process food, etc. 693 - An act permitting the manufacture of sausage contained in colored casings and regulating the sale thereof. This act provides for the use of colored casings on sausage to be sold outside the Commonwealth, so that the sausage industry in Massachusetts may be placed on a competitive basis in ' Qut~of-state markets. A severe fine is imposed on any person who attempts to manufacture sausage in colored casings for sale within the Commonwealth. 695 - An act directi ng the Department of Public Health to place a tablet or marker designating a certain unit of the Lemuel Shattuck' Ho spital as the Paul A. McCarthy Memorial. • •

712 - An act to protect the public against the sale of unwholesome poultry. This legislation will require that all dressed poultry slaughtered without the Commonwealth shall not be sold in the Commonwealth unless it has been inspected by the U.S. Department of Agriculture. 715 - An act establishing a program for the control of alcoholism and establishing an office of Commissioner of Alcoholism. This act also provides for an advisory council of 12 members, of which the Commissioner of Public Health is a member. This council must meet at least twice a year. The program under this legislation will coordinate the work of the Departments of Public Healthl Mental Health, Public Welfare, Corrections and other agencies dealing with the care and treatment of alcoholics. To attain this coordination, certain changes have been made in the laws pertaining to the control of alcoholism carried on by the various State departments. 728 - An act establishing a COmmission on Hypertension. This legislation creates within the Department of Publlc Health a COmmission on Hypertension, consisting of three persons to be appointed by the Governor, to keep informed of the research program relative to high blood pressure and its control at Lemuel Shattuck Hospital, and to make recommen­ dations relative to the program. 731 - An act relative to the reorganization of the correctional system of the Commonwealth, including the Probation Service. Section 11 of this act provides that in the case of a prisoner who at the expiration of his sentence is suffering from tuberculosis or any other disease which is treated at the Department of Public Health institutions for which he will need treatment in excess of 60 days, the Commissioner of Correction shall notify the Commissioner of Public Health who, if facilities for care are available, shall receive the prisoner in a Department institution. If no such facilities are available, the Commissioner of Correction notifies the Commissioner of Publlc Welfare, who arranges for admission to Tewksbury. Resolves Chapter 115 - Providing for an investigation and study by a special com­ mission relative to the shortage of nurses and means of remedying the same. The COmmissioner of Public Health is a member of this commission. 139 - Providing for an investigation by the Department of Public Health relative to the sanitary condition of the Aberjona River and the Mystic Lakes in the cities of Medford and Woburn and the towns of Arlington, Burlington, Reading, Stoneham, Winchester and Wilmington. This investigation will be undertaken by members of our Division of Sanitary Engineering. •

141 - Providing for an investigation and study by a special com.­ mission relative to the slaughterhouse facilities within the Commonwealth. The Department of Public Health is not specifically mentioned in connection with this commission. Acts of 1957 (January 1 to June 30, 1957) Chapter 22 - An act authorizing towns to appropriate money for the control of encephalitis. Sums up to $5000 may be appro­ priated by towns, to match appropriations by the Common­ wealth, to be expended under the direction of the State Reclamation Board. 24 - An act requiring the weight of a child to be included in the record of its birth. This legislation was introduced by the Department, as 47 other states have the birth weight on the birth certificate and to do so in Massachusetts will greatly aid in the compilation of comparable statistics, and will assist in raising standards of maternal and infant care. 122 - An act requiring city or town clerks to give a written receipt of notice of the submission of a plan under the subdivision control law upon request. 136 - An act providing that the operator of or an attendant on an ambulance transporting sick or injured persons shall be trained in first aid. 138 - An act relative to the subdivision control law. This leg­ islation provides that the subdivision control law shall not apply to preliminary plans. 139 - An act to clarify the subdivision control law relative to hearings on amendments to subdivision regulations. 206 - An act providing that certain hospitals shall certify and deliver to clerks of courts records whose production has been required and that such records shall be deemed suf­ ficiently identified to be admissible in evidence. 284 - An act providing that the duration of effectiveness of certain drugs be stated on the label affixed to the con­ tainer of such drugs. Under this legislation a druggist or pharmacist selling a so-called "unstable drug", i.e., a drug which deteriorates after a certain period of time, must label such drug with the date beyond which it should not be used. This will protect the consumer who has a perishable drug in his possession. 298 - An act authorizing certain licensed institutions to obtain lost and strayed animals from animal pounds for the purpose of scientific investigation, experim.ent or instruction. The Commissioner of Public Health is nat authorized to license annually suitable medical, public health, dental, pharmaceutical, veterinary medicine or agricultural schools, medical diagnostic or biological laboratories, hospitals, and other educational or scientific establishm.ents desiring to obtain impounded animals from animal pounds for "the purpose of scientific investigation, experim.ent or instruc­ tion or for the testing of drugs or medicines." A ten-day waiting period followingthe impounding of a stray dog before it can be released to research work is provided. 329 - An act providing for the examination and registration of graduates of foreign medical schools who are applicants for registration as physicians. The Commonwealth has experienced difficulty in admitting to examination for license to practice medicine, qualified physicians from foreign medical schools. Some outstanding professional leaders have migrated to America because of the unsettled situation in foreign lands. This act provides an additional mechanism for the proper screening by impartial examination by the Board of Registration in Medicine. 334 - An act authorizing and directing the Department of Public Health to sell and convey to the city of Westfield certain land in said city. The land in question was not being used by the Westfield State Sanatorium. The transfer will ful­ fill a community need in having it used by the City of Westfield for playground, park and recreational purposes. 356 - An act defining ice milk mix and regulating its manufacture and use. The term "frozen dessert mix" is created by this act, and includes ice cream mix and ice milk mix. The enforcement of the frozen desserts law will be aided by the clarification of these terms. 406 - An act extending the powers of councils for the aging appointed by cities and towns. 423 - An act to provide for the elimination of weeds in Furnace Pond in the town of Pembroke. This act directs the Division of waterways in the Department of Public Works to eliminate the weed growth in this great pond. 449 - An act cequiring physicians to furnish certain information to the Department of Public Health concerning narcotic users. Under this law physicians and hospitals treating persons suffering from the chronic use of narcotic drugs must, within 72 hours of first treatment, furnish this Department with the name, address, certain physical char­ acteristics, date of treatment, and name of narcotic drug used. The Department feels that this leg~slation is a constructive step in locating illegal, as well as legal, users of narcotic drugs. 458 - An act providing for the admission of persons with chronic diseases to the Lakeville state Sanatorium. This legisla­ tion was introduced by the Department and will simplify the admission procedure to Lakeville of persons suffering from chronic diseases. 459 - An act providing for the admission of certain patients to the Pondville Hospital and Westfield State Sanatorium on written application of a physician, and certain charges therefor. This legislation was introduced by the Department. It will permit the institutions under its jurisdiction to have conformity in their admission policies. 460 - An act providing for the admission to Rutland State Sana­ torium and Westfield State Sanatorium of certain persons without resard to residence requirements. This legislation was also introduced by the Department. Under it, the Departm.ent may now legally hospitalize residents who have open tuberculosis but who have not lived in the State a full six months. If such patients are not hospitalized immediately they jeopardize their neighbors and the com­ munity by subjecting them to tuberculosis contagion. 461 - An act providing for the payment charges for support by the Department of Public Health in State Sanatoria for persons not having known settlements. The purpose of this legisla­ tion is to eliminate charges for those patients who are specifically the responsibility of the Commonwealth (the unsettled cases) and at the same time charge those cities and towns with which the State has contracts for the treat­ ment of their tuberculosis patie~ts~

463 - An act to permit aliens to become registered pharm.acists in certain cases. This act establishes certain requirements for the registration af pharmaCists similar to the method of registration now provided for doctors and veterinarians. 482 - An act to relieve the shortage of medical service in certain departments and institutions of the Commonwealth. 492 - An act providing for the examination and registration of graduates of foreign schools who are applicants for regis­ tration as veterinarians. 495 - An act authorizing and directing the Department of Public Health to establish and maintain a clinic for the treatment of physically handicapped children in the Metropolitan area of Boston. This legislation was introduced to provide rehab­ ilitation services to children with orthopedic handicaps in the Metropolitan Boston area which was previously impossible because of lack of financial assistance. However, during the course of the bill through the Legislature the word "clinic" was substituted for "services". As the fiscal year closes, attempts are being made to rectify this matter by the intro­ duction of additional legislation. Resolves of 1957 Chapter 33 - Resolve reviving and continuing the commission to investigate and study the shortage of nurses and means of remedying the same, and increasing the scope of said cOmmission. The Commissioner of Public Health is a member of this cOmmission. This new resolve added training programs for nurses to the field to be studied. The report ordered by this resolve was filed with the Legislature on May 1, 1957. 37 - Resolve authorizing the Department of Public Health to make an investigation and stuO¥ relative to equine encephalitis. The Department will study the manner of spread and the best means of control of this disease which has caused illness in humans in three different years in the past and may continue to appear from time to time. 73 - Resolve authorizing and directing the Water Resources Com­ mission of the Department of Natural Resources to make a survey of the water resources and sewerage disposal facil­ ities of Plum Island within the tQwn of Newbury and the city of Newburyport. 77 - Resolve providing for an investigation and study by a special commission relative to the establishment of an atomic energy industrial research center. 89 - Resolve providing for an investigation and study by a special COmmission relative to the advisability of repealing the provisions of law requiring the cooking of garbage before feeding to swine and relative to methods of relieving econ­ omic distress resulting from such provisions if repeal thereof is not deemed to be advisable. The raising of swine in Massachusetts has many geographical peculiarities which differ from other swine-raising areas. The human health aspect, particularly in regard to the incidence of trichinosis, needs serious study. The investigation under this resolve will produce accurate statistical information on the need for cooking garbage. 106 - Resolve authorizing the Department of Public Health to make a study relative to radioactive materials. The Department will make this study in cooperation with other state agencies concerned with regulatory and protective measures pertaining to radioactive materials; with the Federal agencies concerned; and with the Special Commission created by Chapter 77 of the Resolves of this year relative to the establishment of an Atomic Energy Industrial Research Center. As the 1957 Legislature was still in session on June 30, 1957, additional laws concerning public health and possibly conferring new responsibilities upon the Department, and resolves providing for special investigations will be enacted early in the 1958 fiscal year. Regulations The following rules and regulations have been promulgated by the Department and are still in effect: Distribution of biologic products Adopted 4/9/35; amended 5/14/40; 1/11/49; 12/15/53 Sale of surplus biologic products Adopted 4/12/49; amended 12/15/53

Use of blood or other tissues for ~urposes of transfusion Adopted 1/10/39; amended 4/10/39; 10/7/41; 11/4/41; 9/14/48; 3/11/52; 6/12/56 Cancer clinics and service unit values Adopted 8/10/26; amended 6/14/27; 3/13/28; 1/5/35; 9/14/43; 10/5/43; 11/11/43; 12/14/43; 4/11/44; 1/14/47; 10/18/55 List of diseases dangerous to public health Adopted 1907; amended 12L15/14; 12/14/15; 2/16/17; 4/3/17; 12/18/17; 10/29/18; 11/lli820; 12/8/21/ 9/18/28; 6/11/35; 12/10/35; 11/10/36; 2(14 39; 5/1/41; 5/12/42; 4/14/43; 10/5/43; 12/14/43; 1/11/44; 11/3 8 Diseases declared to be dangerous to the public health and reportable Adogted 1907; amended 12/15/14; 12/14/15; 2/16/17; 4/3/17; 12/18/17; 10/29/18; 11/~820; 12/8/21/ 9/18/28; 6/11/35; 12/10/35; 11/10/36; 2}14 39; 5/1/41; 5/12/42; 4/14/43; 10/5/43; 12/14/43; 1/11 ; 11/3/48 Isolation and quarantine requirements of diseases declared to be dangerous to public health Adopted 8/9/38; amended 5/13/41; 1/11/44; 11/3/48; 8/12/52 Transportation of bodies dead of diseases dangerous to public health Adopted 7/12/38; amended 8/9/38; 2/14/39 Funerals of persons dead of any disease dangerous to public health Adopted 8/9/38; amended 5/13/41; 1/11/44 Cremation Adopted 12/5/07; amended 10/29/18 Treatment of persons exposed to rabies Adopted 8/10/37; amended 5/1)41 Approval Qf bacteriological and serological laboratories Adopted 9/12/39 Use of a common drinking cup Adopted 3/22/16 Use and concerning the providing of a common towel Adopted 12/16/15; amended 3/22/16 Approval of lodging houses Adopted 7/6705 Barbering and barber shops Approved 12/6/49 Cross connections between public water supplies and fire and industrial water supplies Adopted 2/9/37; amended 5/12/42; 10/9/51 To prevent pollution or contamination of any or all of the lakes, ponds, streams, tidal waters and flats within t he Commonwealth or of the tributaries of such tidal waters and flats Adopted 8/14/45; amended 10/14/45 Supervision of plumbing Adopted 6/11/35; amended 8/6/40; 1/10/50; 5/8/56 Minimum standards of fitness for dwellings Adopted 12/6/49; 3/8/55 Operation of plants for the purification of shellfish Adopted 6,5/28; amended 10/7/41 Enrichment of flour, white bread and rolls Adopted 11/3/48 Establishing grades of milk Adopted 578/35; amended 11/17/48; 6/12/56 Egg Nog Adopted 6/12/56 Flavored milk Adopted 6/12/56 Fortified non-fat milk, Half and half, standardized milk Adopted 7/10/56 Cottage cheese Adopted 7/10/56 Mayonnaise, mayonDtse dressing, mayonnaise salad dressing, salad dressing, French dressing Adopted 7710/56 Fruit butter, fruit jelly, preserves and jams Adopted 7/10/56 Sale of rabbits intended for food purposes Adopted 5/14/29 Governing the business of cold storage, made under the provisions of General Laws, Chapter 94, Section 67 Adopted 10/10/33 Sterilization of feathers, down and secondhand material intended for use in the manufacture of articles of bedding and upholstered furniture Adopted 11/12/35 Making of each article of bedding and upholstered furniture Adopted 12/10/30; amended 11/12/35 Manufacture and bottling of carbonated non-alcoholic beverages, soda water, mineral and spring water Adopted 11/12/35; amended 4/7/36 Uncarbonated fruit beverages Adopted 5/8/36 Business of slaughtering and meat inspection Adopted 7/9/31; amended 12/10/35; 9/14/43 Poultry slaughterhouses Adopted 9/14/43; amended 8/6/46 Approval of contracts for the production and distribution of certified milk Adopted 10/14/36 Frozen desserts and ice cream mix Adopted 9/11/34; 5/8/56

Bakeries and b e k8~ products Adopted 2/14/33; amended 1/10/50 Definition of "pasteurized milk" Adopted 7/8/41; amended 11/4/41; 6/15/50 Establishments for pasteurization of milk Adopted 2/12/35; amended 6/15/50; 10/20/53; 6/12/56 Standards and definitions of purity and quality of food Adopted 2/9/37; amended 5/8/56 Pork products intended to be eaten without cooking Approved 2/12/24 Dietetic foods Adopted 5/12/53 Licensing of Hospitals and Sanatoria Adopted 4/14/42; amended 2/9/43; 12/14/43; 3/14/50 Licensing of boarding homes for the aged Adopted 11/3/48 Licensing of convalescent and boarding homes Adopted 11/3/48 Dispensary License Adopted 1/12/19; amended 5/13/19; 5/10/38 Dental clinic license Adopted 8/10/43 General Rules for Police Station Houses, Lock-ups, Houses of Detention, Jails, Houses of Correction, Prisons and Reformatories Adopted 1910; rumended 4/8/30; 6/15/48 To establish standards for tuberculosis hospitals and sanatoria Adopted 6/14/27; amended 6/5/28; 8/12/32; 1/17/39; 5/10/38; 10/21/48 Obtaining state subsidy Adopted 5/11/20; amended 6/5/28; 2/14/33; 3/13/34 Minimum requirements for tuberculosis dispensaries as defined by the Department of Public Health Adopted 4/6/15; amended 7/11/16; 11/7/19; 7/14/25; 4/11/33 Active tuberculosis and methods of determining it in certifications made by boards of hea1th .and physicians Adopted 12/11/56 Responsibility of Superintendent or director of a tuberculosis hospital Adopted 5/14/57 Minimum requirements for uniform dispensary record system Adopted 7/14/25 Governing the hospitalization of patients with chronic rheumatism Adopted 5/8/45 Reporting and control of venereal diseases Adopted 12/18/17; amended 5/12/18; 6/11/18; 3/11/19; 11/12/23; , 10/1/25; 10/8/29; 1/14/30; 1/14/36; 8/9/38 ; 4/11/44; 11/3/48 Treatment of persons suffering from venereal diseases who are unable to pay for private medical care Adopted 2/14/33~ amended 8/10/37; 8/9/38; 9/12/39; 11/6/40; 4/13/48; 11/3/40 Issuance of premarital medical certificates Adopted 4/11/50 Approved prophylactic remedy for use in the eyes of infants at birth Adopted 5/12/36 Physical examination of school children Adopted 3/11/52; amended 8/25/53; 3/9/54; 2/14/56 Labeling of receptacles containing Benzol (Benzene), Carbon •

Tetrachloride and other harmful substances (approved jOintly with Department of Labor and Industries) Adopted 6/12/56 ~ Regulation s promulgated by Director of Marine Fisheries Approved for sanitary requirements 4/13/42

L Medical Panels Under authority of General Laws, Chapter 32, Section 6, wh!ch authorizes the Commissioner of Public Health to appoint chairmen of medical panels to review applicatlons from and examine State and municipal employees applyi ng for disability retirements, the Department processed a total of 791 new applications in the fiscal year 1957. This is approximately the same number as the previous year. However, because of the inability or refusal of one or more panel members to serve, 66 of these applications had to be processed twice, 14 were pro­ ces sed three times, 5 were processed four times, and one had to be processed five times before the panel could be completed. This adds considerably to the work involved in the carrying out of this law. The chairman of each panel, insofar as is possible, must be a physician skilled in the particular branch of medicine or surgery involved in the case. The other two members of the panel are selected by the applicant anq by the local retiring authority. In additi on to medical panels for applicants for disability retirement, upon application by the widow of a fireman or police­ man for an annuity, the Department under General Laws, Chapter 32, Section 89, designates the third member of a board to determine whether or not the death of said fireman or policeman was the result of an injury received in the performance of his duty. These applications have continued at the average rate of 45 to 50 per year. Under authority of Chapter 289 of the Acts of 1956 the Commissioner of Public Health since July 27, 1956 on request advises the Stat e Board of Retirement or the Teachers' Retire­ ment Board in the determination of applications for ordinary disability retirement, accidental disability retirement or accidental death benefit. Ra ting Board As Chairman of the Rating Board, created by General Laws, Chapter 32, Section 6, the Commissioner presided at hearings and interviewed five applicants from the uniformed branch of the State Police applying for retirement because of illness or injury received in line of duty. After examination of the applicants and a review of their records, three were recommended by the Rating Board for disabi lity reti rement. State Police Detective Lieutenants upon reaching the a ge of fifty-five, or completing twenty years of service, must have an annual physical examination to determine their fitness to continue working to the compulsory retirement a ge of s i xty-five. In this group 11 were examined and all were found by the Rating Board to be physically fit to continue for another year. •

Approving Authority The Approving Authority for Medical Schools, consisting of the Secre tary of the Board of Registration in Medicine, the Commissioner of Public Health, an osteopathic member of the Board of Registration, and a layman, held hearings to determine the medical schools whose graduates are eligible for registra­ tion to practice medicine in Massachusetts. On September 25, 1956 the University of Ottawa was approved for those graduates receiving their degree in medicine on or after January 1, 1951. On June 21, 1957 the Royal College of Surgeons, Dublin, Ireland, was approved provided the candidate holds an M.D. degree from the UniverSity of London, and with the proviso that the Com­ missioner of Public Health personally inspect the Royal College . of Surgeons in connection with his proposed trip to Pakistan.

Chapter 759 of the Acts of 1955, entitled nAn Act relative to schools for the training of medical laboratory technologists", became effective in December, 1955. This act provides for three additional members of the Approving Authority to act for purposes of said Chapter 759 only. These three additional members include a hospital administrator or trustee and a member of the Massachu- setts Hospital Association, an adequately trained and experienced laboratory technologist, and a physician appointed from a list submitted by the Section of Physiology and Pathology of the Massachusetts Medical Society. Under this act the following schools of medical technology were approved: Beth Israel Hospital Beverly Hospital Bo s ton Dispensary Burbank Hospital Faulkner Hospital Holyoke Hospital Lawrence General Hospital, Lawrence Malden Hospital Massachusetts General Hospital Massachusetts Memorial Hospitals Memorial Hospital, Worcester 1'1ercy Hospital, Springfield New England Hospital, Roxbury New Engla~d Center Hospital Newton-Uellesley Hospital Quincy City Hospital St.' John's Hospital, Lowell St. Joseph's Hospital, Lowell St. Luke's Hospital, Pittsfield St. Vincent Hospital, Worcester Salem Hospital Springfield Hospital Tewksbury State Hospital and Infirmary Truesdale Hospital, Fall River FISCAL SECTION, BUDGET 1956 ~ 1957

DEPARTMENT - MAINTENANCE rhcal Total leI' 'rotal hI' Total leI' C Year Budget Capita State C'pit! 'ederal Capita 1951 $7.728, 12.47 $1.58 1.13 $.45

IB8TITUTION; - MAINTBNANCE F18ca1 Year 'state Punds Per Capita 1957 $9,241,943.00 $1.89

GIlANDEOTM - DEPARTMENT AND INSTITl1l'lONS P ;al Total 'er Total Per Total Per Year Budget Capita State Capita 'e4era1 Capita 1957 $16,976,815.47 $3.47 $14,714,470.66 $3.02 $2,202,344.81 $.45

DEPAlTHBNT EXlEHDITUIIS 1956-1951 . TOTAL STATE FEDDAL & PaIVATE Commis.ioner's Salary $14,000.00 $14,000.00 AclmlniltraUon 368,432.10 188,999.16 179,432.94 0 TrainlQg and aesearch 396,007.15 396,007.15 ~ Environmental Sanitation 746,684.08 657.S07.80 89,176.28 Special Projects 49.880.72 20,814.23 29,066.49 Preventive Disea.e Control 1,142.280.76 1,058,894.18 83,386.58 National Foundation - Infantile Paraly,18 Trust Fund 27,776.05 27,776.05 'olio Vaccine Pro ram 1.365,913.41 1,344,245.14 21,728.27 (266,703.46)ec Polio Re.earch 12,177.57 12,177.51 Equine Bncepha1itis Study 5.53 5.53 Health S rvices 804,075.69 412,828.63 391,247.06 HO'pita1 'acilities 127,044.76 109,965.44 17,079.32 Tuberculosi. Control 225,225.66 154,029.02 71,196.64 le~bursement to Oities & Towne for T. B. Patienta 366,414.80 366.414.80

Institute of Laboratori 8 629,512.36 612,038.-'62 17,473.74 State Employees Group Insurance 8,881.09 8,881.09 Construction 31,723.38 31,723.38 Grants-Xn-Aid 29,843.11 29.843.11

TOTAL _$.,;;6;.&.' -..34-.5.&.:;29;,,::;3,;.:8 .;.::2.::..2 _~$4. 999 ,241.98 $~.346,696.24 Division of Training and Research This Division acts as a coordinating body for department activities in the field of training and research in public health, and participates in the developmental planning, preparation and presentation of training projects. A major objective of trai ning is to make it possible for each public health worker to use in his daily work the modern scientific knowledge which is continuously becoming available. It is recognized that adequate professional growth is possible to a great extent only as the individual is able to participate in advanced or continuing education. This type of training, to supplement the worker's experience and professional studies, pro­ motes efficiency and economy. As individuals obtain increased knowledge and understanding, and their work becomes more effective and efficient, they tend to qualify for acceptance of increased responsibilities in the public health field. In this way, the people of Massachusetts gain by obtaining better qualified personnel to do the vital work called for in public health. In general the program of the Division involves:

A. Financial assistance to staff members of t h~ Massachusetts Department of Public Health, local health agenoies, and voluntary health agencies for training. B. Field training for prospective new employees as a necessary component of the academi c preparation for employment in public health agencies .

c. Short course training whioh cons~s of refresher courses in the various specialties for health workers employed by local and state health agencies. D. Orientation, observation, and training for foreign nationals working in the public healthfield. All funds used for training are from Federal grants . Professions represented in the training program have been nurses, physicians, sanitarians, la.boratory workers, social workers, and health educators. Types of training included required field training, pre­ service and in-service courses, full-time academic studies, and part-time academic studies. Due to the lack of a full-time director for the past several years, there is a need to re-establish liaison with the various divi­ sions of the Department, local health agencies, voluntary agencies, schools, etc. In the near future it is planned to analyze activities carried on by the Division so that adequate advance preparations may be made. As past programs are evaluated and liaison relationships with concerned a gencies are established, better planning for the future will be possible, and many of the needs for improving public health practices in the State will be identified. The outcome should be greater efficiency and better results which will bring about increased health benefits for the people of Massachusetts.

Division of Health Information The work of this Division in community organization was con­ ducted by two health educators - one on a generalized health educa­ tion program in the Northeastern District, and the other on a special project of accident prevention anong children in the New Bedford area. In the Northeastern District many groups were assisted in specialized programs and studies of local public health situations. Certain projects were inaugurated to serve the citizens of several communities and involved the participation of several agencies; for example, Essex County health agencies cooperated in putting on a "Health Show" at the Topsfield Fair. The legally required vision and hearing testing program was stimulated in public and parochial sch091 systems, as a result of which six additional programs were initiated in North Andover, Beverly, Belmont, Winthrop, Watertown and Reading. In the New Bedford project the health educator worked with parent groups, parent-teacher associations, clubs, etc. in the conduct of programs on child safety, including such special pro­ jects as bicycle safety, swimming, baby sitting, etc.; the local druggists cooperated in an educational campaign warning the public of dangers of accidental poisoning by household drugs and compounds; the Municipal Beach Authority established a swimming instruction program; expanding the annual water carnival to include safety demonstrations and set up first-aid instruction for beach workers responsible for handling emergency cases; a program of safety on playgrounds was furthered by the New Bedford Park Department; and a seven-session training program for nurses on the subject "Under­ standing the Childlt was held in order to integrate accident preven­ tion activities. A report on the statistical findings of the ac­ cident prevention program was presented before the New Bedford Medical So ciety. Ten issues of "Commonhealth" were printed during the year, the November-December issue being devoted to a ten-year history of the Department. The publication "This Week in Public Healthtt continued its reporting of communicable disease facts and figures, departmental and other announcements, health laws enacted, and other significant events. In the film library there are 2til films; a survey is under way to overhaul and reorganize this service to meet present-day demands. At the New Engl and Health Institute in June a "film festival" was held for the first time; after evaluation, 21 films were selected for showing. BUREAU OF HEALTH SERVICES

Division of Local Health Services - -- ~~~ The Commissioner and the Director of the Division of Local Health Services met with the Advisory Committee of Local Health Officers and Agents and discussed such subjects as equine encephalo­ myelitis, health legislation, and promotion of local health services. As a result of this meeting and a later meeting of the Metropolitan Health Officers Association, a joint committee was appointed, com­ posed of representatives of the Metropolitan Health Officers Associa­ tion, Harvard School of Public Health, United Community Services, and this Department, with Dr. Leon Sternfeld, Health Commissioner of Cambridge, as Chairman. The purpose of this committee is to plan for an evaluation of health services in the 47 communities in the Metropolitan area to secure basic information as a first step in the preparation of a self-evaluation form for health officers and agents. A meeting of the Advisory Committee on Accident Prevention, held at the Children's Medical Center, was well attended by local commissioners of health and representatives of the local district medical societies. Preliminary plans were made for a children's accident prevention program. Members of the staff of this Division and of the district offices continued their activities in civil defense, both at State and local levels. In the spring of 1957 a course for the training of nurses in civil defense was well attended. Representatives of the regional office of the Public Health Service conferred with representatives of this Division relative to the civil defense program so far as it relates to medical services.

Nursing Section With the assistance of the Public Health Service, Division of Hospital Resources, a survey was conducted to appraise nursing needs and resources, and to determine the necessary steps to prepare for affiliations for nursing students in schools of nursing. The annual three-day Maternity Nursing Institute held at the Boston Lying-In Hospital for hospital and public health nurses was repeated this year. A two-week Workshop, sponsored jointly with Boston University School of Nursing, on the Preschool Mentally Retarded Child was arranged by the Nursing Section. A joint one­ day meeting with the Massachusetts League for Nursing was held in Worcester for board members of visiting nurse services. In-service education programs for local public health nurses have been conducted in the various Districts; these have covered various phases of nursing to meet the needs of local nurses. Nutrition Section This year marked the tenth anniversary of the Federal School Lunch Program; the Nutrition Section of the Department has cooperated in this program. The future role of the Department nutritionists in creating interest in school feeding programs, following through with the programs, and helping to maintain standards is to be studied. An evaluation will be made of the functions of the nutri­ tionists in the Department of Public Health as distinguished from the functions of the field representatives of the Department of EdUcation. Cooperation between the Nutrition Section and the Crippled Children's Services of the Department has provided an opportunity of demonstrating how a public health team can work together for the benefit of the children and their families. Overall results have been gratifying and there is evidence of a growing awareness of the nutrition needs of patients and families. Our surveys show the same trend as the surveys of the Institute of Home Economics of the United States Department of Agriculture. Between 1948 and 1955 there was little increase in levels of calcium, vitamin A, thiamine chloride and riboflavin. The lowering of the level of Vitamin C was accounted for by the decreased consumption of potatoes and other vegetables. The greater conswnption of meat, poultry and fish raised the levels of protein, iron and niacin. Emphasis should be placed on the eating of more leafy, dark green and yellow vegetables, citrus and other fruits daily, and in watChing that carbonated beverages do not replace milk.

Social Work Section In recent years there has been emphasis on social service for patients receiving medical care directly from the State, as in the Crippled Children's Program. The new medical care programs in which services, including social service, are purchased from hospitals, require a new approach with emphasis on initial organiza­ tion at high professional levels. The interest on the part of the public, both official and non-official, in mental health continues to grow. The increase of mental health agencies has largely eliminated one of the district social worke~s most persistent problems--responsibility for helping those whose problems belonged in the field of mental health but who formerly had no one within that field to turn to for help. Since mental health and physical health are not two separate and distinct things, there are still many problems to be worked out which offer a challenge in developing an interrelationship of mutual helpfulness. An exploratory study of the social factors in heart disease was completed this year. After analysis of the summary of the data received, it is hoped that a three-year study may be undertaken, which would focus upon the meaning of heart disease, patients' under­ standing of their medical sttuation, the sources of information upon which this understanding was based, and the way in which it affects their use of available medioal care facilities. Division of Maternal and Child Health Services A film explaining prenatal, home delivery and postnatal care of patients who could not have a hospital delivery was shown at the Police Academy in Framingham and in ten other communities; over 700 police officers attended these classes. Interpretation of the film and answers to questions asked by the police were made by a physician or a nurse. An educational project, namely a Maternal Mortality Study, begun ten years ago, has continued. Another project, now completing its third year, was the Study of Abnormal Carbohydrate Metabolism in Pregnant Women. During the fiscal year 775 new requests were received for the prenatal letters sent by the Department, and 5300 requests for the postnatal letters. The prenatal series consists of three letters sent prior to delivery and the postnatal series includes seven letters sent at intervals until the baby is two years old. In 1956 the Department of Public Health paid in whole or in part for the hospital care of 100 premature babies who had no settle­ ment in Massachusetts. This was 57 per cent more cases paid for than in 1955 because of the 1955 amendment to the law which increased the weight of infants whose hospital care could be paid for from 4* to 5 pounds. In addition, local boards of health gave financial assistance to 817 cases with Massachusetts settlement. The program for prematurely-born infants is a very active and rewarding program. An important phase of the program is the provision for consultant's discussions with hospital personnel of problems related to prematures. Opportunities for physicians to make ward rounds to the premature nursery at Boston Lying-In Hospital were provided by the chief of this service at the Hospital. Nurses were given special instruction at Boston Lying-In Hospital and at local workshops on care of premature infants. Another nursery school for hard-of-hearing preschool children was opened at Fitchburg; this makes nine such training centers under the Department. This year 33 audiometers were purchased by school departments, making a total of 295 locally-owned audiometers. Annually, at no expense to the schools, these audiometers are calibrated by the central office personnel in the Vision and Hearing Section of this Division. The number of hearing aids purchased by the Department this year doubled over the previous year. The children for whom these aids were purchased were first examined and evaluated at the Children's Medical Center, the Massachusetts General Hospital, or the Clarke School for the Deaf. An interesting and informative twenty-year study of Crippled Children's Services was completed; 325 communities had reported cases of crippling conditions in infants and children; 88 per cent of the 9401 children reported were receiving medical care; 1498 of the children were receiving education in either the home, hospital or convalescent home. During the year 3986 ohildren reoeived care under the Department's program 1n orthopedic, plastic, rheumatio fever, congenital, seizure or speeoh olinics. From all clinics under Crippled Children's Services, 401 cases were referred for hospital care. At Lakeville State Sanatorium, 11,801 days' care were given, and 6698 days' care at other hospitals.

Civil Defense Under an agreement with the Federal Civil Defense Administra­ tion, twenty-eight Federal Civil Defense Emergency Hospitals have been received and stored at various locations throughout the State. Five more hospitals are on order, and the State is allotted an additional five hospitals. The monetary savings to the Commonwealth has been significant. The efforts of communities to provide for the storage of these hospitals have been impressive. There were no major natural disasters during the fiscal year. In May, 1957, forest fires prevailed in several areas of the State but no demands for aid were made upon the Medical Service of Civil Defense. During the period of the fires the Medical Service was on a stand-by basis. The Medical Service Section of Civil Defense is working closely with the Massachusetts Hospital Association in the matter of disaster plans for hospitals. It is felt that civil defense will be strengthened if oommunity hospitals prepare themselves to deal with local disasters; thus, they will be more readily prepared to oope with the disaster victims in case of enemy attack. The Commonwealth took a very active part in the National Civil Defense Training Exercise held between July 20 and July 26, 1957. In May, 1957, the Commonwealth had a pre-alert operation, held separately from Federal Civil Defense Administration Operation Alert 1957. A Disaster Manual for Nurses, designed to serve as a training guide, was oompleted and distributed. A training program for selected first aid station personnel was set up during the year, with four courses, one in Marshfield, one in Falmouth, and two in Leominster. This program is designed to provide the theoretical and practical instruction needed by non-professional personnel recruited and assigned to First Aid Stations now stored in certain cities and towns. Renewed efforts will be made in the next year to stimUlate interest in this vital matter of civil defense. BlTREA. - OF PftEVE:,TTIVE DISE SE CONTROL

Division of Cancer ~nd Chronic Diseases The :::>ivision of Cancer and Chronic Disease is attempting to minliuize disease, disability and death by the application of m dical and public health knowledge and techniques. Research education and service are the methods utilized to accomplish this. Research is being done to evaluate various types of treat­ ment and to find whether relationship exists between the individu­ al diseases and such factors as age, occupation, heredity, habits of living and environmental hazards, One of the most recent studies deals with the associati -n of lung cancer and cigarette smoking. The lung cancer rate is low among non-smokers and short­ time smokers. Individuals who have s~oked the equivalent of one package of cigarettes per day for 25 years or more have high lung cancer rates. Education is directed to both the public and those members of the medical profession who desire refresher courses. Service in cancer is furnished by two state and 25 state­ aided cancer clinics. The clinics furnish group diagnosis for any individual in the state who is suspected of having a malignant condition. During the year there were 6, 727 admissions at the cancer clinics. Another service in cancer is that of the Tumor Diagnosis Service. .ny .l: ,hysician or hospital in the state may have suspicious tissue examined to determine the presence or absence of cancer. There were 13 , 294 specimens examined by the Tumor Diagnosis Service in 1956, a sharp increase over 9,443 in 1950.

ervice for heart diseas is furnished by 8 hea~clinics . During the calendar year 568 visits were made by new patients and 5100 visits were made by ~or.mer patients. The control of chronic disease can be greatly facilitated by the inauguration of a comprehensive registration system. The purpose of the registry is to provide a means of studying the ex­ tent and nature of the individual diseases that make up this category. Such a registry furnishes an opportunity to obtain the lifetime medical history of the affected patient: to evaluate diagnostic and treatment methods; to study the epi1emiology of the disease; and to obtain facts which can be us~d for educational purposes. For many years the Massachusetts Department of Public Health has conducted a cancer registry and it is hoped that this may be expanded to include many other chronic diseases . Division of Dental Health In providing dire-ct assistance to local health programs and consultative services to their personnel, the dental pro­ fession and i ts auxiliary, the staff of the Division of Dental Health, worked in 247 communities this year. Staff reports indicate a predominance of attention biven to preventive and control procedures over those of the reparative type. The annual review of the local dental programs Which the Division serves indicates that 40 per cent of the school-age population received professional dental screening during the year. -bout 8 per cent were treated in public dental clinics for repair of dental defects. Twelve more communities developed new dental programs as a community resource bringing the total for the year to 214. Two more communities adopted the preventive procedure of fluoridation bringing the total in the state to 22 . Surveys in three areas were reported showing a continuing down­ ward trend in dental caries prevalence associated with fluorida­ tion. Of significance this year has been the successful develop­ ment of a training unit for dentists in public health at the Harvard SchOOl of Dental Medicine. unique opportunity has been presented here to train dentists of local programs ~n administrative and preventive procedures to add to their ex­ isting qualifications in the field of dental treatment. A survey of x-ray practice in dental offi"ces was designed and conducted with the Radiological Health Section, Division of Sanitary Engineering. The development of a resource for the treatment of gross malocclusion and related facial deformities was completed to begin operation at the New England Medical Center in late 1957 . Division of lcoholism

On June 30 , 1957, the Division of a lcoholism completed the sixth year of its existence. During the year the n~ er of cooperating alcoholism clinics increased from ~ine to eleve~ with the opening of the clinics at the NAW England Hospital, Roxbury, and at the Brocl~ton Hospital. These clinics are Jocated in the out-patient depart;l1ents of general hospitals in comrnu...'l.ities throughout the Commonwealth, with one exception, this being the ~!dshingtoni&n Hos~ital, a special hospital for the treatment of alcoholism. There are now four clinics in Boston, and one each in Brockton, Lawrence, _ew Bedford, Pitts­ field, uincy, Springfield and }orcester.

EdlJcation, in its broadest sense, has been found to be the only means of coping vIi th alcoholism, a major cause of social malad justJnent. The developing of a healthy and sa""'.e attitude toward life and providin~ the means of attainin~ it seem to be the answer. Edt'cation for prevention must apprise young pe0ple of the risk involved and that a normal life does not require alcohol as a bevera6e; it should not be necessary for the non­ drinker to be on the defensive.

rui le it has been the fund amen tal po Ii c Y of th i s Di vi s ion to reserve in- patient ~osrital care for those patients ~~der- .::;oing treat'Ucnt in the alcoholism clinics l-1ho were in need of special treatment for conditions such as malnutrition, avi tOlTIinosis or psychiatric conditions, the custom has deve10ped in some clinics of R.dmittin.; a patient to the hospital for in-patient cl1.re whi e iZl a state of aCl..'te intoxication . This practice nay serve uTell L a fevl ca ses where there is a reasonable pro spe c t of rehabili ta­ tion, ut it is a ~r ctice which might verf re_dily le~d itself to t..'-,1' "'e' -'.:) ere1'ort;;, the ""'e~art"'1ent recommends that in-patient cap )e reserved f0}" the type of case descri ed above.

The Division of ilcoholism is encoura~ed by the increasino interest shown by the m dical professioD as a whole in the concept of c,lcoho1ism as an illness, and is Gl.tte'u:f,tinb to kvep t1"l e professiC'l.l.l informed of cOJ:n:.nuni ty resource s avu i 19.1) 1e for the reha ilitation of alcoholics . Division of Communicable Diseases During the first three months of the fiscal year the Division devoted much of its time to. the polio vaccine program. The shertage ef vaccine during the late spring made it necessary to. continue the program on into the summer months and vaccine was distributed as rapidly as received until early in October. Thereafter large quantities ef vaccine was easily available, but interest waned and did net revive until the appreach ef the next pelio season. By the middle ef March it was again almest impessible to obtain polio. vaccine for the pregram and there was much delay in setting up clinics for third deses. In fact, the fiscal year ended with vaccine still short , in supply. The excellent coeperatien of lecal beards of health, hewever, had put the pregram ever and a high percentage of these under 15 years ef age had received at least two. doses, but the pregram in these 15 to 19 years of age had net gone so. well. Early in the fiscal year equine encephalitis again became prevalent and by the end of the seasen 12 cases in humans had occurred, eight of them fatal. Because the presence ef the disease was recegnized early in the mesquito season it was deemed impertant to carry out mosquito control measures. Arrangements were made to spend State funds fer the spraying of the large swamps in south­ eastern Massachusetts, leaving the contrel in the built-up areas to local beards of health. Further studies to throw light upon the mechanism ef the spread of the virus were quickly organized and plans were made to centinue the studies in the succeeding seas en. In erder to. ebtain funds for this purpose, the General Court was asked to autheri~e a study and earmark funds for carrying it eut. The Resolve was passed and study began late in the fiscal year. Comnunicable diseases in general were at a low level in Massachusetts in 1956. The 60,000 cases reperted by physicians is the lowest number recerded since the Department began compiling state totals ferty years age. The highest level ever reached was in 1918 (249,000 cases) when influenza was repertable. The highest since that disease was taken eff the list was in 1943 (138,000 cases). The marked fluctuations are due to. the childheed diseases which almost everyone catches. In 1956 all ef these except chicken pex were at lew levels. Seme diseases, on the other hand, have been at low levels because the standards ef heme and cemmunity sanitation are high. Typhoid fever cases have exceeded thirty only twice in the last ten years and bacillary dysentery has been low for several years except for a temporary increase in 1953. Only 13 cases of typhoid fever and 22 cases of bacillary dysentery were reported in 1956. Diseases which can be contrelled by immunizations are also very low. Diphtheria did net drop belew 100 cases per year until 1951, but there were only 19 cases reco.rded in 1955 and 15 cases in 1956. Diphtheria toxoid has not only been markedly improved in recent years, but it has been much more widely used. Whooping cough is beginning to show the impact of a better vaccine and its wide use. Only 769 cases were reported in 1956, which is only slightly more than half of 1521 cases reported last year, which was the lowest annual total up to that time. Formerly, whooping cough regularly exceeded 5,000 cases per year. Smallpox is the best example of the usefulness of immunizationo There has not been a case of the disease in the state since 1932. This would not be true if we did not use about 300,000 doses of smallpox vaccine per year to keep up the immunity of ourpopulation. Poliomyelitis will probably join the list of rare diseases. A large proportion of the most susceptible persons in the state will have received two doses and a booster of polio vaccine before the next polio season. The 101 cases of the disease in the state in 1956 are partly due to the vaccine, but a low year would be expected because we had 3,950 cases in 1955. One disease which has shown a marked increase is saLmonellosis, a disease caused by cousins of the typhoid bacillus. The source of the disease is largely from lower animals, and the bacilli enter our kitchens in the meats and lower animal products which we purchase. Therefore, clean handling and thorough cooking of such foods is advised. Psittacosis, which comes most frequently from the little pet parakeet, is up again this year. Eleven cases were reported, the highest record since reporting began having been in reached in 1954, 13 cases. Last year, only three cases were discovered. Division of Venereal Diseases

The most important single event of the year was an absolute in­ crease in reported syphilis for the calendar year 1956 . Total syphilis increased by 11. 6 per cent over the previous year. More importalt, however, was the sharp rise in primary and secondary syphilis . These two stages increased by 75 .4 per cent . Earl y latent syphilis rose by 2.4 per cent resulting in an increase in infectious syphilis--primary, secondary , and early latent stages by 53 . 5 per cent . L~te latent and late syphilis increased by 8 . 9 per cent, and reported congenital syphilis decreased by 11.6 per cent . There were only 15 less cases of gonorrhea this year from the previous year so that the reported rates remain essentially unchanged . Our records clearly indicate that organized and commercialized prostitution is not a major factor in our venereal disease problem, since approximately 7.8 per cent of our patients with these diseases named prostitutes as their contacts. Our biggest source of venereal disease is the pickup . Most of our patients with gonorrhea are single, but most of our patients with syphilis are married . The average age of civilian patients with gonorrhear is 29 . 1 + 8 . 2 whereas the average age of military patients is 23 .1 + 4.). While- the pickup remains as the biggest source of venereal disease , the places of pick- up are centered primarily around the taverns and restaurants . The home, automobile and hotels in that descending order of frequency are the places of exposure. The Division sti ll continues the follow-up of all selectees discovered to have a positive blood test for syphilis or other evidence of venereal disease . These patients may be examined by their private physician or the nearest State cooperating venereal disease clinic . These reports are evaluated and sent to the Induction Board . Similarly, the Division receives reports from the military of men separated from the Armed Forces who need follow- up for these diseases . Based on its successful experience for the past four years, the Division Staff is now responsi ble for the interviewing of military patients in Massachusetts ald thier contacts. This IDrk is in addition to our contact investigation activities of all contacts of military patients in Massachusetts . In the State cooperating venereal disease clinics there were 5391 patients who were exami ned , and these represented a total of 23 , 649 clinic visits. Our plans for extending our reciprocity arrangements , in so far as the preraarital examination law is concerned , continues. At the present time, out of the forty States which have such laws , Massachusetts will accept the certificates of thirty- six States . In return, nineteen States have agreed to accept our premarital certificates when properly completed.

In addition th the preventive and control activities, the Division is currently engaged in five applied research studies: I . The prenatal syphilis study program - The purpose of this study is to answer five major questions: 1 . What is the incidence and prevalence of prenatal syphilis at the hos itals under study? 2 . How many women develop svphilis during pregnancy subsequent to the initial negativ6 prenatal blood test? 3. t what month during pregnancy is the prenatal blood test taken for patients delivering at a large hospital? 4. How many women delivering at a large hospital have no prenatal blood test taken at all? 5. To What degree will anesthesia influence the blood test? II. Serologic Study - This is a program for the follow- up study of all positive blood tests for syphilis obtained at the Jassermann Laboratory and sent to private physicians . ~e objective of this $udy is to evaluate the completeness of morbidity reporting by private physicians, and to evaluate the incidence of false positive blood tests for syphilis . III. The Military Interviewing Program - This is a cooperative venture in which the Staff interview)military patients for con tacts , and at the same time , trains military Corpsmen in the science and art of interviewing .

IV. The evaluation of the Treponema Pallidum Immobilization Test o V. The evaluation of the Treponema Pa l lidum Complement Fixation Test . •

BUREAU OF HOSPITAL FACILITIES

Division of Hospital Facilities--Licensing Section The significance of maintaining standards in the hospitals of the Commonwealth is becoming increasingly evident with the passage of time . It has become app rent that frequent inspections ar required in order to maintain and improve conditions in all medical care facilities . While it is true that ny sub-standard facilitie have eith r closed their doors or changed to a lower classification and while improvements are being mad in many of our hospital , it has not been possibl with our limited staff to insure a proper level of performance in all of the hospitals throughout the Commonwealth. W find that unless supervision is roaintailled at an adequate level, records will det riorate . Taki one hospital as an example, it was found during a routine inspection that dilitation and curettage were beillg practiced essentially on an out-patient basis. Records revealed no indication for this surgical procedure. The operative records were incomplete and unsigned by the physician. ot infrequently, the anesthesia records were unsigned. There were no histories, physicals or progress notes . In another hospital it was found that post- operative surgical patients and exceedingly ill medical patients were unattended by professional nurses throughout the whole night shift. In another hospital a so-called professional nurse, who claimed to be registered, was found to be unlicensed, even though she had functioned in this hospital for several years as a professional nurse . As the existing shortage of nursing personnel is being aggravated, there is an increasing tendency to substitute non­ professional personnel for professional personnel. This throws an even greater burden on the Division' s inspectional staff. In another situation it was established that because of itlade­ quate laboratory personnel, an almost fatal reaction resulted from the improper administration of blood. The increased incidence of staphylococcal infections in post­ operative patients, as well as in newborn _nfants and their mothers is indicative of the need for strengthening techniques in the operating room, delivery room and in the newborn nursery. Specific studies have indicated the increasing incidence of airborne infec­ tions in all of these areas.

Recent legislation requires the Depart~ent to carry out audits on records and qualifications of the medical staff. However , becaus of lack of funds to pay consultants, it haa not been possible to carry out this program by utilizing presently available personnel working on regular time . •

The emphasi placed during the past several years on improve­ ments in nursing homes and boarding homes ~ s beginning to bear fruit . The situation in these facilities has shown considerable improvement. However, there are problems such as shortage of registered nurses and licensed practical nurses, rising cost of operation, and multiple home ownership. Th re is vidence of increasing need of experts in the several fields of care. The need for such consulting specialists as members of the taff of the Division is becoming more pressing. It is expected that utiliza­ tion of one of our inspectors in the field of blood bank inspection, for example, will yield considerable b nefi t towards the improvement in this area. Th re is further need for speci lizing in the field of g riatrics which is, of course , an area of utmo t importance in th Division's program. Progress has been made in developing new regulations for nursing and rest home and hearings have been held on new regulations in both of th se categorios . inc 1953 when it becam mandatory to license city and town infirmaries, there has been considerable improvement in this area. Almost all of tile infirmaries 1n the Commonwealth have either been lie nsed or have closed their doors, and activ measures are in evidence in the remaining few to meet the minimum standards set by the Department. It is planned during th next year to revise our regulations for clinics and dispensaries and to improve our standards for chronic disease hospitals which are becoming increasingly important as medical care facilities . It is expected that increasing emphasis will be placed in this area since the geriatric program of the Commonwealth must be improved in order to provide more adequate facilities for this ever- increasing segment of the population.

Hospital Survey and Construction Section During the year four voluntary general hospitals in the Common­ wealth, with the assistance of Hill- Burton Funds, were able to undertake construction of completely new hospital plants with a total of 365 beds . In the case of three of these projects new hospitals will replace hospital bUildings in Nantucket, Brooklin and Holyoke . In the other, a new Goddard Iemorial Hospital in Stoughton will replace the building presently located in neighbor­ ing Brockton. In addition, six hospitals in the State undertook substantial improvement and expansion programs during the past year with the assistance of Federal Funds . To date 20, 000,000 in Federal Funds has been allocated in the Commonwealth for general and chronic hospital construction.

Grants allotted to the State under th Medical ~acilities Act of 1954 have been used this past year to a sist in the construction of new diagnostic and treatment facilities . These were in hospitals located in Lawrence, Brockton, oestfield, and in the new Judge Baker Guidance Center in Boston. • •

Also using runds under this Title , a new nursing home is b ing constructed in the Town or Ipswich. This project is expected to offset the need ror additional hospital beds in this area. In ston a new Jewish Home for Aged will receive Federal assistance for construction or an extensive iDrirmary or nursing home wing. Following a decision by the State dvisory Council to consider the use or Federal Funds for the construction of school of nursing facilities, the Survey and Construction Section of th Division undertook this year a state-wide survey of school of nursing facili­ ties. Fifty-two hospital diploma schools, twenty practical nursing schools, and seven collegiate schools were included in the survey. The adequacy of student residences , classrooms and recreation facilities were observed and noted. Data was collected on the recruiting experience, school enrollments, ffiliations with other schools and hospitals and projected plans for tmprovement. Findings showed that considerably more than half of each of three types of schools were located in the Boston region. Generally speaking, the hospital schools in the State experienced close to aximum enrollments except for the schools located in the Pittsfield area. As to the adequacy of nursing residences, 44.8% of student beds were in non-acceptable buildings. Eleven hospital diploma schools and two schools of practical nursing in hospitals house their students in mult~tory wood-frame buildings, many of which had no sprinkler protection. After considering various rormulae for d termining the relative needs of the several schools, it was felt that th interests of nursing education would be best served by setting forth a list of four priority principles to be used in the sele~tion of priority projects . These were as follows: 1 . Pooling School Resources: Building projects aimed at om­ bining the resources of one or more schools in conti~ us areas . 2. Elimination of Multi-story Wood Frame Residences, especially those wlthou~spririkler protection. Additional Student Capacity. Projects which offer promise of increasing the capacity for training additional nurses. 4. Adequacy of Classrooms, Libraries and Recreation Facilities. An important phase of the work of this Division continues to lag; namely, the evaluation of completed projects . This activity, while included in the daily work schedule , is continually put aside in favor of more urgent functions connected with the processing of new applications. Th shortage of staff personnel continues in this respect to be one of the Division' s chief problems . However , the Division continues to exercise its role as the State ' s leading planning agency in the medical care field by constant refinement of the inventory and distribution of medical care facilitie and services throughout the Commonwealth. BUREAU OF TUBERCULOSIS AND INSTITUTIONS Division of Tuberculosis and Sanatoria Tuberculosis continues to be a major public health problem, chiefly because of the financial drain placed on the community for its adequate control. The major portion of the public health dollar on a state-wide basis is spent for treatment of this disease. The shift in the method of attacking this public health problem continues. Greater efforts are being made to popularize the intradermal test as a case-finding procedure in order to reduce the number of x-rays necessary to discover new cases. l\10re emphasis is being placed on the fo110w-up of suspicious cases found in all types of survey so that correct diagnoses might be established. The large scale tuberculin testing programs in individual communi ties indicate that the rate of tubercul()'Us" infection is gradually declining in the community. During 1955, 2,036 cases of tuberculosis were reported. The case rate of 40 .0-per 100,000 population represented a drop from a rate of 47.6 in 1954, when 2,361 cases were reported. The mortality rate in 1956 was a further drop to 37.7, or a total of 1,84.0 cases reported. This decrease is not as great as it seems since improved reporting, improved statistical methods and frequent revocation of wrongly diagnosed cases contribute to a considerable portion of the decrease in cases indicated above. A new case-finding activity was undertaken this year. The Department of Agriculture cooperated fully through area extension service to provide the names and locations of non-contract migrant workers in Massachusetts. The District Health Officers and the county sanatoria superintendents who took part in this survey reported a good response from ".fOrkers and acceptance by the fa~lers. Although this program has not revealed a great number of cases of active tu~reulosis found, sufficient interest was aroused so that the Department of Agriculture is advising all farmers to hire only contract workers since they are x-rayed prior to admission to Massachusetts. The continuation of this program has been left in the hands of the sanatorium superinten­ dents who are now planning well in advance for the coming growing season. A most rewarding program, judged by the number of active cases of tuberculosis found per x-ray, was started in April, 1957 under the auspices of this Division, the Massachusetts Correc­ tional Institution at Bridgewater, and the Commission on Alcoholism. All admissions to the state Farm at Bridgewater are routinely x-rayed at weekly intervals. This is the most highly productive group for case-finding in the state . Unfortunately, largely because of lack of personnel, there has been insufficient super­ vision of these active cases at the State F1arm . Efforts will be continued to find a solution so that this reservoir of tuber­ culosis will be continued under control. Improved working relationships beb;een the voluntary and official agencies interested in the control of tuberculosis in Boston 'Nill assuredly have a very significant effect on the morbidity rates of tuberculosis in the Commonwealth in the future. A survey t"o ::'be conducted by the Public Heal"i:;h Service of the facilities for tuberculosis control in B08ton is expectE}d to be most helpful for all agencies concerned. The accomplishments in the field of legislation have been very satisfactory. Elimination of the means test" of removing restrictive residency requirements for the treatment of tuber- ~ culosis and other conditions, and liberalization of admission requirements including non-tuberculous J ccmdi tions and chronic ,.-. diseases to State' institutions have been accepted for the state but not for the city and county tuberculoUis hospitals. Considerable progress is being made to establish the deten­ tion center for recalcitrant tuberculous patients at Rutland. Efforts are being made to improve clinical facilities for diagnosing, treating and follow-up of tuberculous patients. Every effort is being made to assist in the establishment of local clinics in the general hospital wi tll partial financial support either through state or Federal flunds. Lakeville state SanatoriWIl rfhere were 195 patients at the Lakeville State Sanatorium on July 1, 1956 and 208 patients at the close of the year June 30J 1957. Following the poliomyelitis epidemic in the year 1955 emphasis vias paced on the admission of chronic orthopedic con­ ditions such as rheumatoid arthritis and neuromuscular disorders. A considerable increase in the arunission rate of these two con­ ditions can be recorded. A new service was added during January of 1957 by admitting patients with old fractures. The demand for admission of patients of the latter category is slowly increasing. The admission rate for tuberculous patients and method of treatment remained prac­ tically unchanged. This sanatorium took the initiative in furnishing increased services to the community by expanding the admission program of patients with chronic orthopedic conditions such as rheumatoid arthritisJ neuro-muscular disorders and fractures in older personsJ to name but a few examples. The daily census rate has increased remarkably in spite of the decline in admissions for cases with orthopedic tuberculosis and paralytic conditions following poliomyelitis. North Reading state 3anatorium The activities of the North Reading 'tate sanatorium during the year 1950- 1957 centered around the medical care for children suffering from tuberculosis . There has b en a slight increase in the nunlber of patients treated, the daily average census being 137. The therapy of these patients is an active type of therapy utilizing the three major drugs, Isoniazid, Streptomycin, and Para- animo-salycilic acid. Other drug preparations such as Pyridoxine and Thorazine have been used where, clinically, their use was indicated. These latter preparations are not considered to be antituberculous, but are used as a supplement for avitimi­ nosis vfhere large doses of Isoniazid are used and the Thorazine is used in the older teen age group where emotional instabilitJ associated with adolescense is prominent . The official closing of the Town Dwnp for North \Jilmington has been a highlight of the year through 'che elimination of the nuisance due to odors and a fire hazard to the sanatorium. A substantial addition to the Admission and Isolation Build­ ing is urgently needed to provide for fire-proof housing of all patients and eliminate the use of wooden Ilards and pavilions which are uneconomical to heat and maintain, are a distinct fire hazard, and a danger to the lives of the patients who must be housed in them .

utland State ~anatorium The patient population at this institution has continued its do\'mward trend. The apparent increase in horne treatment of tuber­ culosis and the shorter period of hospital treatment required have reduced the bed occupancy. The institution had 179 patients at the beginning of the fiscal year and luI at its close. The highest number present at any one time was 212 and the lowest 161. TtIe daily average number of patients was 195 . During the year 257 patientn \'1ere admi ttedj of these, 225 were from corrununi ties ,vi th a popula­ tion over 25,000. The average age of patients admitted "las 47 years . Among the patients discharged there w'ere 122 inactive; 67 active, improved; 53 actlve, unimproved; 22 dead. The rehabilitation of the type of patients at this institution is difflcult because of their age and the number of alcoholics among them. Plans are being formulated for the creation of a center for treating recalcitrant tuberculosis patients . During the coming year, with the completion of the renovation of ,'lard D, an orthopedic service \'/ill be organized. The percentage of cases requiring chest surger-y has remained at about the same level as in the past few years . l1estfield State Sanatorium In November, 1950 Hestfield state Sanatorium became an insti­ tutional member of the American Hospltal Association and of the Jl.1assachusetts Hospital Ansociation, \vhich also covers affiliation vii th the Ne\,l England Hospital Assembly . •

The School for Practical Nurses has continued its dual role of education and alleviating the critical lack of nurses at this sanatorium. New classes are admitted every I,1arch and September. In November., 1956 fifteen students were graduated and in June., 1957 nine were graduated. Tuberculosis Service . The daily ave:r:'age census vms 122; there were T~4 arnnissions during the year and the average length of stay was 259 days . This service has been normally active both on the vmrds I"i th 87 per cent capacity and in the two types of clliinics (the intra­ mural \'li th 6., 779 visits and the rive extramural centers with a combined total of 2,698 visits) . These latter clInics are now in a transition period. For many years they have been held by the institution in various sections of western Massachusetts . Efforts are being made to get the clinics reorganized on the basis of local hospi tal s~pport v-1i th aid from the sanatorium and from the Division of Tuberculosis and Sanatoria. This will result in a sounder long-range program of tuberC1..110sis case finding and control. Cancer Service. There v-lere 839 admissions to this service; the average length of stay ''las 14 days and the daily average census ''las 32 . This represents an average 64 per cent capacity. Early in the year there was some delay in operating schedules because of a shortage of nurses and a nurse anesthetist. This shortage I'ms overcome during the year. The low ce sus was also dlle to the policy of admitting no untreatable cases. Some exceptions to this rule have been made, but too many such arnnissions could quickly fill with patients requiring only nursing care beds intended for cases 11ho could benefit by operation or tx'eatment. The cancer out-patient service has been decidedly busy l'li th 8,746 visits. Consideration is being given to the possibility and advis­ ability of starting a cancer service for children. Such a service might be a real accommodation to the parents of children who now go to Boston to the Children ' s Medical Center, but before inaugur­ ating such a service close planning must be arranged b tween the Center and 1:Jestfield State Sanatorium. Pondville Hospital On July 1, 1956 there were 100 patients at this hospital. During the fiscal year 1,457 patients were admitted; of these, 764 were new and 693 were readmissions . Of the new patients 36 came from other State institutions. On June 30, 1957 there were 99 patients in the hospital. The smallest number of patients in the hospital on anyone day was 75, the largest Ill . The average period of hospi taliza tion was 2L~ . 1 days . General clinics were held on Mondays and Thursdays at which 0,865 patients were seen. The average attendance at these general clinics was about 68 . 671 clinic patients were subsequently admitted to the hospital after their first clinic visit. In addition to the general clinics, gynecological, genlto- urinary, x- ray, nose and throat, thoracic, medical, and neurological clinics were held, at which 8,363 patients were examined. During the year two classes of student nurses were graduated. TVlelve members of the November, 1956 class elected to remain at Pondville, and five members of the June, 1957 class . These ad­ ditional nurses permitted the hospital to increase its active bed capacity; more terminal cases "'lere trl8ated VJhich, in turn, prolonged the average period of hospitalization. Throughout the year numerous professional and non- professional groups from local and distant areas within the United states and many European and Asiatic countries visited the hospital for seminars in the cancer field. Lemuel Shattuck Hospital Every department shm'ls an increase in activi ties . This was to be expected inasmuch as the average dai ly census rose from 203 tp 243, and 88,579 patient days care were given, as compared to 74 , 249 last year. Departments not dependent on nurses, such as the Out-Patient Department, the Clinical Laboratories and Physical Medicine, reported striking increases in the number of patients served. Training programs for doctors, nurses and various types of technicians \'[ere expanded, and the residency training programs in medicine and pathology were approved by the American Hedical Association and the respective specialty boards . The hospital participated in the oral examination given by the American Board of Internal Medicine, and several members of the staff were exam­ iners . All this indicates the growing professional stature of the hospital . The School for Licensed Practical Nurses admitted the first two classes during this fiscal year. If these nurses can be con­ vinced to stay '(IIi th the hospital follot'ling graduation, they may \'lell represent the backbone of the nursing service . During the year many of the research laboratories completed, presented, or published work relatinc; to problems in chronic disease . A new hypertension research laboratory VlaS established. These activities have great promise f or the future in contributing to the care and understanding of problems of chroni.c disease . The growth of all these hospital acti·lTi tes is most encouraging and gratifying. The one disturbing element that remains is the slowness of expansion of the hospital in the face of the increas­ ing demand for admission of patients . This is due to the shortage of registered nurses . This shortage became critical this year when salaries at other hospitals in Hetropolitan Boston were greatly increased, and resulted in a steady stream of resignations from the hosPital Unless registered nurses salaries are raised to a competi1;i ve 1evel Vii th tne other hosp1tals in this area, resignations \'1ill increase in number . i1~thout nurses patients cannot be given care. Massachusetts Hospital School During the fiscal year 32 boys and 29 girls were admitted to this school; in the same period 37 boys and 30 girls were dis­ charged. There 'I'lere 120 operations performed" 317 casts applied, and 62 transfusions given. 7,683 physical therapy treatments were given. 490 clinic sessions were held. In comparing the statistics over the past four years, there is a gradual increase in all activity at this school . There has been a 10 per cent increase in daily average census, a 100 per cent increase in operative procedures, a 300 per cent increase in the number of clinics; in all respects the medical side of the hospital school showed increased activity. By its positive approach to the problem of the paraplegic and quadriplegic patients, the Massachusetts Hospital School is att cacting a good deal of favorable publicity . Instead of accept­ ing these patients as severely handicapped vii th little or no hope of becoming acceptable to society, economically or socially) the hospital school has accepted the premise that through cooperative efforts of physician, school teacher, physical therapist" occu­ pational therapist, social worker, and vocational rehabilitation advisel"', these severely handicapped patients can in practically all cases be returned to society economically and socially acceptable . Over the past eight years, eight quadriplegics have been returned to their homes able to take care of practically all of their personal needs and to take an active part in the business life of the co~nunity. At the hospital school it is stressed that each child should be considered in its entirety; that physic,al rehabilitation should not be considered to the neglect of education and other phases of development . School was in session on 182 days, with a total of 150 students . A comprehensive program of studies is planned; those who are preparing for higher education find that they can meet the requirements of colleges and technical schools and make good records in such institutions . The experimental program for all eighth-graders has continued, giving the students a chance to find out whether or not they are interested in continuing on a pre- vocational basis courses in printing, photography) art, ceramics, nutrition, etc . The commercial courses continue to meet the requirements of many pupils in preparing them for office work in stenography, bookkeeping, general clerical work) filing~ etc . A comptometer has been added to the school ' s equipment and pupils are being trained on this machine . The students vlho pursued their studies in accounting and taxation last year on a post- graduate level have gone out to use their knmvledge and stills in a vocational career. BUREAU OF INSTITUTE OF LAB ORATORIES

Division of Biologic Laboratories The staff of this Bureau pooled efforts toward making plans for improved diagnostic facilities to event ual ly replace the present inadequate Bussey Building and the temporary arrangements existing in the virus and mycology sections. In accordance with the provisions of Chapter 92 of the Resolves of 1956 a survey was made and a report filed. This report recommended purchase of the Bussey grounds by the Commonwealth, a new diagnostic building, and a separate power plant. Other legislat ion implemented these recommendations to the extent of land acqui sition and funds for building. Legislative action had not been taken at the close of the year. Studies were undertaken during the year on several aspects of the field of biologics and many studies were continued from previous years. The most extensive study initi ated concerned the immunity and incidence of reactions in man to various strengths of combined diphtheria and tetanus fluid toxoids. This study has involved groups in widely separated parts of the country as well as in Massachusetts, ~d also a considerable number of pediatric and adult private patients. Among the larger groups are medical students in Kentucky, mental patients in New Mexico and Minnesota and the Massachusetts Air National Guard. A con­ siderable portion of this study is being financed by the Armed Forces. It is hoped that the study may be continued for a period of two years or more. Work is going forward on a major step in laboratory "automa­ tion". A new automatic filling and stoppering machine is in the process of being installed in the sterile fi11ing area. With the antiCipated arrival early next year of an automatic capping machine, some of the burdens placed on the filling department by the in­ creasing high distribution of products will be relieved, and also some of the factors of human error and the danger of contamination in this sterile operation. A total of 539,181 individual doses of diphtheria, tetanus and pertussis multiple antigen were distributed during the calendar year 1956. This is an all-time high for this or any product manufactured by the laboratories. In plasma fractionation, much effort was expended during the year to adopt a new albumin container and administrati on setj the problem was to convert from the double-ended two opening vial to a single opening vial, and this change was made by the Red Cross. Total useable plasma received under contract with the Red Cross dUring the year amounted to 4,345.32 liters. Red Cross payments for the fractionation of this material, including shipping costs, amounted to $52,402.76 for the year. •

Diagnostic Laboratory During the calendar year 1956 the Diagnostic Laboratory per­ formed tests on a total of 57,762 specimens, which is slightly less than the last two years, Which included pre-natal blood grouping tests now no longer done. Actually the total work per­ formed by the Laboratory is greater than for either 1955 or 1954 because the very time-consumi ng Salmonella isolations increased to a figure approximately half again as great in 1956 as in either 1955 or 1954, while the beta hemolytic streptococci isolations increased 25 per cent over 1955 and 75 per cent over 1954. This load of work makes it impossibl e to properly evaluate and change to improved techniques as they become available. A comprehensive study of 2,625 Salmonella isolations over the preceding sixteen years was made and published, the mycologi­ cal diagnostic service was improved, important virological st udies aiding in the diagnosis and epidemiological knowledge or pol~omye­ litis and encephalitis were carried on, and a study of blood typing and cross matching procedures in hospital blood banks was started. More rapid methods for the isolation of Eastern equine encephalitis virus and the neutralization tests for its presence with the use of chick embryo tissue culture methods were developed.

Wassermann Laboratory During the calendar year 1956 the Wassermann Laboratory per­ formed 508,579 tests. Approximately two-thirds of the specimens were received from hospitals and inSitutions, and one-third from private physicians. A total of 54,446 specimens were tested for premarital purposes, and 46,115 for prenatal purposes. Out­ of-state premarital health certificates were issued to 1,308 applicants. This year 137 laboratories took part in the intrastate evalua­ tion of serologic tests for syphilis; 51 laboratories obtained ap­ proval for standard tests and 75 were approved for rapid tests for bloOd donor purposes only. Ten technicians from participating hospitals were given refresher training in the serology of syphilis.

The Wassermann Laborator~ participated in the National evalua­ tion conducted by the Pub~ic Health Service. As in the past, the series consisted of 2UO matched samp~ s of serum. The results showed that the Department's Wassermann Laboratory still maintained its high degree of efficiency. This laborat ory also participated in a survey conducted by the Public Health Service involving the testing of 1500 sera for evaluation of original serologic met~8 and treponemal tests; the results of this evaluation are not as et available. The program of testing cattle for the eradication of brucel­ losis in the State has greatly expanded. This work is being con­ ducted in cooperation with the United States Department of Agricul­ ture. Over 100,000 specimens of blood sad 12,000 specimens of milk were tested this year.

Experimental work on the Treponema Pallidum Complement Fixation Test using virulent treponema as antigen has been done on over 300 specimens of blood. Before definite conclusions are drawn, it is felt that this test should be studies further. It is hoped that it will prove helpful to physicians who have received a report of a positive Hinton test where there has been no clinical evidence or history of syphilis. BURRi U OF ENVIRONrIENTAL SANIT TIOlJ

Division of Sanitary Engineering

The public water sup~)lies of l1assachusetts serving a1"'out 98.5% of the total population of the State have been well main­ tained throughout the year in spite of th.e fact that a severe drought starting in April, 1957, resulted in several towns having to draw water from emergency sources. In addition, it be­ came necessary to restrict the use of water in many communities. To meet the water supply needs caused by the increasing demands three communities have made arrangements to obtain their water supply from the works of the Hetropolitan District Commission. Many communities have made studies for tb.e development of additional sources of supply to meet the demands for water. Two additional towns have begun fluoridation of their water supplies, making a total of 22 communities with a total popula­ tion of 234,000 using fluoridated water. The water consmTIption from public water supplies is now about 500 million gallons per day and, if the rate of increase contj.nues, the water consumption by the y:J3.r 2000 1rJill probably be in excess of a billion gallons per day. The growth of cities and towns together with industries has required th&t more and more consideration be given to providing adequate Sel-Iage and industrial waste treatment plants to treat the increased amounts of sanitary sewage and industrial wastes being discharged to rivers and strea,TIs in the Commom..realth. Some of our streams have reached their natural waste assimilating capacity and are in a nuisance condition durins the dry summer months . During the dry summer months frC'm June to October, routine stream samrJles are collected at some 260 sampling stations throughout the Comll1onwealth together with samples of sewage eIDuents. Special studies were made on the Connecticut River, Chicopee River, Housatonic River, Beaver Brook, Spicket River, Deerfield River and Hoosick River. The l1etropoli tEL District Commission has made considerable progress during the year toward the cleaning up of Boston Harbor. new tunnel under the Boston Harbor to car'ry sewage from the Boston Main Drainage District to Deer Island was completed to- 6ether with another tunnel from Chelsea Creek to Deer Island. Preliminary plans for the new sewage treatment plant at Deer Island, to have a capacity of 343 million gallons per day, have been prepared together with a new outfall sewer into Presidents Road off Deer Island. The Metropolitan District Commission interceptinb sewer, to serve Natick and Framinoham, has been completed and put in operation. Construction also continues on the new South Charles Relief Sewer. Construction plans are being prepared by the Metropolitan District Commission fora new intercepting sewer to serve the towns of andolph, Holbrook and part of Braintree. The neH sewage treatment plant constructed by the Metropoli­ tan District Commission for the town of Clinton has been com­ pleted and is now in operation. New Primary treatment has been constructed at the Hyannis sewage treatment plant. The town of East Longmeadow has constructed a new pumping station, ru1d excess flows over 0.4 million gallons per day are now pumped to the Springfield sewerage system. The town of Franklin has completed ne1'[ primary treatment works for the existing sewage treatment plant to replace the inadequate septic tanks. The city of Lynn has completed a new sewage booster pumping station on Sanderson Avenue to prevent the overflow of sewage into Stacey Brook which discharges into Kings Beach, a bathing beach maintained by the Metropolitan Distr:tct Commission .

The Department is constructin ~ a new sewage treatment plant for the town of Southbridge in accordance 1,'vi th Chapter 779 of the cts of 19S~ , as amended. The construction work is approximately 80 per cent complete , md it is contemplated that the project will be finished in October 1957 . The Department has assisted various consulting engineers, industries, and towns in determinlng the type and degree of treatment necessary for certain industrial wastes . Lawrence Experiment Station conducted special research studies regarding settled tannery wastes. Special studies were also made on the wastes from an ice cream plant in North bington. Consultant engineers have prepared special reports regarding sewerage systems and sewage treatment plants for the municipalities of Brockton, Hopkinton, Hudson , Lenox, Leominster, Marshfield, Maynard, Milford, Scituate and Ware. The following municipalities have appropriated funds for se'toJage treatment works : Agawam , Barn­ stable, Easthampton, Ipswich, LongmeadoloJ, Marshfield, I-Tilford and Northampton. Under the Federal ';vater Pollution Control Law, grants have been offered by the Federal Government for the construction of sewage treatment works for the municipalities of Easthampton, East Longmeadow, Longmeadow, Agawam, Northrunpton and Barnstable. The total allocation for the Cowaonwealth for the fiscal year

-2- .. .

endin-:- June 30 , 1957 is ~~ 1,137,12 5. Of this amount, a total of .,>6§4,110 has been allocated to the above municipalities . The allotment for the Commo'1.wealth for the fiscal year endin..; June 30, 1958 is ~1,126,450. s adequate funds are available for Federal Grants for sewage treatment W)rks, no difficulty has been e~perienced in allocat ng priorities for projects. increasing amount of work of the section is approving plans for septic tank installations, schools, public buildin6s, churches, and small industrial plalts, camps, trailer parks and other small installations. Sewage disposal facilities for subdiv·isions continued to be a problem, and local boards of health have requested advice and assistance of the Department in regard to this matter. In one housing development in Billerica the soil did not prove satis­ factory for septic tank installa tions, aJ. d the Federal Housing Authority is constructing a (;eYltral sewerage system and small treatment plant to serve thi"' suh ivis10n .. The Department continued its routine sampling and surveys of shellfish areas throuGPout the State together with sanitary surveys to determine the extend and degree~ of pollution. Sever­ al shellfish areas l-lere opened for a limited pe:t.·iod of time durin6 the year when pollution was at a minimum ~ll1d i 1:$ effect on shell­ fish negligible. These areas included Provincetown Harbor, parts of Hull and the quincy Flats. Special surveys were conducted on the Faska:munsett River and estruction Brook in "Jartmouth and. these areas were found St i table for the taking of shellfish. ~ s.pec ial study of ahant Harbor showed that the area continues to e polluted witb sewa6e from the outfall sewers . Shellfish areas in Plymouth Harbor and KinGston Bay were resurveyed ~~d the shellfish are s redefined. Various inspections made during the year showed th&t the New uryport shellfish treatment plant was functioning properly. Special investigations of t. e hot dip method of shellfish purification were carried out and the results were not encouraging. ".8 was the case last year, passage of Chapter 310 of the .ctf! '"'f lC)55 , an act co lcel"'nLl"; t ~ssignment of places for pu lic nd private dumps, h s greatly increased the volume of VJ0r1.:- con­ nected l.V"tth this phase of community sanitation. Communications were sent to 15 municipaliti6s relutin5 either to the operation of public dumps or to proposed sites. s the result of a protest y residents of the Beverly Farms section of the city of Beverly against the assignnlent of a site in that l ~cality , a hearin6 was held by the Division of Sanitary Engineeri:ng and, after requesting the advice of the lttorney General, a communicatio w s sent to the Board of He lth rescinding the assignnlent of the site on the basis that it Has in an area zoned for single faiuily residences and was not a legal ssignnlent .

As a result of complaints received examinations were made of piggeries in five communi ties in the eo. '3terly portion of the Commonwealth . -3- ,; .

The atmospheric pollution control and radiologica l health section of the Division during t~ e past year has been very active in its advice and assistance to numerous mllnicipalities and individuals on matters of at-nospheric polll1tion control and radio­ logical health and its oversight of the JvIe t ropiitan Smoke District under whos ", aegis the Smoke Division funct :L ons. The laboratory facilities and equipment at the Lawrence Experiment Station have been expanded but the need for mOr>e space , facilities and personnel is recognized. 1ra i n ing pro­ grams for 0 X sting personnel, (engineerin:; , chemical, field and a oratory) are greatly needed in view of t he fact that ther e is a dearth of trained personnel available to immediately perform the duties required. The Smoke Division, in addition to ma oing approximately 115, 000 smoke emis SiOL observL.tions, made approximate y 800 plant inspections, held 12 conferences and 12 fornal hearings in connection with 312 violations of the s ~oke l aw and as a result of 261 complaints received fron the public. The nature of these newer activities, together with the uniqueness of legislation involved relative thereto , dictates that considerable efforts be expended on policy matters and administrat ion in these new fields of public health. The Division of Sanitary En.::;ineering has cooperated in the preparation of plans and specifications and the supervision of the constructIon of works for water supply, sewage disposal and fire protection for the seven institutions under the control of the Division of Tuberculosis. Assistance has been given in the preparation of plans and specifications and the supervision of construction of certain other work pertaining to maintenance projects requiring engineering at thes o insTitutions and also at the Lawrence Experiment Station. The D ivE~ also cooperates in certain other work "vi th the engineer of the Commission on dminis­ tration and Finance. The Division of Sanitary Engineering is represented in two of the Civil Defense services. The .;later Service is under rhe direct supervision 0f the Chief Sanitary Engineer and the anita­ tion Section of the Medical Service is staffed from the "Division. Both groups of the Division personnel participated in Operation lert 1956 and in Operation Fre-lert 1957 . The Lawrence Experiment Station during the fiscal year has eX~1ined some 38,000 samples in its several laboratories. The station is operated under five sublaboratories Imown as the Bacteriological Laboratories, Chemical Lab ratories, Engineering Besearch Laboratories , Air Pollution Laboratories and the Plumbing Lahoratories. In addition t o the routine analyses re­ quired by the supervision of water supplies , bathing places, stream. pollution and shellfish examinatior:s, s p ecial ~lITork is required in connection with radioactivit; surveillance. The work in regard to the latter r'as been ex::.:,anded considerably during the current y e ar in the work of th~ Division in co­ operat ion with the Uni ted States Public Helal th Service and tomic Energy Commission. In addition to the rO'utine wor:\< of the several laboratories, the ngineering Res61arch Laboratory has been engaged in experimentation on the treatment of industrial wastes in cooperation with industry . The Plumbinc'; Laboratory hc.s been operating in cooperation lvi th the United States Public Health Service, labor organizations and others in the demonstra­ tion of the importance of proper plumbing in the protection of health.

-5- Division of Food and Drugs New regulations concerning the pasteurization of milk and frozen desserts were promulgated and adopted. Of p ime importance in these regulat10ns i the precipitous reduc tion in the maximum allowable bacteria count for milk and frozen de sserts tiithin the requirements of the preventative program, which makes it mandatory that pasteuriza­ tion plant licensees and frozen dessert plant licensees have their produots tested by private approved laboratories twioe a month in the case of milk, once a month for each flavor pr oduced in the case of ice cream. Regulations concerning the addition of Vitamin D to milk and labeling requirements for various dairy produots have been promul­ gated and passed.

Comprehensive leg~ation designed to prevent the abuse of harmful and narcotic drugs was promulgated and passed into law, with extreme penalties to be handed out to the violators thereof and with clear definitive responsibilities for all ooncerned in the handling and sale of these products. The Division ha initiated and is carrying out a program with State and local Police Agencies, the Attorney General, the District Attorneys and the Board of Registra­ tion in Pharmacy for enforcement of the narcotic drug laws . New regulations have been promulgated and passed concerning the fishing industry, in cooperation with the Department of Natural Resources, sa1d regulations to bring into focus modern concepts of sanitary food handling for the fishing industry. New regulations by the Milk Regulation Board are also designed to bring about pre- testing of their products by the produc ers of milk located outside of the Commonwealth and establish new bacterial counts of the produced milk as well as eliminate Raw Certified Milk, Raw Special ilk, and Raw Grade A Milk from the Massachusetts market. The Divimon has been working with the D partment of Labor and Industries, and new regulations have been promulgated for the proper labeling and control of the sale of harmful and toxic substances and the vapors that might be evolved therefrom. We have cooperated with the Board of Registraunin Pharmacy , in drawing up regulations conoerning the proper labeliI~ and oontrol of the sale of poisons , which regulations have been promulgated and passed. Though the scallop industry is excluded from the provisions of the fishery laws , oooperation and educational procedures by t his Division are eveloping a cognizance of modern sanitary practice in responsible circles conc erned with this industry to the effect that voluntary compliance with modern sanitary concepts is being accomplished. Destruction of the facilities at the Brighton abattoir has placed added responsibilities u~ on the Division in supervising the transition of slaughtering operations from the ab ttoir to existing facilities in other locales . The conditions created by this transition pose very serious public h alth problem. New regulations and an extensive educational program will be necessary to bring about conformance iith the modern ccncept of slaughtering practices. The registration of food processors is being carried out in cooperation with local Health Departments an should in the future provide a valuable adjunct in bringing about compliance with sanitary food handling operations. esp ct.full.y

nrkiiOia~ M. b. r r Fubllc Health

aorairi tf. Pilr~ :d. S., ... IJiS ..

WIlli HOI arItrID, D. M. b.

p i J. JalmuiUh, M.D.

Conrad W IJSeihOet£, M.D.

wllliiiikY, M.b. blle Health WlC11

L