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MASSACHUSETTS 
DEPARTMENT OF PUBLIC HEALTH 
1869-1944 
THE COMMONHEALTH 
Special Number ACKNOWLEDGMENTS 
The writers wish to record their appreciation of the assistance rendered by 
all the Division Directors and Bureau Chiefs in the preparation. Especially 
are they grateful for the careful reading given the manuscript by Dr. Merrill 
E. Champion and Dr. Edward G. Huber. The preparation of the paper was 
greatly facilitated by the editorial assistance of Miss M. Elizabeth Donegan. 
Though many members of the staff of the Department have helped in 
telling this story, the writers must bear the entire responsibility for its histori- 
cal accuracy. 
The Massachusetts Department of Public Health is indebted to the John 
Hancock Mutual Life Insurance Company for relinquishing the services of Ray- 
mond S. Patterson, Ph.D., so that he could collaborate with Mrs. Mary Carr 
Baker in the preparation of this historical review of the Department’s history. 
R.S.P. 
M.C.B. TABLE OF CONTENTS 
Page 
The Pioneering Decade (1869-1879) 3 
Six Years of Doldrums (1879-1885) 10 
“The Golden Age” of Sanitation (1886-1913) 13 
The New Department (1914-1935) 22 
New Functions Meet New Deeds (1936-1944) 38 
Report of a General Plan for Promotion of Public and Personal Health, 
by Lemuel Shattuck 55 
Chronological List of Dates Relating to Public Health in Massachusetts 61 
Members of State Board of Health 66 
’ 
r ■* . 
Commissioners of the Department of Public Health . 67 
Members of Public Health Council 68 
Division Directors 69 
State District Health Officers 71 
Superintendents of Sanatoria 72 THREE-QUARTERS OF A CENTURY OF PUBLIC HEALTH 
IN MASSACHUSETTS 
By Raymond S. Patterson, Ph.D. 
Ip 
Director of Health Education 
John Hancock Mutual Life Insurance Company 
And 
Supervisor of Health Education 
Massachusetts Department of Public Health 
Mary Carr Baker, A.B. 
A surveyor pressing on into uncharted regions establishes bench marks as 
he moves along. These are points set on solid, immovable objects to which he 
can sight back to give him a base for new observations. By the same token, 
it is helpful to us, who are charged with the duty of finding new ways to protect 
the public health, to look back occasionally toward the bench marks estab- 
lished by our predecessors. This seventy-fifth anniversary of the founding of 
the Massachusetts State Board of Health—the first in America—seems an ap- 
propriate time for us to turn for a moment to take our bearings anew. 
This taking of our bearings is a wholesome experience. It was Chapin who 
warned us that those who ignore the past tend to become complacent about the 
present. He made it clear that what we need is a healthy dissatisfaction with 
our own work. For public health—like other human endeavors—does not long 
remain static. Either it rises to new levels of achievement demanded by the 
social needs of the day, or we find it beginning to sink below the levels estab- 
lished by its predecessors. We, who must anticipate and prepare for new func- 
tions and duties which a thriving public health imposes upon us, can best 
gain the necessary perspective to do our work well by knowing and understand- 
ing the past—by seeing as a whole the moving stream of public health adminis- 
tration in which we so briefly play a little part. 
In the illustrious records of the first seventy-five years of state public 
health administration in Massachusetts there will be found many solid, immov- 
able achievements. There are five bench marks toward which we may in turn 
profitably sight back in order to take our present bearings and possibly to 
glimpse the future. 
BENCH MARK 1869 
Beginning the Pioneering Decade 
We can only speculate on the precipitating causes that gave to our country 
the first State Board of Health. It is reasonable to assume that Civil War 
experience was not without its effect, for diseases caused by insanitary environ- 
ment and infected wounds killed many more soldiers than did the bullets of 
the combatants. Recognition of the deficiencies of military sanitation was car- 
ried over to civilian fife and soon after the war’s end we read of public agitation 
for the creation of a central health agency of some sort. Four years after the 
War Between the States, the Act of 1869 was passed. 
We know that diphtheria had reached a peak at this time. Massachusetts 
suffered under this scourge along with most of the other populated areas of the country. Thousands of cases occurred each year and deaths were counted 
by the hundreds. This could not have been without effect. 
Fear of cholera may have played its share. In the Board’s first annual 
report, the Secretary writes: “In 1866, when an epidemic of cholera was feared, 
the selectmen of Brighton employed Dr. Henry G. Clark of Boston to make 
a sanitary inspection of the town.” 
Whipple* credits Dr. Henry Ingersoll Bowditch with the pressure that 
induced the General Court finally to establish a State Board of Health. At 
his instigation, the Massachusetts Medical Society twice memorialized the legis- 
lature to authorize such a board. A survey of the State’s needs w'as proposed, 
and later a general health agency was demanded. Through the efforts of 
politically influential friends, the legislature voted the enabling act—three 
years later. 
Dr. Bowditch himself refers at length in an early paper to the celebrated 
Chadwick reports which had led to the great sanitary awakening in England. 
The Chadwick Report a generation earlier undoubtedly had considerable in- 
fluence in New England. 
The second chairman of the Massachusetts State Board of Health, in a 
candid moment, wrote that the movement had its inception chiefly because 
of an outbreak of typhoid fever in a girl’s school in which the wife of one of 
the leaders of the legislature was interested. 
To a student of the history of public health, our failure to list Lemuel 
Shattuck’s “Report of a General Plan for the Promotion of Public and Personal 
Health”—the Sanitary Survey of 1850—may seem heretical. We find but 
slight evidence in the recorded annals of the early days of the State Board of 
Health that this Report did, in fact, influence the founding of this pioneering 
venture.* 
Whoever, or whatever, may have provided the stimulus for the enactment 
of the Act of 1869 by the General Court of Massachusetts, the framers of this 
law showed a surprising grasp of the sanitary needs of the times in the specific 
obligations which they imposed upon the Board to be created. The law reads 
in part: 
“The board shall take cognizance of the interests of health and life 
among the citizens of this Commonwealth. They shall make sanitary 
investigations and inquiries in respect to the people, the causes of dis- 
ease, and especially of epidemics, and the sources of mortality and the 
effects of localities, employments, conditions and circumstances on the 
public health; and they shall gather such information in respect to those 
matters as they may deem proper, for diffusion among the people. . . . 
They shall, in the month of January, make report to the legislature of 
their doings, investigations and discoveries during the year ending De- 
cember thirty-first, with such suggestions as to legislative action as they 
may deem necessary. 
“The board shall meet at the state house once in three months, and as 
much oftener as they may deem expedient. . . . 
“It shall be the duty of the board, and they are hereby instructed, to 
examine into, and report what, in their best judgment, is the effect of 
the use of intoxicating liquor as a beverage, upon the industry, pros- 
* “State Sanitation.” by George 0. Whipple. 
* The Sanitary Survey is such a remarkable State paper that an abstract of its principal 
recommendations will be found in the first appendix. 
4 parity, happiness, health and lives of the citizens of the state. Also 
what additional legislation, if any, be necessary in the premises.” 
Soon after the passage of this law the Governor appointed a board of 
three physicians and four laymen and instructed the chairman, Dr. Henry I. 
Bowditch, to call his fellow members together. We have an entertainingly realis- 
tic picture of this first meeting. The members gathered in a committee room 
of the State House, for no other quarters were provided. The address which 
Dr. Bowditch had prepared has about it a ring of solemnity which suggests 
that the author was impressed by the historical potentialities of the moment. 
As this oration is preserved intact in the first annual report and has been widely 
copied in other histories, only his admonitions to the members, phrased in the 
florid language of his day, need be recorded here. After reviewing at some 
length the earlier movement in England, he concluded: 
“Let us look for a moment at some of the general objects and duties 
involved in the Act establishing our Board. 
“First. It directs the Board to take cognizance of everything tending 
to public health, and of course requires us to endeavor to eradicate 
everything tending to public disease and death. 
“Second. It directs us to diffuse among the people a knowledge of the 
means of obtaining individual and public health and of preventing 
disease. 
“Third. We are ordered to investigate the effects of the use of intoxicat- 
ing liquors upon the industry, prosperity, happiness, health and lives of 
the people, and it is intimated that we may suggest legislation on any 
or all of the subjects committed to us for investigation. . . . 
“The law requires us to diffuse among our people any already established 
laws of public health, and also whatever we may hereafter discover on 
that subject. I look upon this feature of the law with deep interest, for 
I believe by it we may do much service to the people. 
“How shall we diffuse this knowledge? (a) By lectures from our Secre- 
tary or from members of the Board on various special subjects con- 
nected with public hygiene—such as ventilating, and building, and lo- 
cation of houses; on various well-known diseases capable of partial or 
entire prevention on knowledge of causes being given. . . . (c) By the 
publication in a compact form and the wide circulation of the pitch of 
our general knowledge on public hygiene. . . . (d) By our annual reports 
to the legislature, which, I trust, will always be models of brevity and 
of compact learning. . . . 
“In conclusion, gentlemen, let me say that, while I feel alike our grave 
responsibilities and the dignity conferred on each one of us by His 
Excellency the Governor in his selection of us for these offices, I have 
at the same time no misgivings; but on the contrary, the liveliest hope 
that this Board will faithfully and in an able manner perform its duties, 
and that thus it will become a. real blessing to our State, not only at 
the present time, but long after every member of it has died. It will 
assuredly be such if we, the necessary originators of its various details, 
only look at our duties in the light of the broadest philanthropy and as 
far as in us lies, the wisest statesmanship, and finally with all the knowl- 
edge that modem science can at present give us.” 
5 An Inquiring Board Initiates 
A Variety of Investigations 
A week after this inaugural meeting, the Board 
members reassembled to adopt by-laws, and at 
this session a half-dozen activities were singled 
out for investigation by the members—insanitary conditions in slaughter-houses, 
sale of poisons, an inquiry into sickness and mortality rates in the slums, and 
a circularization of the local boards of health to advise them of their powers 
and duties. They proposed to collect and publish the numbers and prevailing 
causes of death in the larger communities. 
Dr. Bowditch’s conception of the Board’s proper function was that it in- 
vestigate causes of disease lurking in the air, the earth, and the waters which 
cover it, and that it give advice to local boards and to the public generally. 
For many years this able Board was to carry on these varied investigations— 
some in the realm of sociology, some in environmental sanitation, others in more 
direct disease control. Those which were to prove most far-reaching in their 
effect on the national public health were the pioneering studies on the purifi- 
cation of water and sewage. Although the Board had no power to compel action 
by the cities and towns or the individuals in them, its influence was so great that 
Massachusetts took the lead in the protection of water supplies and the safe 
disposal of sewage. The early investigation into the sources of communicable 
diseases did not achieve brilliant results, for there was as yet but a shaky basis 
for the nascent epidemiologic science and the energies of the members were 
forced into other channels whether they wished it or not. 
Just as the Board’s influence began to be firmly established, and its in- 
vestigations well under way, someone blessed with unusual foresight and mindful 
of the historical import of these early pioneering days, seems to have decided 
that posterity should have a clear picture of the years which were to do so 
much to mold public health practice in America. While the Secretary of the 
Board, Dr. Charles F. Folsom, was abroad studying European sanitary engineer- 
ing procedures, Dr. William Lambert Richardson—long the guiding influence of 
the Boston Lying-In Hospital—was deputized, as acting secretary, to prepare 
a summary of the first seven years of the Board’s work. It is a brief document, 
but of absorbing interest to one who is curious about these exploratory years. 
In this summary is quoted the circular letter which the State Board of Health 
sent during the first month of its existence to the health boards of the several 
cities and towns of Massachusetts. After some introductory paragraphs in 
which Dr. Bowditch voiced the solid convictions of the Board members that 
public cleanliness is the desired goal if the public health is to be preserved, he 
wrote: 
“In entering upon our duties, which are rather advisory than executive, 
we desire to establish such communication with the local boards having 
this important subject in charge, that all may work together for the 
common advantage of the people, for the prevention of disease, and for 
the prolongation of life. 
“We believe that all citizens have an inherent right to the enjoyment 
of pure and uncontaminated air, and water, and soil; that this right 
should be regarded as belonging to the whole community; and that 
no one should be allowed to trespass upon it by his carelessness, or his 
avarice, or even by his ignorance. This right is in a great measure recog- 
nized by the State, as appears by the General Statutes. 
“If these were strictly and impartially enforced, we should have a con- 
6 dition of public cleanliness, and of public health, which would make 
Massachusetts a model for all other communities. . . . 
“It has been doubted, whether the public mind is sufficiently aware of 
the dangerous elements around us; whether the connection between 
filth and disease is as yet proved to the public satisfaction; whether the 
people are convinced that undrained land is unwholesome to live upon.” 
After calling attention to certain laws which local health boards were 
directed to administer, he closes with these stirring admonitions: 
“We confidently look to you for the enforcement of these laws. 
“We believe that public opinion will fully support you in so doing. 
“We will give all the help in our power. 
“There is a great work before us, which, if carried out in the letter and 
spirit of the laws referred to, we cannot doubt will justify the wisdom 
which framed them. 
“In making this our first communication to the boards of health of the 
various cities and towns of the Commonwealth, we sincerely hope that 
it may serve as the opening of friendly and helpful relations between us, 
and that it will lead to reforms the effects of which will be evident in the 
improved condition of public health.” 
Board Members Look First to the 
Purity of Water Supplies 
As soon as its investigations were set in 
motion, the Board employed William Rip- 
ley Nichols, a chemist twenty-four years 
old and a professor at the lusty new Massachusetts Institute of Technology, re- 
cently established in the Back Bay, to begin the examination of ponds which 
furnished the water supplies for a number of cities north of Boston. This talented 
chemist continued, for nearly a score of years, to contribute to, and guide the 
sanitary investigations of the State health agency. To him must be accorded 
the honor of establishing the technology of water chemistry. 
The General Court called upon the Board soon after it had settled down to 
business to look into the matter of stream pollution throughout the State. Of 
necessity this included an investigation of sewage disposal. Early findings of 
this survey inspired the Secretary of the Board, Dr. Folsom, to write a lengthy 
treatise, published in a later annual report and entitled “The Disposal of Sew- 
age.” The limitations of the adolescent engineering science of that time are 
suggested in the following quotations from it: 
“Water-supplies necessitate sewers; and sewerage-systems in most coun- 
tries involve pollution of streams. Offensive as this pollution may be, 
it is less dangerous to health than retaining filth about our dwellings 
in vaults and cesspools. • 
“In Salem, Lynn, Haverhill, Worcester, and Boston, with its adjacent 
cities, the nuisance from putrefying sewage incompletely removed has 
become a serious evil. The remedies must be determined in each case 
by careful especial study by experts. We can only say that the principle 
should be established that each community should dispose of its own 
filth without allowing it to be a source of offence to others. In the sea- 
board cities, some modification of a system of intercepting sewers will 
probably prove the most ready solution of the difficulty. In inland 
cities and towns, irrigation would be likely to be successful, and not 
involve a large annual cost; after some experience, it is very likely 
that even a profit may be realized from it.” 
7 Noses Are Directed Toward 
Brighton Slaughter-Houses 
It must be remembe red that the Massachusetts 
Board began its labors in a day when scientific 
beliefs were still befogged with Pettenkofer’s 
assumptions that emanations from moist soil could somehow cause typhoid fever. 
Scientists still believed that offensive smells gave rise to epidemics—“If anything 
is settled as to the causes of disease it is the influence of decomposing organic 
matter in giving life to . . . typhoid fever”, wrote the Secretary, so it is not 
surprising that this Board, composed chiefly of Boston members, first turned 
their attention—and their noses—to the nearby town of Brighton. In this com- 
munity a half-million animals were butchered and dressed each year in fifty or 
more small and exceedingly filthy slaughter-houses. Connected with each were 
piggeries in which hogs wallowed all summer in decomposing offal, and as a result, 
there was within a few miles of the center of the crowded metropolitan area an 
unspeakable nuisance which might at any time—the Board was convinced— 
become a menace to the health of the inhabitants of Boston. In other nearby 
cities there were rendering establishments which caused “the air in the immedi- 
ate neighborhood and oftentimes for miles around to be contaminated with the 
foul odors and vapors escaping from the vats and improperly constructed chim- 
neys.” 
The Board members called for an immediate abatement of this nuisance 
and to this end they proposed an act to finance the construction of central abat- 
toirs. “The plan proposed met, as was perhaps natural,” reports the disillusioned 
Secretary, “with an almost unanimous opposition from the Brighton butchers 
who regarded the whole scheme as visionary and impractical.” The Board per- 
sisted, however, and lived to see its efforts crowned not only with the building 
of the once unanimously opposed central abattoirs, but by the enactment of a 
law concerning slaughter houses and noxious and offensive trades. This act 
prohibited the building of slaughtering or rendering establishments without official 
permission and gave the Board authority to order any person engaged in such 
business to cease and desist. So we find the Board, which only two years before 
had been created solely to advise and suggest, given the power to enforce com- 
pliance with at least one order. 
The Chairman Envisages the 
Health Menace of the Slums 
Something of the breadth of the interests of 
this trail-blazing Board is indicated by the 
variety of its concerns. Early attention was 
turned to the sanitary condition of the homes of the poor. The Chairman of 
the Board visited London and while there made it a point to see the sprawling 
city’s worst slums, of which he gives us a graphic account. Too, he looked into 
the maiden effort of certain of the public spirited British gentry to provide 
minimal decencies in the housing for the London poor. Returning home, inspired 
by this evidence of an awakening social conscience, the Chairman and the Secre- 
tary, accompanied by well-armed police, visited the slums of Boston. Here 
they found degradation and filth worse than any that existed in London. The 
obvious danger of serious outbreaks of diseases in the crowded, filthy slums, 
caused the Board to address a letter to the aldermen of the city, who were by 
law made responsible for health, calling attention to the statutes relating to 
tenements, which were daily so flagrantly violated. Nothing daunted by the 
masterly inattention paid to this communication, the Board began an effort to 
ft waken public interest, hoping to show that adding to the health and physical 
8 well-being of the poor “would also greatly contribute to the material prosperity 
of the rich, by furnishing a sure return for the money which might be invested 
in the sanitary improvements so much needed.” This promising financial op- 
portunity seems to have tempted no great number of investors. 
“Two difficulties were encountered,” writes the Board’s reporter. “In the 
first place, there was found to exist an utter indifference to the subject in the 
public mind; and in the second place, all health matters were, according to the 
existing local laws, in the hands of politicians, whose tenure of office was so 
precarious that they were unwilling to inaugurate any movement which, owing 
to ignorance or prejudice, would naturally meet with more or less opposition.” 
Nothing seems to have come of this attempt to find a way to decent housing but 
the Board, through its efforts, did succeed in arousing public opinion to a point 
which demanded the passage of an ordinance fixing responsibility and granting 
necessary powers to the city board of health. 
Demon Rum Does Not Escape 
Board’s Roving Curiosity 
Parallel with these eminently practical ef- 
forts looking toward the improvement of 
the health and well-being of the public were 
others which seem today less worthy of the Board’s talents. To its correspond- 
ents throughout the State and, in fact, to many of the American Ministers at 
foreign courts and to Consuls in the principal ports of the globe, the Board 
mailed questionnaires about the use of intoxicating liquors and how far the abuse 
of alcohol was productive of crime. From the two hundred and more replies 
received, an analysis was undertaken “of the most valuable information bearing 
on the subject under investigation.” From this analysis the Chairman, Dr. 
Bowditch, came to the unique but firm conclusion “that intemperance was really 
governed by a cosmic law.” Space does not permit a review of the reasoning by 
which he reached this strange conclusion or an elucidation of its theory—it is 
enough to record that it seemed both to satisfy the members and to fulfill the 
demands of the Act creating the Board. One tangible result of these investiga- 
tions was a proposal that the State establish inebriate asylums in various parts 
of the Commonwealth, but this appeal came to nothing. 
In another report, the attention of the public was called by the Secretary 
to the hygienic hazards which the erection of dams might produce in their im- 
mediate neighborhood. A careful examination of the opinions of many observers 
convinced the Board that the raising of the level of stream waters was unques- 
tionably prejudicial to health, for epidemics, consumption, and malarial fevers 
were alleged to be especially prevalent near such places. So Professor Nichols, 
busy with his water and sewage studies—research which w*as destined to benefit 
the sanitary practice of the country—was sent on a wild goose chase to examine 
ground air to find out, if he could, what baneful and noxious miasma lurked there. 
Consumption Investigated 
Without Benefit of Koch 
“About one-fifth of all who die in Massachusetts 
fall victims to consumption,” so wrote the Secre- 
tary of the Board in his commentary on a con- 
certed attack on this public health problem inagurated by Dr. Bowditch, him- 
self a. specialist in the field of tuberculosis. The first step was to issue a cir- 
cular letter to the local correspondents throughout the State whom the Board 
had asked to be appointed by the officials of each town and city. In addition, 
other members of the medical profession who might throw some light on the 
9 subject were addressed. A careful tabulation of the replies led Dr. Bowditch 
to the assumption that tuberculosis is influenced by hereditary tendencies. The 
effect of drunkenness of parents on consumption in their offspring is not strongly 
marked, he argued, but the effect of drunkenness in the individual is. Con- 
sumption is favored by overwork, by certain trades and by mental trouble. Of 
the 210 correspondents, only 100 held the disease to be contagious, but 168 be- 
lieved it to be caused by a wet location, thereby strongly reinforcing the theory 
held by Dr. Bowditch himself. Thus, by the democratic process of weighing 
preponderance of opinion, did the Board fortify its beliefs about the cause of 
consumption. It is small wonder then that when a few years later, certain com- 
municable diseases were declared dangerous to the public health, tuberculosis 
was not to be found among them. 
Throughout this decade of pioneering, there was a steady growth in the 
number of public water supplies. In 1869, when the Board came into existence, 
there were only seventeen cities which piped running water to most of the house- 
holds of the community. At the close of the decade sixty-eight cities provided 
such facilities. It is to be noted that despite this increase, the neighborhood 
pump was still the principal supply of domestic water and the outdoor privy 
the chief means of the disposal of wastes. 
The Six Years of Doldrums Commence 
BENCH MARK 1879 
After a solid decade of productive pioneering the progress of the Board 
came abruptly to a halt. The cause of the unfortunate interference with the 
public’s health is given in Dr. Bowditch’s angry explanation for his resignation 
from the Board. He wrote: 
“In 1878 came mutterings of political disaster to the ruling powers, and 
forebodings of what the renowned General Butler would do with 
the numerous 'commissions’ (that of health among them) that were 
'spending wastefully the people’s money.’ Accordingly, to attack this 
redoubtable General upon his political 'flank’, the legislature, under 
suggestions from Governor Talbert, merged the three departments 
of Health, Lunacy, and Charity, a Cerebrus (sic.), in fact, in its gro- 
tesqueness of head. Three commissions, all different in ideas and modes 
of action, jumbled into one heterogeneous mass, simply because the 
ruling party feared the advent of power of a political adventurer! 
The prospects were chilling in the extreme to me, and I soon found two 
sad results; viz., heartburnings and jealousies among the increased num- 
ber of members, and an almost total neglect of sanitary work. At 
one time, for three or four successive meetings, nothing was done about 
sanitation, the time being occupied in discussions on lunacy and charity, 
on both of which subjects, so far as they had relation to the State, 
neither I nor my comrades on the old board knew anything. Such 
neglect of that which we had been for years laboring for was distressing. 
I appealed in vain for a return to the single board. Political dema- 
gogism was rampant, and our efforts were fruitless; and finally, as a 
solemn protest against the absurd and fatal combination, I resigned, 
after months of fruitless effort to persuade a change.” 
So health administration in Massachusetts lost the benefit of the guidance 
of a courageous gentleman, a physician soundly based in the medical sciences 
10 of his day, broad in his scientific interests and endowed with an essential 
curiosity. Whether or not fear of political consequences inspired this weird 
conjunction of health with lunacy and charity, it was soon to be evident that 
the union was a hopeless one. 
Enter the Sanitary Statesman— 
Henry Pickering Walcott 
Massachusetts was perhaps luckier than 
it deserved to be for so wantonly losing the 
services of the dynamic Bowditch, It was 
saved from its folly by the chance enlistment of another able sanitarian, Henry 
Pickering Walcott, who came into the Board’s service first as medical health 
officer of the sub-committee on health. Later he was to become chairman of 
that sub-committee. Dr. Walcott was a man of many parts—an educated 
gentleman, a well-trained physician and an outstanding administrator skilled in 
the several sciences which, with medicine, go to make up public hygiene. In 
addition to his contributions to health work in the Commonwealth, he was a 
hospital board chairman, a member of the Corporation of Harvard University, 
twice acting as temporary president, chairman of the Metropolitan Water Board 
and the recipient of honors so many and so varied that they may not even be 
enumerated here. 
Because the administrative activities of the overshadowed sub-committee 
on Public Health of the combined State Board of Health, Lunacy and Charity 
seemed to wallow listlessly in the doldrums, it does not mean that this was a 
period lacking any sanitary progress. Indeed, this was a time of marked advance 
in the creation of municipal water systems. Studies in stream pollution, water 
purification and sewage treatment which were carried on by the engineers of 
the State Board’s Division of Sanitary Engineering, have become classics in the 
realm of sanitary science. Incidentally, the creation of this Division of Sanitary 
Engineering in 1886 was the first instance of formal and functional organiza- 
tion of the Board’s work. The Division—oldest of all, and about to celebrate 
its sixtieth anniversary—has had but two heads since 1895, the able engineers 
Goodnough and Weston. That is such an unusual record that we cannot forego 
mentioning it here. 
The General Court enacted a law requiring local water boards to furnish 
data about their community supplies to the newly created Sanitary Engineering 
Division which annually sent out a questionnaire relating to such practical 
matters as the source of supply and the quantity of the water consumed. A 
drainage commission was appointed to plan a metropolitan sewerage project, 
to apportion its cost, and finally to administer it. The report of this commis- 
sion is another of the great engineering papers for which the early Massachusetts 
pioneers are justly entitled to fame. For this report, Dr. Walcott wrote the 
inspired concluding paragraph: 
“Precisely the same principle which enjoins a watchful care over the 
exterior waters of the State would seem to call for at least an equal 
solicitude concerning the abuse of its interior waters. But mindful of 
the tenderness with which Massachusetts has always treated the indus- 
trial classes, we think it would be wise to embrace in the enactment 
one peculiarly characteristic feature borrowed from the act establish- 
ing a railroad commission, and which has proved strong enough to 
11 enforce amply all the rights of the public in that class of highways 
called railroads. ... In a word, it shall be their especial function to 
guard the public interest and the public health in its relation with 
water, whether pure or defiled, with the ultimate hope, which must 
never be abandoned, that sooner or later ways may be found to redeem 
and preserve all the waters of the State.” 
During the time of the Board’s eclipse, a Food and Drug Act was passed, 
the second oldest in the United States. In those days nearly every article of food 
that entered commerce was adulterated in one form or another. Flour was 
often of inferior quality and even contained dirt. For butter, oleomargarine was 
frequently substituted. Canned food was preserved with chemicals. Ground 
coffee was combined with chicory, nut shells and burnt sugar. The list was 
endless; the variety of adulterants a monument to man’s cupidity and careless- 
ness. To put a stop, both to outrageous adulteration and to accidental con- 
tamination, four chemists and two inspectors were set to the Herculean task 
of enforcing the new law. The activity of these men resulted, very soon, in 
reducing the most frequent of the violations and the worst of the gross care- 
lessness. 
During the doldrums, the members of the health sub-committee and the 
staff all did what they could to mitigate the outbreaks of the various diseases 
that occurred. Of historical interest is the account of an investigation of an 
epidemic of malaria in Framingham. Here the relationship of this disease to 
standing water was discussed, although the agency of the Anopheles mosquito 
in transmitting the plasmodium was not suspected. The legislature, again 
“mindful of the tenderness with which Massachusetts has always treated the 
industrial classes”—in Walcott’s words—enacted another law requiring local 
health boards to notify the State agency of cases of smallpox. Later diphtheria 
was added, and one by one scarlet fever, measles, typhoid fever listed as diseases 
dangerous to the public health. 
Little by little, the idea of the germ causation of communicable disease 
was beginning to take hold of the minds of Board members. Dr. Samuel W. 
Abbott, who succeeded Walcott as health officer of the health sub-committee, 
made a search of the old case records of cholera in Boston and in connection 
with it, mentioned Koch’s bacteriological discoveries. This is the first public 
record of the Board’s comprehension that germs might be the cause of com- 
municable diseases. 
Talbot, the Governor pilloried by Bowditch in his letter of resignation 
and the signer of the law joining health with lunacy and charity, later accepted 
the chairmanship of the triple-functioned Board. He paid handsomely for his 
alleged political timidity, since the Board was continuously under fire, and soon 
he had his fill of badgering. He resigned and within a year the separation of 
these agencies took place. 
Throughout tins period, Walcott had risen in stature. He was in the later 
forties at this time and in the prime of his influence and understanding. He 
was ready to take over the reins of the Board when it was released from its 
combination with lunacy and charity and to give it a singleness of purpose so 
that productive leadership might achieve far-reaching results. 
12 BENCH MARK 1886 
Signalling “the Golden Age” of Sanitation 
The eventful eighties were stirring times. The Brooklyn Bridge—one of the 
world’s wonders—was opened to traffic; a German professor announced the 
discovery of the tuberculosis germ; the first electric streetcar ran in a city 
street; Klebs saw the diptheria bacillus; Finlay pointed an accusing finger at 
the mosquito as a carrier of yellow fever; Trudeau went into the Adirondack 
wilderness to be cured of tuberculosis and there he built “Little Red.” 
Sewage Experiment Station At 
Lawrence Earns High Honors 
In the eighties, Massachusetts, through its 
rejuvenated Board of Health was to make one 
0f its greatest contributions to sanitary- 
science—this contribution was the product of the fertile brains of men newly 
appointed to the staff of the Lawrence Experiment Station * The station itself 
was a crude shack of rough lumber, certainly unimposing in appearance, but from 
it flowed achievements truly impressive. As Whipple says, “The results of its 
researches have probably been as valuable as the results of all other American 
sewage experiment stations put together.” The establishment of this productive 
venture must be credited to Hiram Francis Mills, C.E., a member of the Board, 
who conceived the idea of experiments on the treatment of water and sewage 
and proceeded to put them into execution. For thirty long years he gave 
unstintingly to the progress of this work, always without remuneration. His 
friendship for, and collaboration with, Henry Pickering Walcott throughout all 
the full years of their association will long prove an inspiration to those of us 
who hold that man’s greatest satisfaction springs from efforts to improve the 
lot of the race and that in public health there lies an unparalleled opportunity 
for such service. 
Tribute must also be paid to all the pioneering staff of this Station, who, 
working under the guidance of Mr. Mills and inspired by him, did great things. 
Because of their zeal and vision, giant strides were made in our knowledge of 
sewage disposal. Mr. Mills used to say that his greatest discovery was Allen 
Hazen. Almost a stripling, he was given charge of the Experiment Station in 
1886 and, in later years, he became known as one of the outstanding sanitary 
engineers of his day. The same is true of George W. Fuller, who joined Hazen’s 
staff as a bacteriologist and later succeeded him in charge of the Station. The 
list of others who were associated from time to time in this work reads like “Who’s 
Who in Science,” for, working at the Lawrence Station or in the related chemistry 
laboratories set up at Massachusetts Institute of Technology, were Dr. Thomas 
M. Drown, consulting chemist, Professor William T. Sedgwick, consulting biolo- 
gist, Edwin 0. Jordan, bacteriologist, and Harry W. Clark, chemist, who suc- 
ceeded to Fuller’s post and continued in charge of the Station until his retire- 
ment. 
Not only did the young Professor Sedgwick contribute mightily to the 
findings of the Lawrence Experiment Station, but in other ways he added 
materially to the scientific accomplishments of the State Board of Health. He 
made a revealing investigation of the conditions of market milk in Boston and 
* A chronological list of the beginnings of the chief activities of the Board, and the Depart- 
ment will be found in Appendix II. We believe that this account will be found more readable 
if it is not encumbered with a superabundance of historical dates. 
13 as a part of this survey, he carried out the first bacteriologic examination of a 
municipal milk supply ever made in the United States. His studies of typhoid 
fever broke new ground in developing the epidemiologic method of disease 
control. 
Drainage Commission Recommends 
Oversight of All Inland Waters 
As a result of the independent investiga- 
tions of the Massachusetts Drainage 
Commission, a law was enacted giving 
to the State Board of Health general oversight of inland waters. It was instructed 
to consult with and advise the officials of municipalities and firms concerning 
proposed systems of water supply and sewerage. The law decreed that this 
advice should include recommendations for appropriate sources and methods of 
assuring the purity of potable water and the best methods of disposing of drain- 
age and sewage. Although this legislation made it mandatory to consult with 
cities and corporations engaged in manufacturing which might give rise to the 
pollution of inland waters, the Board was given no power to compel action. 
Despite this lack of real authority—or punitive measures of any kind—the 
Board’s influence on sanitary improvement of the State was enormous. The 
newly created Division of Sanitary Engineering published exhaustive reports on 
the science and mechanics of water purification and sewage treatment—reports 
which today are classical and which for many years were considered textbooks 
on matters of water supply and sewage disposal. 
The Massachusetts Board of Health was to make another series of out- 
standing contributions to America’s public health administration. These were 
in the realm of the infant science of bacteriology and were to come from a 
venture in practical preventive medicine, a biological manufacturing laboratory 
initiated jointly by the Board and Harvard University. Since its beginning, 
the Massachusetts Antitoxin and Vaccine Laboratory has played a continuous 
and often highly significant role in the history of the production of prophylactic 
and therapeutic products for the free use of the citizens of the Commonwealth. 
Rapid scientific advances in the prevention of communicable diseases created 
administrative problems which the State Board determined to surmount so that 
the resultant knowledge could be put to practical life-saving use. Although the 
value of smallpox vaccine had been established for nearly 100 years, the practical 
job of making a reliable vaccine readily available at all times was yet far from 
solved when the Board recommended the establishment of a State vaccine institu- 
tion. There were, it is true, numerous sources of vaccine lymph but the quality 
of the vaccine fluctuated greatly so that there were many failures in creating satis- 
factory immunity, and a considerable number of untoward reactions. More than 
thirty years earlier, the farsighted General Court had made vaccination a 
prerequisite to school attendance, so the Board felt that it had an obligation to 
provide a dependable vaccine in available quantities. For some years, the 
recommendation of the Board fell on deaf ears. 
Walcott’s Vision of a 
Laboratory Is Fulfilled 
However, when Behring and Kitasato discovered that 
injection of animals with the toxin of the diphtheria 
bacillus would produce in the animal’s blood serum an 
antitoxin having remarkable curative powers for diphtheria—this knowledge 
called for action. Diphtheria at that time was a disease of widespread prevalence 
and tragically high mortality, and for it no effective cure had been discovered. 
14 Reports from Europe, and observations following use of the small quantities of 
antitoxin available in this country, indicated that immediate and dramatic 
benefits followed administration of antitoxin even to extremely ill patients. 
Antitoxin was scarce in America, however, and that which was obtainable from 
Europe varied considerably in quality. The existence of such a remedy and the 
difficulties in the way of its general application confronted the State Board of 
Health with an immediate need for action which could not be ignored. Under the 
forthright leadership of Dr. Walcott, the Board therefore undertook the produc- 
tion of diphtheria antitoxin in 1894. The City of Boston also began serum 
production at this time, but discontinued it about four years later. 
The production of antitoxic serum was begun at the stable of the Bussey 
Institute in Forest Hills, and the serum was processed at a laboratory in the 
Board’s offices at the State House. The first serum was distributed in March 
1895. At about that time it became apparent that the nature and scope of the 
work required the direction of a trained bacteriologist. The Board of Health— 
thanks to Walcott’s directness and foresight—obtained the services of Dr. Theo- 
bald Smith, who was already one of the outstanding bacteriologists of that time. 
Dr. Smith left a position in Washington as Director of the Division of Pathology, 
Bureau of Animal Industry, to become Pathologist to the Board. At the same 
time he was enabled to continue his distinguished researches through his ap- 
pointment to the Professorship of Comparative Pathology at Harvard Medical 
School—a position established for this purpose through the generosity of Mr. 
George F. Fabyan of Boston, 
Laboratory Prospers Under 
Theobald Smith’s Administration 
The acceptance of diphtheria antitoxin by 
the medical profession was rapid, and pro- 
duction expanded from the first year’s out- 
put of 1700 doses to over 33,000 four years later. The clinical results achieved 
with antitoxin were indeed remarkable. A Dr. Mason, writing in that year, 
noted, “The change in the appearance of diphtheria wards since the introduc- 
tion of antitoxin has been very marked. In making a visit one cannot help 
being struck with the bright and cheerful appearance of the children.” The case 
fatality rate in diphtheria fell from a general average of 25% before antitoxin 
to an average of about 11% in treated cases during the very first years of its 
use. An involuntary experiment which demonstrated the value of antitoxin 
occurred when “In consequence of an interruption of the use of antitoxin at a 
well-known hospital, due to a failure of the supply, for a period of a few weeks 
the mortality among the diphtheria patients immediately rose again to its 
former height.” In 1901 Dr. Smith came to the conclusion that during the first 
seven years in which antitoxin had been generally available, about 10,000 lives 
had been saved by its use. During the last two years of this period, the anti- 
toxin distributed was produced at a cost of $14,000, whereas its purchase from 
outside sources would have cost at that time about $140,000. A questionnaire 
revealed that from 25% to 90% of the treated patients in various communities 
would not have received antitoxin if it had not been available free of charge. 
The staff of Dr. Smith’s laboratory at that time has been pictured by Dr. 
Reagh, who began work with Dr. Smith on September 19, 1900. In the annals 
of vaccine production, Dr. Reagh’s record must be high for he celebrated the 
beginning of his 45th year of service by inoculating his 1152nd calf. He recalls 
that the personnel at the Forest Hills Laboratory in the early days comprised: 
15 D,r. Smith, Director; Mr. E. L. Walker, Bacteriologist; Dr. J. R. Stewart, 
Veterinarian in charge of the stable; with Mr. Nahum Mitchell and Mr. Julian 
Horne as assistants. Miss Adams, assisted by Miss Mahoney did the laboratory 
work and kept records of the antitoxin production supervised by Dr. Smith. 
Last and largest came Doonan, the “diener”, who cared for guinea pigs and 
attended to the janitor’s work. 
During this early period Dr. Smith worked steadily at the problem of 
producing a higher grade antitoxin, and he and his associates carried out in- 
numerable studies to this end. In the annual report for 1896 appears an ac- 
count of an extensive investigation into the toxin-producing capacities of various 
strains of diphtheria bacillus.* The success of these studies may be measured 
in part by the rise in the average potency of the serum distributed, from 100 
units per cubic centimeter in 1896 to 425 units in 1900. 
Largely as a result of the successful experience with antitoxin, the General 
Court authorized the Board to produce and distribute vaccine lymph as well. 
Such an undertaking was out of the question at the already overcrowded quarters 
in the Bussey Institute. Harvard University therefore made available some 
adjacent land and, through the munificence of a friend of the University, erected 
a two-story building designed especially for the work of the laboratory, and the 
production of smallpox vaccine was begun in this building. 
The following year, in a. report on “The New Antitoxin and Vaccine Labora- 
tory,” Dr. Smith reviewed the history of the institution, pointing out the wisdom 
of the decision of the Board in initiating this work eleven years previously. He 
showed that the State’s provision of free antitoxin to all, had greatly reduced 
the mortality from diphtheria; and furthermore that there had resulted from 
this policy a steady rise in the amount used per case both in Massachusetts and 
elsewhere. “This influence,” he wrote, “has been salutary, for it has been shown 
that the doses used in the earlier years of antitoxin production were too low.” 
Anent the duty of the State to provide smallpox vaccine, particularly where 
vaccination is compulsory he wrote, “In European countries this duty is today 
generally recognized and assumed by public authority. In our country scarcely 
a beginning has been made. Massachusetts is as yet the only State which has 
taken up this task; others will certainly follow, for the production of animal 
vaccine by the State is a logical necessity. Furthermore, it is the only way to 
bring the physician who performs the vaccination in close touch with the pro- 
ducing laboratory.” 
A Tribute to Theobald Smith, 
The Man 
Great as were the contributions of the Anti- 
toxin and Vaccine Laboratory, the ultimate 
value to the world of Theobald Smith’s other 
scientific activities during his period of service to the Board was even greater. 
He made extensive studies of malaria in Massachusetts, in which he explored 
the theory that the disease was transmitted by a mosquito and that human 
beings, especially foreign workmen, were the carriers. His work on human and 
bovine tuberculosis was continued throughout his years in the Commonwealth 
and he found time to study anthrax, glanders, and poliomyelitis, among other 
diseases. Theobald Smith was not only a national but an international authority 
* “A Comparative Study of the Toxin Production of Diphtheria Bacilli,” by T. Smith and 
E. L. Walker. 
16 as well, and the Commonwealth of Massachusetts proudly acknowledges its great 
debt to him. 
This story would not be complete without some indication of the tremendous 
effect which Dr. Smith’s personality, character and intellect had upon the forma- 
tion and growth of the laboratory. Distinguished by the possession of one of 
the most remarkable scientific minds of his age, Dr. Smith was also endowed 
with an integrity which was as quick to insist upon scientific accuracy, as it was 
to command personal loyalty and quality of performance. Many of the stories 
about him which still circulate at the laboratory portray his scorn for intellectual 
or physical laziness; for he could tear the cover from weakness in character with 
a taciturn wit that left the recipient demolished of argument but wiser in mind 
and spirit. It is largely due to the standards set by Dr. Smith that the laboratory 
owes many of the characteristics which it retains today. One cannot at this point 
overlook Smith’s frugality, which was of truly anecdotal quality. It is said that 
his discovery of anaphylaxis was a consequence of his policy of using the same 
guinea pigs repeatedly for antitoxin testing. The often told story that he would 
borrow a calf from a neighboring farm, vaccinate it, harvest the vaccine and 
return the calf reflects not so much his frugality as it does the strangely lax 
production methods of the time. 
A “Small Shack at Sharon” Points 
The Way to Nearby Care of 
Tuberculosis 
Not all the Board’s successes were 
achieved in engineering research and 
the biological laboratory; scientific ad- 
vances that were to change the face of 
public health administration were made in the field as well as in the laboratory. 
The way was shown to local sanatorium treatment for tuberculous patients by 
Dr. Vincent Y. Bowditch, son of the illustrious first chairman of the State Board 
of Health. Medical opinion during the early years of the era was colored by the 
teaching of Trudeau who believed that it was the clear mountain air which was 
the essential element in his successful treatment of tuberculosis at “Little Red,” 
his pioneering venture in the Adirondacks. As a consequence, the Southern 
Appalachians, Colorado and California had become centers of tuberculosis sana- 
toria. Realizing the inability of any large proportion of Massachusetts patients 
to travel to these distant places, the younger Dr. Bowditch determined to test 
the possibility of treating tuberculosis near the towns where people lived. His 
“small shack at Sharon,” which he himself built, was the first sea-level sanatorium 
and in it he demonstrated the far-reaching findings that success in every way 
comparable with those achieved at inaccessible sanatoria and at high altitudes 
were possible at home. On the basis of these results, Bowditch and his con- 
temporaries were able to convince the State legislature of the advisability of 
establishing in the Commonwealth a State sanatorium for the treatment of 
patients with incipient tuberculosis. 
This sanatorium for tuberculosis—the first State institution of its kind in 
America—was established at Rutland. The new hospital, laboring under the 
handicap of the name “The Massachusetts Hospital for Consumptive and 
Tubercular Patients,” not only brought sanatorium treatment to the people but 
it was the first to provide at public expense treatment for individuals unable 
to pay for their own care. For patients unable to pay even a nominal rate, 
treatment at the expense of the town of their residence was provided. These 
17 PULMONARY TUBERCULOSIS IN MASSACHUSETTS 
DEATH RATES PER 100,000 POPULATION 
BY FIVE YEAR PERIODS FROM 1849 TO THE PRESENT 
LEGEND 
MALE FEMALE 
RATE PER 100,000 POPULATION 
18 two principles—nearby, and free, care—unquestionably laid the foundation for 
the development of the sanatorium movement in this country. 
Following the establishment of the Rutland State Sanatorium, clamor for 
hospital care was so widely voiced that a legislative commission was appointed 
to investigate measures for the further relief of “consumptives.” The outcome 
of this survey was the establishment of three additional State sanatoria for 
tuberculous patients. But provision of treatment centers was not enough, com- 
munity control was called for and we shall learn later how the Board proposed 
to meet the need. 
Before the nineteenth century came to a close, the seeds of still other out- 
standing pioneering ventures were sown. The need for some public agency 
looking to the amelioration of cancer was first noted and recorded. The Massa- 
chusetts Board reviewed the records of cancer increase over a period of 30-40 
years, and this preliminary ground work was followed by the famous Whitney 
report—a. statistical study analyzing the alleged increase in cancer throughout 
the Commonwealth. At the same time, Harvard University appointed a Cancer 
Commission which began immediately to play a part in the explorations that 
were to lead to cancer control in Massachusetts. Progress toward the solution of 
the cancer problem in this State has continued without interruption from this 
period. 
A Medical Officer Is Appointed 
To Deal With Local Health 
As demands on the State Board of Health 
became pressing and more numerous and 
as problems needing study multiplied, it 
became apparent that permanent employees other than food analysts, sanitary 
engineers and bacteriologists were needed. As a consequence, the first permanent 
fulltime medical employee of the Board was added to the staff. The Board’s 
reasoning which prompted this step can be learned from the annual report of 
1898, “For the purpose, therefore, of facilitating investigations of sanitary ques- 
tions in cities and towns and of aiding the work of local health workers, the 
State Board has organized a new Department of Health of towns and of cor- 
respondents with local boards of health, and has appointed Dr. F. L. Morse as 
its medical and sanitary inspector.” Since Dr. Morse’s day there has always been 
a permanent medical personnel to collect information, investigate outbreaks and 
formulate recommendations. 
Nothing in the annual report of the first year of the new century suggests 
that Walcott and his associates on the Board looked back on an impressive record 
of pioneering in this “golden age” of sanitation with warranted, and human, 
pride in accomplishment. But, at this distance, one cannot dismiss their ac- 
tivities without according praise to Walcott and Mills and their contemporaries, 
who in the final reckoning were responsible for the inspired undertakings of 
those fruitful years. 
Twentieth Century Opens 
Fruitfully If Unsuspectacularly 
The first half of this Board’s tenure of office 
had ended with the close of the century. It 
may be characterized as a period of great 
engineering progress and of achievement in the laboratory and in the field. The 
second half was to prove to be a time for systematizing and organizing. Though 
this second decade may hold less of historic interest for us, the work which con- 
tinued until the next reorganization of the Board was of immense effect through- 
19 out the Commonwealth. During the first decade of the new century one pioneer- 
ing venture was the appointment of district inspectors, for this was the first 
attempt in the United States to localize health adminstration. There were 
also a number of improvements in the previously established services of the 
State Health Board which must be recorded. 
In the Antitoxin and Vaccine Laboratory the final years of Dr. Smith’s 
directorship were marked by consolidation of and improvement in laboratory 
techniques and by the assumption of certain new duties. The preparation of 
silver nitrate for the prevention of opthalmia neonatorum was undertaken. 
The production of anti-meningococcic serum was begun following the demon- 
stration by Flexner of its therapeutic efficacy. Typhoid vaccine production was 
taken over from Dr. Spooner of the Harvard Medical School. This, incidentally, 
represented the first of many collaborations by the Antitoxin and Vaccine 
Laboratory with nearby academic institutions in making new or untried products 
available and in improving established biologic products. 
As was hinted at the close of the discussion of tuberculosis sanatoria, the 
need for community control of tuberculosis had long been recognized. Now 
the Board was in a position to play its part in stimulating the extension of 
local services, for the legislature had enacted a law creating fifteen health 
districts, each to be under the supervision of a physician known as the State 
inspector of health. One of the chief duties of these district representatives of 
the Board was to inform himself concerning the prevalence of tuberculosis 
within his area. The State bacteriologic laboratory, which had been in existence 
more than ten years, was called upon to make examinations of sputa and other 
material for the tubercle bacillus at the request of practicing physicians through- 
out the State. Because the great majority of tuberculous patients were coming 
to the sanatoria in an advanced stage of the disease, the legislature passed the 
60-caIled dispensary act requiring every city of more than ten thousand popula- 
tion to establish and maintain a dispensary for the discovery, treatment, and 
supervision of needy persons with tuberculosis. 
Fewer Milk-Borne 
Epidemics 
Despite these stirring advances, numerous outbreaks of 
typhoid fever ascribed to water and milk supplies con- 
tinued to occur throughout the early part of the first 
quarter-century. But when local supervision of these public health hazards was 
undertaken by the cities and towns, water and milk-borne epidemics became 
rarer year by year. Emergency pasteurizations of market milk protected the 
public from doubtful milk supplies during epidemic periods. Begun in this way 
as an emergency protective measure against typhoid fever, pasteurization by 
demonstrating its efficacy, soon became a standard procedure for all municipal 
milk supplies. Meanwhile, the diagnosis of typhoid fever was placed upon a 
much sounder basis. The Widal test was made available throughout the State 
by the Board's laboratories. Tests of cultures from blood, feces, and urine 
were added later. 
The most frequent type of milk-borne disease came to light with the 
discovery that epidemics of sore throat frequently were transmitted by milk. 
As a consequence, the Board’s field personnel devoted much of its time to the 
encouragement of the use of safeguarded milk and this, in turn, stimulated the 
protection of commercial pasteurizing methods. Common sense frequently came 
to the aid of official pressure, for after each new epidemic many persons who had 
20 learned by tragic experience that raw milk supplies are dangerous, turned to 
the use of pasteurized milk. 
Systematic dairy farm inspection was undertaken and the deplorable sani- 
tary conditions found in some of the farms induced the Board to urge the 
passage of legislation obligating local boards of health to undertake dairy 
inspection. 
Insanitary practices surrounding the slaughtering of food animals, a subject 
which the first State Board of Health attacked courageously and effectively, 
still continued to plague the third Board forty years later, although a succession 
of laws had been passed governing the inspection and supervision of abattoirs. 
An investigation of current conditions revealed more than a hundred slaughter- 
ing places doing their grisly business without a sign of worthwhile inspection. 
Men lacking any qualifications were using the stamp of approval, becoming 
accomodating “stampers,” instead of inspectors appointed to discover and cor- 
rect insanitary conditions. The general picture was not only one of abattoirs in 
disgraceful insanitary condition but one which revealed that diseased and con- 
taminated food was reaching the public markets. The legislature, acting promptly 
and wisely in the public interest, transferred the supervisory powers over 
slaughtering inspection from local boards to the State Board of Health, giving 
it power to approve the appointment of local slaughtering inspectors. These 
instances are typical of the great growth and improvement in administration. 
It is unnecessary—indeed impossible—to list them all here. 
New Days, New Needs, 
New Means, New Faces 
That remarkable quarter-century, dubbed appropri- 
ately the “golden age” of sanitation, was the time 
during which the Massachusetts State Board of 
Health was a conspicuous contributor to scientific progress, but the days 
of the Board itself were numbered. The magnitude and the far-reaching 
social consequences of the component sciences of the new public health called 
for new methods and new types of organization. No longer could an unpaid 
Board shoulder anonymously the responsibility for all the variety of services 
which health administration implied, no matter how earnest and willing 
the Board members might be. The day of the amateur administrator was 
past. Times called for professional, full-time leadership in which the ulti- 
mate responsibility could be placed upon a single individual. 
It is strange that so little is remembered today about the men and 
women who influenced the legislature to change the organization of the 
State health agency. Dr. Enos Bigelow, a man of parts, and influential 
member of the Massachusetts Medical Society, a member of the General 
Court, was one instrument. Other physicians joined him in asking for 
the change. It is likely that age, and time too, played a part. Henry 
Pickering Walcott was seventy years old. For thirty years his vigorous 
personality had dominated every phase of the State Board’s work. He 
maintained an intimate and a firm control upon each of the special ac- 
tivities of the staff. Holding a team with a tight rein may help it pull 
a heavy load, but when the team grows in number, the reins may be too 
many for one pair of guiding hands, however firm those hands may be. 
Perhaps New York State pointed the way to change. Herman Biggs, 
already a national as well as state leader in public health, was chairman 
of a New York survey committee, which had recommended in 1913 a 
21 departmental organization for the health administrative agency of that 
State. Necessary legislation was passed and he was appointed commissioner. 
Many leaders noted, and applauded this pioneering in the science of public 
health administration, and Massachusetts especially, must have heeded for 
the whole government of the Commonwealth was in process of reorganization 
along modern lines. 
Whatever may have precipitated the change, an act was passed in 1914 
dissolving the Massachusetts Board of Health and creating the State De- 
partment of Health. 
BENCH MARK 1914 
A New Department Breaks New Ground 
Of the several bench marks, that of 1914 is perhaps the most warmly 
reassuring of all, for we see here our democratic institutions beginning to func- 
tion at their best. Ready at hand was a new and potentially more efficient 
health administrative instrument which could be sharpened and improved, 
or dulled, by the caliber of the staff assembled to man it. 
The then Governor, Hon. David I. Walsh, sought the ablest man available 
to fill the newly created commissionership. He succeeded in inducing the United 
States Public Health Service to release to Massachusetts, Dr. Allan J. Mc- 
Laughlin, an officer who had proved his abilities in the field of health administra- 
tion and a man of outstanding leadership and ability. Incidentally, he had 
enjoyed a wide international experience having served in the Philippines soon 
after they were released from Spanish domination. To advise and consult with 
the new Commissioner, the Governor appointed to the Public Health Council 
men extraordinarily qualified to uphold his hands. On it he placed Sedgwick, 
the professor of biology at the Massachusetts Institute of Technology, and 
Whipple, the sanitary engineer—and historian upon whom we have leaned for 
much that is related in this account—and Wheelright, a lawyer of wide attain- 
ment. With them were the physicians—Edsall, Gallivan and Lamoureux—all 
men of prominence in their profession. The new Commissioner and Council 
wisely retained the services of most of the staff of the old Board. At the head 
of the divisions, which were to be comparable to their former positions, the 
Commissioner appointed Goodnough, Lythgoe and Clark. For the new divisions, 
the services of Kelley, Rosenau and Gunn were enlisted. 
Goodnough, Lythgoe 
And Clark 
Surely it is fitting that we halt this story briefly to 
pay our respects to these outstanding men. Xanthus 
Henry Goodnough, C.E., had come to the Board of 
Health twenty-eight years earlier, at the time when it was released from lunacy 
and charity, as an assistant engineer to the stalwart Stearns, whom he suc- 
ceeded in 1S95. He carried on the traditions of Mills and Stearns to the Sani- 
tary Engineering Division of the new Department which he served as Chief 
Engineer until 1930, when he was succeeded by Arthur D. Weston, the present 
Chief Engineer. 
As the last century was coming to a close, a young analyst began his work 
as assistant in the Food and Drugs Laboratory. Forty-six years later, Hermann 
C. Lythgoe, full of honors and ready for retirement, was to be drafted for the 
22 duration of World War II to continue the direction of the Division of Food and 
Drugs to which he had been appointed by McLaughlin. At the time of the 
re-organization, McLaughlin said of him, “Mr. Lythgoe is known to be an expert 
chemist and analyst and as the director of the division he lias demonstrated 
that he is an energetic executive officer as well.” McLaughlin’s measure of the 
man has stood the hard test of many years. 
Another gifted administrator who served as quietly and efficiently, and for 
an even longer period of years was Harry W. Clark, a chemist who followed in the 
tradition of Hazen and Fuller as director of the Lawrence Experiment Station, 
finding time to manage the Water and Sewage Laboratories at the State House 
as well. 
Throughout the years of his fruitful, if unassuming, leadership, he was 
responsible for many advances in the technology of sewage disposal. Imhoff 
himself attributed to Clark some of the improvements which he incorporated in 
his methods of sludge digestion in sewage treatment. 
Kelley, Rosenau 
And Gunn 
The Division of Communicable Diseases was to embrace all 
the work done by the former State Board of Health in sup- 
pressing epidemic diseases and to cover as well much new 
territory in the special fields of tuberculosis and syphilis control. It was evident 
that the proper direction of such an extensive service required the full-time at- 
tention of a competent public health administrator. The new Commissioner was 
successful in securing as Director of this Division, Dr. Eugene II. Kelley, formerly 
Commissioner of Health for the State of Washington. Not only was he a man 
of proved epidemiologic skill, but when larger responsibilities were to come to him 
he was to reveal that he was endowed with the vision to guide an expanding 
department into new fields of endeavor opened by the sharpened needs of a 
postwar world. It is said of Dr. Kelley that throughout his career he knew 
more people and was known by more people than any other man in health work. 
He was influential in the Conference of State and Provincial Health Officers and 
the American Public Health Association. 
Dr. Milton J. Rosenau, a teacher of preventive medicine, once a member of 
the old Board, and formerly Director of the Hygienic Laboratory of the United 
States Public Health Service, took charge of the new Division of Biologic 
Laboratories when Theobald Smith resigned because of the larger opportunities 
offered him by the Rockefeller Institute. Rosenau carried the laboratory through 
six difficult years, from the outbreak of the first World War with its critical 
shortages of personnel and supply, into the period of postwar reaction. Under 
Dr. Rosenau the laboratory acquired a license from the United States Public 
Health Service. Compliance with the high standards demanded for this license, 
further insured the quality of the products of our State Laboratory. 
Closest to the heart of Dr. McLaughlin was the new Division of Hygiene. 
In planning the departmental program, McLaughlin envisioned this new agency 
as one which would undertake a field broad enough for three divisions into 
which he hoped the work might ultimately be divided. To launch its ambitious 
and far-reaching program—on the very small funds available for the purpose— 
required a division chief who would be resourceful, energetic and would be 
blessed with sound judgment, Selskar M. Gunn, Professor of Hygiene at the 
Massachusetts Institute of Technology, was appointed on a part-time basis. Of 
him Dr. McLaughlin says, “Because of his dynamic force he has been able 
23 to accomplish more than other available men would have accomplished on full 
time.” Of such was the stuff of the men whom the Commissioner and Council 
selected to guide the destinies of the new Department of Health. Once again 
Massachusetts had shown that a public service could be organized without 
carrying a burden of incompetents. 
The 1915 Report Paints a 
Picture of Men at Work 
We can visualize the beginnings of this promising 
reorganization by selecting a few brief, “thumb- 
nail” quotations from the account of the depart- 
mental activities in the first annual report of the new Department: 
“The Engineering Division was in existence as a smooth running unit 
under the old State Board of Health. It is in charge of a highly efficient 
engineer, Mr. X. H. Goodnough, who also possesses executive ability of 
a high order. 
“The division has been operated together with the Water and Sewage 
Laboratories and the Lawrence Experiment Station, chiefly under ap- 
propriations for purity of inland waters and examination of sewer out- 
lets. 
“The work of the Engineering Division has increased enormously be- 
cause of the increase in requests for advice from cities and towns. . . . 
The field work of the engineers in complying with these requests from 
cities and towns has increased to such extent that for three years the 
field force has been overtaxed.” 
The Commissioner added this yardstick: “The splendid work of these two 
divisions (Sanitary Engineering, and Water and Sewage Laboratories) in the past 
in safeguarding the public water supplies of the State is best expressed by the 
enormous reduction in typhoid fever.” 
The tables he offered as evidence show that, for the five-year period ending 
in 1900, the average annual typhoid fever rate was slightly in excess of 25 deaths 
per hundred thousand. For the five-year period ending in 1910 the average 
rate had fallen below 14 deaths per hundred thousand, whereas for the same 
period ending in 1915 the average rate had sunk to 7.8. “In addition to con- 
trolling public water supplies,” he added, “very interesting problems in trade 
wastes are being solved in the laboratories and very valuable research work 
has been done in regard to depth of sewage filters which activated sludge.” 
The largely unrelated activities classified under the general head of Food and 
Drugs had been carried on by the old Board in several different locations by 
inspectors and chemists who found themselves each responsible to several heads. 
These positions were transferred to the new Division of Food and Drugs. “I 
believe,” writes Dr. McLaughlin, “that a Division of Food and Drugs would 
contemplate a broader field than the mere examination of milk, food and drugs. 
The question of drug addictions, the misuse of so-called proprietary and quack 
medicines, all present fruitful fields of action.” So the new Division bravely 
set out on its appointed tasks. One example of the variety of problems it faced 
is typical. Before World War I, America had depended upon Europe to supply 
the arsenicals used in the treatment of syphilis. When war cut the supply it 
was discovered that the German patent formulas were fraudulent. It became 
necessary for the Division of Food and Drugs quickly to synthesize a safe drug, 
and having accomplished this, to manufacture the new arsphenamines. The 
Division continued to make these products available for the Commonwealth until 
24 DIRECTOR 1 
EPIDEMIOLOGIST 1 
DISTRICT HEALTH OFFICERS A 
BACTERIOLOGIST 1 
ASSISTANT BACTERIOLOGIST 1 
LABORATORY ASSISTANTS 2 
CLERICAL 6 
ACTIVITIES 
PREVENTION OF ALL COMMUN- 
ICABLE DISEASES. 
I 
COMMUNICABLE DISEASES 
Organization of Massachusetts department of Health 
NOVEMBER 30,1915- 
DIRECTOR & ANALYST 1 
ASSISTANT ANALYSTS 4 
FOOD A DRUG INSPECTORS 4 
VETERINARY INSPECTORS 3 
COLD STORAGE INSPECTORS 2 
CLERICAL 3 
MESSENGER 1 
ACTIVITIES 
EXAMINATION OF MILK, FOOD 
Sc DRUGS. 
DAIRY INSPECTION. 
COLO STORAGE INSPECTION. 
SLAUGHTERING INSPECTION. 
FOOD ECONOMICS. 
DRUG ADDICTIONS. 
PATENT MEDICINE FRAUDS. 
I 
FOOD AND DRUGS 
! 
DIRECTOR *■ 1 
ASSISTANT DIRECTORS 2 
EXPERT ASSISTANT 1 
LABORATORY ASSISTANTS 5 
OTHER ASSISTANTS 3 
TECHNICIANS 1 
CLERICAL 1 
JANITOR 1 
ACTIVITIES 
MANUFACTURE & DISTRIBU- 
TION OF DIPHTHERIA ANTI- 
TOXIN, SMALLPOX £ TYPHOID 
VACCINES. ANTI MENINGITIS 
SERUM. WA3SERMANN TESTS 
FOR SYPHILIS. 
PART TIME * 
BIOLOGIC LABORATORIES 
I 
COMMISSIONER OF HEALTH I 
AND 
PUBLIC HEALTH COUNCIL | 
CLERICAL 6 
MESSENGERS Z 
ACTIVITIES 
CORRESPONDENCE. 
FINANCIAL. 
STATISTICAL. 
RECORDS. 
I 
ADMINISTRATION 
I 
DIVISIONS OF 
DIRECTOR * 1 
ASSISTANT TO DIRECTOR * 1 
HEALTH INSTRUCTOR 1 
FIELD SUPERVISOR 1 
CLERICAL 2 
ACTIVITIES 
INFANT MORTALITY. 
CHILD HYGIENE. 
INDUSTRIAL HYGIENE. 
RURAL HYGIENE. 
HEALTH INSTRUCTION. 
PART TIME 
HYGIENE 
DIRECTOR £ CHIEF CHEMIST 1 
ASSISTANT CHEMISTS 5 
BIOLOGIST 1 
LABORATORY ASSISTANT 1 
CLERICAL Z 
LAWRENCE EXPT. STA. 
ASSISTANT CHEMIST 1 
BACTERIOLOGIST 1 
LABORATORY ASSISTANT 1 
FILTER ATTENDANT 1 
LABORER 1 
ACTIVITIES 
INVESTIGATION OF WATER, 
SEWAGE AND TRADE WASTE 
PROBLEMS. 
WATER AND SEWAGE 
LABORATORIES 
DIRECTOR < CHIEF ENGINEER 1 
ASSISTANT ENGINEERS 12 
DRAFTSMAN 1 
CLERICAL 5 
MESSENGER 1 
ACTIVITIES 
ADVICE TO CITIES ft TOWNS 
IN REGARD TO WATER AND 
SEWAGE PROBLEMS. 
FIELD SURVEYS AND INVESTIGA- 
TIONS NECESSITATED THEREBY. 
SPECIAL ENGINEERING PROJECTS 
IMPOSED SY THE GENERAL 
COURT. 
I 
SANITARY ENGINEERING 
i 
25 improved commercial techniques made it possible to supply the drugs at prices 
lower than the Division’s cost of production. 
Not only did the Communicable Disease Division face from the beginning, 
the control of the usual epidemic diseases by the time-honored method of isola- 
tion, but it had to master an entirely new technique of disease prevention, for 
diphtheria prophylaxis was soon to become a reality. Almost from its first days, 
the division demonstrated the Schick Test, and both Schick testing and im- 
munization entailed a brand new educational effort if parents were to be per- 
suaded to permit their children to be tested and protected when found susceptible. 
The point need not be labored that Kelley and his staff found plenty to do. 
The act creating the new State Department of Health provided for the 
employment of eight full-time district health officers instead of the fifteen part- 
time physicians who had devoted much of their effort to the investigation of the 
health of factory workers. Though these district health officers were to be the 
representatives of the entire State Department of Health in their respective 
districts, the supervision of their work was a function of the Director of the 
Division of Communicable Diseases. Upon them Kelley placed responsibility for 
much of the pioneering in promoting general Schick-testing, and later, diphtheria 
immunization. 
From the same annual report we get the most revealing picture of the 
ambitious program proposed for the new Division of Hygiene: 
“Health officers,” wrote Commissioner McLaughlin, “are justified in 
being proud of the achievements in the prevention of disease and the 
reduction of the death rates which are recorded in recent years, due 
largely to official activity. We have now reached a point, however, 
where further progress demands the hearty support of the individual 
citizen, and wider application of the principles of personal hygiene by 
the individual citizen himself. This means education of the people in 
their obligations to their neighbors and in the simple gospel of disease 
prevention. .. . 
“To reach these people, two very effective agencies are in our hands. . . . 
I refer to the possibilities of public health or visiting nurses and to the 
hygiene of school children. In view of the great reductions already ef- 
fected in the mortality rates for tuberculosis, typhoid fever, diphtheria, 
and other diseases, largely due to official activitity, it may be said in 
Massachusetts that further reductions will be in direct ratio to the num- 
ber of women employed in public health nursing. . . . 
“We must concede that this part of the health officer’s problems, in 
which success depends upon the voluntary cooperation of the individual, 
is much more difficult than that which may be solved by the passage 
and enforcement of laws and ordinances. The skepticism, and apathy, 
the passive and even active resistance displayed toward health instruc- 
tion comes largely from an adult population whose early training did 
not include hygiene. 
“To care for this problem of health instruction the new Division of 
Hygiene was created. Its scope will include infant mortality, child wel- 
fare, medical examination of school children, industrial hygiene, and 
health instruction in general. It will devote much of its energies to ed- 
ucational methods through literature, lectures illustrated by moving pic- 
tures and lantern slides, and personal instruction by its exhibits and 
health instructors. No special legislation can absolve this Department 
26 OPERCENT TOTAL POPULATION j 
DIAGRAM SHOWING 
RELATION OF TYPHOID FEVER DEATH RATE 
TO THE 
PERCENT OF POPULATION OF THE STATE 
IN 
MUNICIPALITIES NOT HAVING PUBLIC WATER SUPPLIES 
TYPHOID FEVER DEATH RATE PER 
100,000 POPULATION SHOWN THUS - 
PERCENT OF TOTAL POPULATION OF 
STATE IN MUNICIPALITIES NOT 
SUPPLIED WITH WATER FROM 
PUBLIC WORKS SHOWN THUS - 
RATE PER 100,000 
!l -S. CJ 
27 from its obligation ‘to take cognizance of the interests of life and health 
among the citizens of the Commonwealth'. 
“The possibilities of this division in life-saving and disease prevention 
exceed those of all the other divisions combined.” 
Each Division Charged With a 
Definite Life-Saving Job 
So we catch a glimpse of the several activities 
of the Department of Health taking shape, 
and with many growing pains, the divisions 
achieving a maturity of purpose in their ambitious programs. The new Depart- 
ment had inherited from the old Board a communicable disease problem so 
extensive that detailed investigations were out of the question—except in direct 
emergencies. The numbers of cases of such diseases as typhoid fever and diph- 
theria were huge as compared with what we have become familiar in recent 
years. At the beginning of his administration, Commissioner McLaughlin charged 
each of the various divisions with responsibility for its appropriate share of the 
existing death rate. The Division of Communicable Diseases, for example, was 
debited with 15,920 annual deaths which included mortality from syphilis, 
tuberculosis, pneumonia, diphtheria, measles, scarlet fever, typhoid fever, whoop- 
ing cough and influenza. Later because of the creation of new divisions for 
handling these particular diseases, syphilis and tuberculosis were removed from 
this list leaving a total of 7,920 deaths within the province of the division. If 
the same allocation were to be made at the beginning of 1944, the total number 
of deaths for which this division could have been held responsible would have 
been only 1,020. This, more clearly than anything else, indicates the tremendous 
reduction in the incidence of communicable disease which has taken place during 
the last twenty-nine years. 
An All-Out Attack 
On Pneumonia 
Soon after the reorganised Division of Communicable 
Diseases began its control activities, the Rockefeller In- 
stitute announced the production of a serum for the treat- 
ment of pneumonia caused by certain types of pneumococci and the Department 
took steps immediately to make use of this discovery. Because lobar pneumonia 
was the outstanding cause of death among the diseases still debited to the Divi- 
sion, the condition was made reportable and the manufacture of a serum for the 
treatment of Type 1 pneumonia was begun. The serum was eventually made 
bivalent by the addition of Type 2. However little use of the serum was made 
at the beginning, except in metropolitan hospitals where the then cumbersome 
methods of typing pneumococci could be carried out. After Dr. Felton of the 
Harvard Medical School produced a more potent product by the chemical 
concentration of batches of serum supplied by the State Antitoxin and Vaccine 
Laboratory, a more effective therapeutic agent was available, but still the serum 
treatment of pneumonia was limited because no practical method for treating 
cases in the home could be devised due to the lack of laboratory facilities for 
typing pneumococci. 
The Department was dissatisfied with this state of affairs and decided 
that the program must be either expanded or discontinued. This wholesome 
dissatisfaction led to action. A five-year study was outlined and the proposal 
28 presented to the Commonwealth Fund of New York City as a project worthy 
of their underwriting. The Fund agreed to supply the means to carry out the 
study which was to cover three important phases: (1) laboratory investigations 
to improve the potency and quality of serum; (2) epidemiologic investigations 
to add to our knowledge of the nature and mode of spread of the disease; (3) 
field demonstrations to encourage the use of anti-pneumococcic serum by 
practicing physicians. Noteworthy accomplishments resulted in all three of these 
fields. The use of serum increased markedly and many hundreds of lives were 
saved during the period of the five-year study. A rapid method of typing 
pneumococci by the Neufield reaction was initiated by the bacteriological labora- 
tory of the Department and this increased the effectiveness of the program* and 
over eighty typing laboratories and serum distribution centers were set up in 
hospitals throughout the Commonwealth. 
It would be impracticable to trace the work of the Division of Communicable 
Diseases in connection with all the infection during the two decades of adminis- 
trative expansion under review. Although the Department has been a pioneer in 
devising and applying new methods to the control of diseases other than pneu- 
monia, it is difficult to leave this intriguing subject without some reference to 
the related work of the Diagnostic Laboratory. For the first two decades of its 
existence, one bacteriologist had been able to perform with reasonable adequacy 
the limited number of examinations which science had perfected but, with the 
reorganization of the Department, Miss Edith A. Beckler, who has been in 
charge ever since, was appointed a full-time bacteriologist and the staff began 
thereafter to increase rapidly. Within a few years, it became necessary to keep 
the laboratory open daily and Sundays and to give twenty-four hour service— 
one bacteriologist being on call during the night. The work of the Laboratory 
had been limited mainly to the bacteriologic diagnosis of communicable diseases. 
Laboratory tests such as urinalyses and blood chemistry had never been under- 
taken, but the development of serum and drug therapy of pneumonia complicated 
the work and imposed further burdens, for a variety of detailed studies may be 
necessary upon a single specimen from a case of communicable disease. Such 
studies have proven valuable to the epidemiologists of the Department in 
tracing sources of infection, and intricate bacteriological work of this nature has 
continued to increase to this day. 
With the creation of a venereal disease subdivision in the new Division of 
Communicable Diseases, a Wassermann Laboratory was opened as a unit of the 
Division of Biologic Laboratories under Dr. William A. Hinton, who was to 
give to the country a simplified but sensitive blood test which bears his name* 
Soon, thereafter, the State Department of Health declared syphilis and gonor- 
rhea to be diseases dangerous to the public health—which must be reported. 
A program for handling and recording case reports of gonorrhea and syphilis 
was formulated and set in motion. 
* Just as the use of antipneumococcic serum was becoming universal, the sulfonamide 
drugs were introduced for the treatment of pneumonia. These drugs, and later penicillin, 
have proved so effective that the need for serum treatment is greatly reduced. However, serum 
still plays a role in the pneumonia control program. In certain cases of pneumonia, serum 
remains essential to good treatment. So, despite the marvels of present-day drug therapy the 
pneumonia studies of the Department may be set down as one of the modern contributions 
comparable to those which came from the Board’s staff during the middle nineties. 
* A survey conducted jointly by the U. S. Public Health Service and the American Society 
of Clinical Pathologists has shown the Hinton test, as carried out in this laboratory, to rank 
among the first three in nationwide evaluations. 
29 With the Treatment of Venereal 
Diseases the Department Embarks 
Upon Medical Care 
Free diagnostic facilities for venereal 
diseases were put into operation and 
efforts made to establish a state-wide 
chain of clinics. Distribution of arsphena- 
mine was instituted, and when the first World War came, the State venereal 
disease control program was geared to the nation-wide plan of the War Depart- 
ment and United States Public Health Service. Twelve clinics began to function 
when the Federal allotments under the Chamberlain-Kahn Act, with matching 
funds from the State, provided the means for these health and medical services. 
An ahead-of-the-time study of social service needs of venereally diseased patients 
was initiated and the first medical social worker in the Department was ap- 
pointed as a result. According to the annual report of that first war year, 
“The Subdivision of Venereal Diseases has been able to function better. . .due 
mainly to the addition of a social worker and a special investigator. . .” The 
duties of both these new employees included the follow-up of infected eases, 
visits, and cooperative work with boards of health, State clinics and social serv- 
ices. The report comments, “Pleasant cooperation was established, but with 
only one social worker in the State an effective demonstration of the possibilities 
of medical social work was scarcely possible.” 
An Ambitious Program 
In Hygiene 
In his original assignment of deaths to be prevented, 
Commissioner McLaughlin had assigned to the Com- 
municable Disease Division the task of preventing 
deaths from the epidemic diseases; but upon the Division of Hygiene, he im- 
posed a still greater responsibility. Control of deaths from the diseases of in- 
fancy, tuberculosis, cancer, and all the so-called wear and tear diseases of adult 
years was placed on the shoulders of the hygienists. This was a large order. The 
early years of this new division were of necessity exploratory, for there were 
few precedents to guide it. A dozen different surveys, tentative activities and 
demonstrations were gingerly attempted. A statistical study of the infant 
mortality of 355 towns was undertaken to determine where the health educational 
needs were greatest and what means might be employed to meet them. 
A health lecture service and a motion picture distribution plan were set in 
motion. Health films of that day left much to be desired, but they did serve as 
bait to draw audiences. Health education was in the stage of trial and error— 
performance might be less than perfect, but aim and spirits during this period 
were high. An ambitious child health exhibit with the usual profusion of panels* 
was hurried from community to community by two public health nurses who 
interpreted for the open-mouthed audiences the wealth of statistical data the 
panels displayed. The nurses gave numerous talks to children as a sideline 
feature. The breadth of the educational interests of the division are indicated 
by the appearance of such diverse brochures as the booklet “Baby and You” and 
a pamphlet on mosquitoes and malaria. The former monthly bulletin, dignified 
now by the title “The Commonhealth” made its pedagogical bow to the 
Commonwealth. 
* The twenty panels of the child welfare exhibit called attention to successive steps in the 
care of infants and children. In great profusion were displays of model layettes of baby clothing; 
iceboxes; infant feeding outfits; horrible examples of ill-kept rooms, and, by way of contrast, 
an attractive nursery. As evidence of the area which infant hygiene proposed to include, a 
polluted water supply and a protected one were thrown in for good measure. The extent of the 
infant mortality problem was dramatized by means of a “flashing device,” so the report informs us. 
30 For a number of years both the Department of Education and the State 
Board of Health had had responsibilities placed upon them to guard the health 
of school children, but there had been little collaboration between them. Shortly 
after 1918, a closer liaison was effected between these two departments for there 
was a growing interest in the health of the school child on the part of both. 
A record form was devised to improve annual medical examinations of school 
children which were supposed to be carried out in every community in the State. 
Joint conferences were held by the two departments with school superintendents, 
physicians and nurses in order to promote a better understanding of the possibili- 
ties in school health administration. State normal school summer courses were 
given so that teachers and school nurses might gain some appreciation of the 
value of the health instruction of the children in their charge. 
Some measure of the deficiencies of school health supervision of that day is 
found in the number of full-time medical inspectors in the entire State. There 
were three. In addition to stimulating good medical services, the Department 
sponsored the passage of a law requiring a school nurse for every community. 
Within a few years this requirement had been fulfilled. Neither was the subject 
of nutrition to be neglected, for a staff member, officially labelled “qualified food 
worker,” was employed to write and talk on the broad topic of food in all its 
hygienic aspects. One good thing leading to another—a “mouth hygienist” was 
later added to the staff, largely because of the efforts of Dr. Edwin P. Kent who 
had given his services in laying the groundwork for a dental program. 
Insistent demands of a nation at war deprived the State of Allan Mc- 
Laughlin’s able leadership, but Dr. Kelley, with rare administrative capacity, 
succeeded him as Commissioner and directed the Department so successfully 
that it met its larger obligations which had been revealed dramatically by the 
first World War draft. 
As the scope of the Division of Hygiene’s activities had been stretched to en- 
compass the cradle and the grave, the administrative obligations involved were 
so onerous that no part-time head could possibly direct them all. Professor Gunn 
—and his immediate successor—bowing to inexorable reality, had resigned and 
when Dr. Kelley assumed the commissionership, he appointed immediately a 
full-time director of the Division of Hygiene. He selected Dr. Merrill E. 
Champion, a district health officer, to undertake the job of guiding the varied 
and seemingly unrelated parts of the divisional program. 
From its inception, the preponderant part of the effort of the Division of 
Hygiene was directed toward child health, the remainder being devoted to adult 
hygiene. During these early years, the staff continued to show the multipaneled 
educational exhibit at county fairs. In connection with this display, a pediatrician 
gave free examinations to children who were presented by their parents. A 
dental hygienist looked into the children’s mouths, while a nutritionist demon- 
strated to their parents all the foods that might later go into the same mouths. 
Perfectionists among present-day psychologists and pedagogues may frown upon 
such side-show demonstrations as educational devices, but the interest they 
generated in the townspeople who swarmed to the fairs did much to stimulate 
the desire for school nursing services under local auspices throughout the State. 
The success of the child health exhibits at the fairs led the Department to 
widen the field of this educational device. A model “T” Ford truck to transport 
it and an allegedly portable tent to house it were purchased. A troupe of per- 
31 formers was organized to take the show to granges, health weeks, indeed to any 
place where an audience could be induced to gather. The nurses, nutritionists and 
educators lugged their own trunks, they cleaned the hall, they set up the “pitch” 
like any trouper, then hurriedly changed their costumes and put on the show, 
a part of which was a dramatic performance called “The Lion and the Nurse,” of 
which it is said, that in its histrionic effect “Uncle Tom’s Cabin” paled in 
comparison. When the last child and parent had been entertained, examined or 
instructed, the crew folded their tent “like the Arabs” and wearily called it a 
day. After some years of trouping the realization began to take shape that 
this shotgun educational method might better be superseded by an effort aimed 
more particularly at definite hygienic objectives. 
Early Days of Well Child 
Conferences 
Inspired in part by the portable educational ex- 
hibit, well child conferences were conducted at the 
request of some responsible local agency with per- 
mission of the board of health, and were held in a school house, town hall or some 
other central building. No medical treatment of any kind was given. The pur- 
pose of the clinic was merely to demonstrate a need and a method of meeting it. 
When children were found ill or in need of corrective treatment, they wrere re- 
ferred to the family physician. Not only was no medical treatment given, but the 
conferences were intended to be demonstrations only. Once their value had been 
made clear, the Division felt its duty had been fulfilled, temporarily at least, be- 
cause the responsibility for carrying on the work now rested with the community 
itself. The services of the State staff were always at the disposal of the com- 
munity to assist, but not to supplant, local child health activities. 
Although the legislature, with rare and typically New England independence, 
refused to accept the Federal funds allocated to States under the Sheppard- 
Towner Act, it did increase appropriations for child health work to such an ex- 
tent that it was possible to employ an adequate staff of competent specialists in 
the fields of pediatrics, dental hygiene, public health nursing, and nutrition. (It 
may be of interest to note that although Sheppard-Towner funds were refused, a 
previous legislature had not been averse to matching Federal funds appropriated 
for venereal disease control under the Chamberlain-Kahn Act.) 
Tuberculosis Prevention Becomes 
A Major Activity 
Soon after the State Board of Health was 
reorganized to form the State Department 
of Health it became apparent that the 
treatment and prevention of tuberculosis was a major obligation which could not 
effectively be met as a subdivisional activity of the Communicable Disease Divi- 
sion. A general rearrangement of many Massachusetts Boards and Commissions 
effected a second reorganization of the Department of Health, in which the name 
was changed to the State Department of Public Health. One of the chief pur- 
poses of the reorganization was to delegate to the Department the administra- 
tion of the Commonwealth’s tuberculosis sanatoria. So, a State Division of 
Sanatoria and Tuberculosis was duly established in the Department and the ad- 
ministration of the hospitals was transferred from the Boards of Trustees who 
had formerly managed these institutions. To Dr. Sumner H. Remick, the 
second Director of this Division, is due the major credit for the sound planning 
of the next decade which served to place Massachusetts in the front rank of 
32 sanatoria administration. Of interest to the collector of odd items, is the trans- 
ference of the Penikese Leper Hospital to the Division along with the sanatoria. 
Few people are aware that the State ever maintained a hospital for lepers—or 
indeed that there were lepers in Massachusetts. 
Prior to the passage of the reorganization act, the tuberculosis work of the 
Department had been carried on through the district health officers and the 
central staff of the Division of Communicable Diseases. Reports of cases and 
deaths from tuberculosis came from physicians and boards of health, and lists 
were compiled of known cases covering the period between reorganizations. To 
the district health officers now was given the job of putting these lists to practical 
use in the solution of the tuberculosis case-finding program. 
Chadwick Clinics Begin 
Ten-Year Project 
High mortality from tuberculosis among adolescents, 
both in the State Sanatoria and in homes through- 
out the Commonwealth, so impressed the State 
legislature that, at the close of the first quarter of the twentieth century, a State 
program was authorized for the prevention and control of tuberculosis in child- 
hood. Under the leadership of Dr. Henry D. Chadwick, mobile clinics were 
organized for the examination of school children, using the tuberculin skin test 
as a screen and providing X-ray chest examinations for those showing positive 
reactions. By the discovery and treatment of the then-called childhood infec- 
tions, it was thought possible to prevent the development of tuberculosis in adult 
life. During this period of ten years, nearly a half million children were ex- 
amined and several thousand were hospitalized. Two State sanatoria were 
converted into institutions for the care of children* 
The second half of this period of departmental growth (1925-1936) began 
tragically. Dr. Kelley, still a young man with a challenging future, had taken 
up the burdens of administration where Dr. McLaughlin had been forced to 
drop them. In a few brief years he had measurably increased both the scope 
and the life-saving values of the departmental program. His sudden death 
came as a disheartening blow to his associates, every one of whom was a devoted 
friend filled with admiration of him as leader and man, and it required all the 
really great capabilities of the versatile George Bigelow to rally them from their 
despondency. But Dr. Bigelow, brilliant in mind, shrewd in leadership and 
always inspiring, tossed into the task of carrying on the work of the Depart- 
ment all his seemingly inexhaustible store of vitality. He succeeded not only 
in creating a new will to achieve, but at the same time he overcame con- 
tinuing public indifference to the need of good health services with a good- 
natured gusto, but often with scarcely-veiled sarcasm. 
This was a period of economic ups and downs. The roaring twenties, with 
their promise of ‘'permanent prosperity”, saw the Department embark upon 
a cancer program as radically new and as far-reaching in its potentialities as the 
* Although the hope of preventing tuberculosis by the hospitalization of children with primary 
disease was not realized, the Chadwick clinics proved as useful to the science of public health 
administration in their negative findings as in their positive answers to the questions of tuber- 
culosis prevention. The program had far-reaching results in the education of the public about 
tuberculosis. Among the significant facts brought out was the relatively high resistance in 
children between three and ten, and the high fatality of tuberculosis in the teen ages. The 
survey showed that under present day conditions, tuberculosis disease in childhood occurs in 
such a small percentage of cases that the routine examination of children in the elementary 
grades is not justified. But the findings did indicate the age groups and the social conditions 
under which tuberculosis testing might profitably be intensified. All in all, the Chadwick clinics 
contributed greatly to the nation’s understanding of the problem. 
33 celebrated Chadwick clinics were in the field of tuberculosis, and when the pros- 
perous twenties had given way to the desolate thirties, the departmental activi- 
ties turned toward the relief of human want and malnutrition. 
Events demanded that the Division of Hygiene be separated into two new 
and independent divisions—one to be concerned with adult health, the other 
with maternal, infant and child health. For administrative purposes the divid- 
ing line in the responsibilities of the two new agencies was to be age eighteen. 
Adult Hygiene—Euphemism 
For Cancer Control 
Early in his administration Commissioner 
Kelley broke new ground when he asked for 
an appropriation to be used for the control of 
cancer, for no other state health agency had entered this field. The funds he 
received were used to inaugurate the tumor diagnostic service and to carry on 
a statewide educational program—treatment having no part in this plan. 
Meanwhile, Monsignor Roche, a Chaplain of one of the few hospitals which 
then would accept cancer cases for terminal care, became the central figure in 
a movement demanding of the legislature the granting of appropriations for a 
State hospital to care for cancer patients. Though a joint committee of the 
Departments of Public Health and Public Welfare opposed a State supported 
hospital and recommended that the Department concern itself with promoting 
the extension of facilities for the care and treatment of the disease, the legisla- 
ture ordered the establishment of both a hospital and diagnostic clinics which 
were to be administered by the Department of Public Health. A vacant insti- 
tution was reconditioned to care for cancer patients—the Pondville Hospital. 
Three years elapsed before the Division of Adult Hygiene was created, 
and during the interim the cancer program was carried on by a cancer section 
in the Division of Hygiene. When the new division was established, the name 
Adult Hygiene was used as the word cancer was then held to be too obnoxious. 
There was no intention at that time of entering generally into the broad field 
of the hygiene of the adult. 
The cancer program evolved by a committee appointed by the Commis- 
sioner had as its principal feature: cancer clinics, tissue diagnostic service, hos- 
pitalization of cases, public education and both etiologic and evaluative research. 
The plan was accepted, the General Court appropriated funds for twelve diag- 
nostic clinics, and so the Department was embarked upon the first cancer control 
program to be undertaken in any State. With the exception of the administra- 
tion of the cancer hospital, which was placed with other department hospitals 
under the jurisdiction of the Division of Tuberculosis, the cancer program was 
administered by the newly formed Division of Adult Hygiene. 
Diagnosis and treatment are not enough. Cancer control, like that of 
tuberculosis, is a social problem. People must be induced to seek protection. 
One of the most influential activities in the cancer clinic program proved 
to be the first of the “Cured Cancer Clinics.” These were reviews of 
case records of patients from whom proved cancers had been removed, 
and who had lived beyond the time of probable recurrence. These “Cured 
Cancer Clinics” were most influential in changing the attitude of the prac- 
ticing physicians of the State toward the control program, from one of 
skepticism to one of warm support. Although the practicing physicians came 
to appreciate the value of the whole cancer preventive program, there was 
34 evidence that the public could not thus be awakened to the life-saving possibili- 
ties in cancer control. A realization of this public inertia set the Division in 
search of a new educational device, which later came into being. 
Emergency Relief Colors 
Child Hygiene Program 
The exigencies of the world-wide depression of the 
early thirties was not without its effect upon the 
program of the Child Hygiene Division which had 
just been separated from adult health work. Not-to-be-denied demands for 
concrete relief measures, rather than for professional guidance, were heard 
throughout the State. It was a time for bold decisions, and Dr. M. Luise Diez, 
the newly appointed Division Director, made them gallantly. The day’s work 
was concerned more than ever with such practical matters as low-cost menus 
for children and pregnant women, and inexpensive meals for other adults as 
well. One nutritionist was sent to the then bankrupt city of Fail River to devote 
her entire time to a struggle with the dire problems of planning meals on a 
subsistence level. Calls came from wholesale and chain gtbcers for help in 
passing on the day-to-day advice about food economies to their hard-pressed 
customers. Great quantities of leaflets on nutrition for the emergency were 
struck off for quick distribution throughout the State. The American Red 
Cross, busily distributing flour to the needy, called for the active support of 
all the nutritional staff to help them in educating homemakers. 
In cities where the need was greatest, the nutritionists entered the markets 
to give on-the-spot advice about economical wholesale buying. Surveys made of 
school meals revealed their nutritional inadequacies, and as a result demonstra- 
tional school lunch projects, some free, were conducted in the neediest com- 
munities throughout the State. Pediatricians,' nurses and nutritionists alike 
pitched in to give hard pan services. 
It should be noted, however, that the staff, even as they rose to these emer- 
gencies, did not neglect their demonstrational well child conferences and other 
services designed for long-range health improvement. Dental hygienists con- 
tinued to conduct research on the health of children in sanatoria. High school 
health councils were being formed, and a demonstration in health education 
was given in one of the Lynn high schools in cooperation with the Massachusetts 
Tuberculosis League. 
It would be unprofitable to enumerate here all the conventional sanitary 
and preventive medical services which the various divisions of the Department 
continue to perform during fair economic weather and foul, but this account 
cannot overlook several of the more newsworthy activities that were under- 
taken or developed during this eventful decade in the Department’s history. 
Path-Finding in Shellfish 
Sanitation 
Clams grown in polluted water create a health 
hazard which had long been a matter of Depart- 
ment concern. The law had obligated it “to ex- 
amine from time to time the tidal waters and flats of the Commonwealth and 
samples of shellfish therein” to determine if they were unfit for food and dan- 
gerous to the public health. Many areas where shellfish grew abundantly were 
found polluted, so experiments were begun at the Lawrence Experiment Station 
to determine the practicability of purifying soft-shelled clams from the less 
grossly polluted areas. Later these experiments were conducted on a larger scale 
35  i 
Mole. Because odreduced 
personnel doe lo World 
WorH> opp/lco lions odler 
194-0 corfo/led /n order fo 
render os mod? as sis lorrce 
os possible Ad Armed forces 
I I 1 1 —— ' 
NUMBER OF APPLICATIONS 
RECEIVED BY 
DIVISION OF SANITARY ENGINEERING 
YEARS 
5NUMBER OF APPLICATIONS* 
36 PIONEER IN PUBLIC HEALTH 
Lemuel Shattuck 
1793-1859 SECRETARIES 
OF 
MASSACHUSETTS BOARD OF HEALTH 
1869-1914 
Henry Ingersoll Bowditch, M.D. 
Henry Pickering Walcott, M.D. COMMISSIONERS 
OF 
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH 
1914-1933 
Allan J. McLaughlin, M.D. 
Eugene R. Kelley, M.D. 
George H. Bigelow, M.D. COMMISSIONERS 
OF 
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH 
1933 
Henry D. Chadwick, M.D. 
Paul J. Jakmauh, M.D. 
Vlado A. Getting, M.D., Dr. P.H. in Newburyport. The outcome was the establishment at Newburyport, of the 
first shellfish purification plant, in the country—and today the Sanitary Engi- 
neering Division maintains close supervision over this useful method of con- 
serving a not inconsequential part of our food supply. 
Federal emergency work projects of various kinds made new demands upon 
the sanitary engineers of the Department. Before the C. C. C. camps could be 
established, sanitary surveys of the areas proposed for sites had to be made. A 
wide variety of water supplies and sewage treatment works, the construction to 
be financed through W. P. A. funds, each had to be approved by the De- 
partment engineers before the Federal green light was given. So, the depression 
complicated the program of the Engineering Division as it did the others. 
An explosive outbreak of milk-borne septic sore throat in a small western 
community which had insisted upon its right to enjoy the dangerous liberty of 
drinking raw milk was turned to good use elsewhere in the State. In the years 
which followed, numerous Massachusetts communities have adopted regulations 
for the pasteurization of all market milk so that more than 90% of the entire 
population of the State now enjoys safe market milk. In some areas cooperative 
pastuerization plants smoothed the way to the enforcement of municipal regu- 
lations. 
Biologic Laboratory Branches 
Into New Fields 
Once again the irresistible pressure of depart" 
mental growth made impracticable part-tim#1 
administration, however competent, and Dr 
Rosenau resigned to give his entire time to teaching and research. The consoli- 
dation, improvement and expansion of the Antitoxin and Vaccine Laboratory’s 
work was stepped up under Rosenau’s successor, Dr. Benjamin White, who took 
over the direction on a full-time basis. Dr. White took a leading part in the 
Department’s diphtheria control program, which was built about the production 
of toxin-antitoxin mixture and a state-wide campaign of education in its use. 
Thus, by the time diphtheria toxoid became available, a decade later, the 
recognition of the value of such a prophylactic agent was thoroughly estab- 
lished throughout the State. Later, as the pneumonia control program de- 
veloped, higher types of antipneumococcic horse serum were added to the pro- 
duction schedule, with the subsequent development of therapeutic rabbit sera 
for pneumococcus typing reagents. The demand for therapeutic serum greatly 
expanded as its use became more widely understood, and sera for all types of 
pneumonia were made available, some by state purchase. 
The scarlet fever control program of the Department was extended to in- 
clude experimental production of scarlatinal streptococcus toxin and toxoid, and 
processing of convalescent serum obtained from—and returned to—certain co- 
operating towns and cities. Community participation in a convalescent serum 
program was difficult to maintain, due to the irregular occurrence of the disease' 
in any one area, and this part of the program was ultimately abandoned. The 
experience gained, however, showed that the only logical way to organize a 
convalescent serum program was to place it on a larger population basis—thus 
ensuring more or less continuity in the supply and demand, and providing a 
central processing and distributing center on which any community could draw 
when in need. 
Use of scarlatinal toxoid in preventing the disease has not as yet progressed 
37 beyond the experimental stage. Studies carried out by the Division of Com- 
municable Diseases, based on one year follow-up Dick tests of individuals in- 
oculated with toxoid, have shown an immunity rate considerably lower than that 
obtained, for example, with diphtheria toxoid; furthermore, the chemistry of 
scarlatinal toxin renders its detoxification a long and uncertain procedure. The 
problem remains one to which an answer is yet to be found. The work on 
scarlet fever led, however, to the development of methods for production of 
extremely high potency toxin and for titrating the toxin in vitro by means of a 
flocculation test. 
Measures of 
Progress 
A fitting commentary on the ultimate effect of these two decades 
of departmental growth, from its inception in 1915, is the fol- 
lowing summarization from a recent paper by Dr. Merrill E. 
Champion: 
“On looking back over the history of communicable disease in this State 
and the progress made in its control, certain things strike one at once. 
One is the virtual disappearance of smallpox in Massachusetts. No case 
has been reported in this State since 1932. It is reasonable to conclude 
that this result is due in large part at least to the fact that we have had 
for many years a law requiring vaccination of all children about to 
enter school. Unquestionably another factor has been the excellent 
vaccination practices of surrounding states. 
“Diphtheria, too, is a disease which has shown a startling diminution 
during the years that have elapsed since the creation of the State De- 
partment of Health. In 1915 there were 9,282 cases of diphtheria in 
Massachusetts with 720 deaths. In 1943 there were 140 cases of diph- 
theria with 11 deaths. 
“Typhoid fever in 1915 occurred in 2,204 cases with 246 deaths. The 
corresponding figures for 1944 were 32 cases and 1 death. On the other 
hand, it is only fair to say that some of the other communicable dis- 
eases follow a regular course with relatively little difference in the inci- 
dence from decade to decade. These are the diseases for which we have 
no specific preventive or treatment. As an example, one may mention 
measles of which 22,881 cases occurred in 1915 and 35,098 in 1943. 
“This Department of Public Health like all others is still hoping for a 
feasible method of detecting those who are susceptible to poliomyelitis 
and for an effective treatment for this much feared disease. We have 
not yet discovered how to prevent meningitis although great advances 
have been made in the treatment of this disease. We have not yet been 
able to get the general public sufficiently health conscious to make pos- 
sible the carrying out of various health procedures which we do know 
about. This is only another way of saying the State Department of 
Public Health and local boards of health as well as all private agencies 
interested in the promotion of public health still have plenty of room 
for expansion.” 
BENCH MARK 1936 
New Functions Meet New Needs 
Our last bench mark has two bases. One is a state activity, the other federal. 
This year saw the publication of the Report of the Special Commission to Study 
and Investigate Public Health Laws and Policies, a document which still in- 
38 fluences the entire course of public health administration throughout the Com- 
monwealth. Social Security, too, perhaps in a more tangible way, is fostering 
a broader program. So, it seems especially appropriate that we take our last 
bearings at this point. 
The Report of the Special Commission is a remarkable document, the 
product of the painstaking study by the leaders of the profession. Its proposals 
deal with the whole range of urban and rural health administration by state and 
local agencies. In the depth of its research and the cogency of its proposals it 
is a fitting complement to the report of that First Special Commission, the 
famous Shattuck Report of 1850. Some of its recommendations for the bet- 
terment of local health administration have been made possible by federal grants 
through Social Security. 
The broad intent of the Social Security Act is stated in its preamble: 
“To provide for the general welfare by . . . enabling the several states 
to make more adequate provision for aged persons, dependent and 
crippled children, maternal and child welfare, public health. . . .” 
Specifically, the Act provides grants to be made to the states to aid maternal 
and child welfare activities, and for public health work generally, featuring aid 
in the development and maintenance of state and local services—among many 
other activities. 
Charged with the administration of health provisions of the Act, the Federal 
Public Health Service determines the conditions under which grants to the states 
may be used in establishing and maintaining statewide and local health services. 
The regulations setting forth the type of community program for which financial 
aid might be expected were promulgated at the time of the Act’s passage, and 
were approved by the Conference of State and Territorial Health Officers. Un- 
der the accepted plan, aid for local health services could be given only when 
the public health program of the city, county or district was under the direction 
of a full-time health officer. In addition, there should be such medical assist- 
ants, public health nurses, sanitary officers and clerks as would insure at least 
a minimum of effective health administration. Unfortunately, the communities 
in the Commonwealth with full-time health personnel and therefore eligible 
for Social Security allotments could be counted on one’s fingers. By and large, 
these were the communities that least needed the aid which might be forthcom- 
ing from this source. 
Throughout the State most of the towns still were served by a board of 
health composed of public spirited citizens who employed an agent, usually on a 
part-time basis, who might be assisted by the whole or part-time services of a 
public health nurse and a sanitary inspector. With the exception of the ten 
larger municipalities and one or two combined districts—at which we propose 
to look in a moment—local health administration in Massachusetts was in 1936 
essentially at the same level of development that it was when Walcott guided 
the destinies of the Commonwealth’s health administration in the “golden era.” 
Weaknesses in local health organizations had long been apparent to leaders 
in the field of public health. Earlier attempts had been made to remedy the 
most obvious defects, and a law permitting the voluntary joining of communities 
to form a combined health unit had been passed. One fault of the law lay in the 
fact that communities might join and leave such associations at will, a condb 
tion which precluded the possibility of assuring continuity of service and tenure 
39 of employment, which would make for competent administration. Despite 
the limitations of the law, there were instances in which communities had united 
to permit joint health services, but this did not alter the situation generally, 
which was one of serious weakness insofar as suburban and rural health is con- 
cerned. However, the Social Security funds did extend the life of these State- 
aided, combined health units. 
Nashoba and Southern Berkshire 
Demonstrations Helped 
For twenty years it had become increas- 
ingly apparent that the organization of 
local health activities was greatly handi- 
capped by the inability of small political units to employ trained, full-time pub- 
lic health workers. As has been mentioned, towns had joined to provide for 
special public health services, by competent personnel, and it seemed logical 
that more completely functioning health units might be encouraged. In order 
to give this idea a satisfactory trial, the Commonwealth Fund of New York was 
invited to subsidize a five-year demonstration of town unions in rural areas in 
Massachusetts. With funds assured, one union was organized in Southern Berk- 
shire County and another in the Nashoba Valley District of Middlesex and 
Worcester Counties. At first the health services were provided without expense 
to the towns. At the end of three years, when the communities were asked to 
begin a partial support of the program, the districts had to be reduced in size, 
for a third of the towns refused to contribute even a part of their proportion- 
ate share of the support of the unit and consequently withdrew. By the time 
the Commonwealth Fund demonstration was completed, Federal allotments 
through the Social Security Act providentially became available and the demon- 
stration was enabled to continue for a further trial. Later the Southern Berk- 
shire District had to be disbanded because additional towns could not be induced 
to join it and the population then served was insufficient to make the unit self- 
supporting. The Nashoba Valley District continued to function but with only 
ten towns having a total population of 17,000, until the wartime shortage of 
medical officers resulted in the inability to fill the position of medical director. 
On a restricted basis the union continues without a medical officer, even though 
the subsidy was withdrawn. 
The only joint service on a county-wide basis which has persisted despite 
the weaknesses of the permissive State law is the Barnstable County Health 
Department on Cape Cod. Serving a relatively small population, this agency 
was never able to carry out a full administrative program, but the advent of 
Federal funds through the State Department did permit an increase in the 
services which it renders to the towns of Cape Cod. Despite the new financial 
support, the county unit stumbles along because the town boards of health retain 
all their powers except those they willingly delegate to the unit and because they 
employ personnel independently of the county unit they must decide each year, 
whether to remain within or to leave the administrative union. 
Though the Social Security Act may have accomplished less in the improve- 
ment of Massachusetts local health administration than its sponsors hoped— 
largely because Yankee love of autonomy conflicts with desire for competent 
full-time administration—the Act did implement an immense increase in the 
volume and variety of services rendered to the Commonwealth by the State 
Department of Public Health. Some measure of the influence of the Social Se- 
40 curity Act may be gained from glimpses of the activities of the various divisions 
of the Department undertaken in the years following its passage. To Massa- 
chusetts came new funds equal to about half the total public health budget of 
1936—exclusive of the support of the tuberculosis and cancer hospitals. 
Child Health Services 
Markedly Expand 
In the Child Hygiene Division the professional staff 
was doubled. Where one well child conference unit 
had tried to cover the State previously, two now were 
made available. The well child conference unit was increased to comprise a 
pediatrician, a public health nurse, a dental hygienist, and a nutritionist. This 
team of professional people visits designated communities in the State to give 
a practical demonstration of the complete infant and preschool program. In 
anticipation of the team’s visit, the public health nurse of the district enlists 
the support of a local committee which arranges for the pre-conference pub- 
licity, provides transportation of families to the clinic and generally holds itself 
responsible for the attendance. For both the child and his mother the confer- 
ence is a unique experience and the community enjoys a continuing benefit, for 
the local nurses are charged with the duty of following-up the findings of the 
clinic team. They seek to have physical defects corrected, and enlist professional 
support in curing faulty habits. Most important of all, by this practical means, 
the town is led to see the need for locally conducted well child conferences, the 
local committee being responsible for the continuance of the service. Thanks 
to the new funds, twice the number of communities profit from these demon- 
strations. 
It is manifestly impracticable to tell in detail of all the augmented adminis- 
trative activities of the Division of Child Hygiene. They are, however, three 
projects which demand our attention at this point in our history. The first of 
these was an attempt to find a complete plan for testing the eye and ear func- 
tions of young children in order to overcome learning handicaps. A new testing 
mechanism, adapted for children, was evolved and the results of this project 
are so satisfactory that the approval of the Massachusets Vision Test was given 
by both the Public Health Council of the Department and the Council on 
Physical Therapy of the American Medical Association. Its introduction into the 
schools of the State followed, and it is finding its way into institutions throughout 
the country, even to the United States Army and Navy. Following the vision 
testing studies have been made of children’s hearing, and the outcome of these 
studies has been the development of tests which are still in process of standardi- 
zation. These two tests should go far toward removing remediable handicaps in 
young children. 
The second project was new service. The marked decrease in infant 
deaths focused attention upon premature births which remained one of the un- 
solved problems of infant mortality. Concerted attack upon the problem led 
to an immediate reduction in the rates which promises to be lasting. In each 
of forty-eight centers in the Commonwealth, hospital facilities for the immediate 
care of prematurely born babies were established and an ample equipment of 
warmed carrying baskets was made available through local boards of health. 
Public health nurses then demonstrated that any “premie”—anywhere in the 
State—could be carried without delay or exposure from home to hospital. 
The last of these new activities is a joint service carried on by the Depart- 
41 ment of Public Health and of Education. A School Health Council composed 
of the Comnfissioners of Public Health and of Education and of certain members 
of their staffs was created and charged with the effort to improve school health 
programs. This heart-warming example of productive collaboration between 
two State Departments is especially worthy of note. Federal funds permitted 
the employment of a trained staff to carry out an ambitious health education 
program looking to the preparation of teaching units in the elementary and 
secondary schools. The workshop method was adapted to the health field and 
by it teachers were induced to evolve practical programs to meet the particular 
needs of their own classrooms. 
Adult Hygiene Evolves 
Educational Techniques 
Cancer control activities celebrated a tenth anni- 
versary in 1936, the first clinic having been opened 
a decade earlier. In this and the others which had 
been organized in rapid succession to offer diagnostic facilities, a novel educa- 
tional program was begun when Social Security funds became available. Its 
objective was to give exact knowledge to individuals gathered in small groups to 
be addressed by an authority in the person of a local practicing physician. To 
make this plan a reality in a state of more than 350 communities, having a total 
population of nearly four and a half million, and served by more than seven 
thousand physicians, was no mean task. In each town—or city neighborhood—a 
committee composed of representatives from every local organization was formed. 
The recruiting of the committees was done by the personnel of the Division of 
Adult Hygiene. These committees differ from most local health councils chiefly 
in that they are not selective or limited to groups or classes, but represent every 
level of interest in the community—religious, service, political, labor and racial 
groups. Each club or association represented on the committee is asked to agree 
to devote one meeting a year to a talk on cancer. A local physician is asked to 
be the teacher in this program because the early detection of cancer is in his 
hands. He knows the community in which he lives and it is the duty and right 
of a physician to teach. 
Tuberculosis Preventive 
Services Rounded-Out 
Looking always to the control of tuberculosis, con- 
struction of State, county and municipal sanatoria 
proceeded steadily after the establishment of the 
Rutland Sanatorium until Massachusetts enjoyed the distinction of being num- 
bered among the few States which could furnish nearly three beds for each annual 
tuberculosis death: authorities in this field having set two and one half beds per 
annual death as the objective to be attained. When one of the two sanatoria de- 
voted to the care of tuberculous children during the Chadwick clinic program 
was found to be no longer needed for that purpose, Westfield Sanatorium was re- 
built and facilities for treating adults for both tuberculosis and cancer were pro- 
vided in the new building. The long hospitalization required for patients with 
extra-pulmonary forms of tuberculosis as well as their special needs had made 
them step-children at the established sanatoria and unwelcome guests in general 
hospitals. On the recommendation of a special commission, Lakeville Sanatorium 
was therefore converted into a hospital exclusively for the treatment of these 
patients. So, at least, the modern treatment of tuberculosis in all its forms was 
fully available. Later the Department was authorized by the legislature to admit 
cases of infantile paralysis to the Lakeville State Sanatorium, 
42 Another pioneering activity of the Department is the hospitalization of a 
limited number of patients with chronic arthritis. For a number of years the 
demand had grown for a new State hospital to be devoted solely to the care of 
medically indigent rheumatic patients. At the suggestion of the Department, 
and in response to this demand, the legislature authorized a study of the whole 
problem of the prevention and treatment of chronic arthritis in one of the large 
metropolitan hospitals. The Department, then contracted with the Massachusetts 
General Hospial for the care and study of not over twenty patients at a time. 
Besides furnishing treatment for a substantial number of medically indigent pa- 
tients, this project is providing invaluable findings on which to base further meas- 
ures for the prevention and treatment of this most disabling of chronic diseases. 
Control of Venereal Disease 
Achieves Divisional Status 
The year 1936 was marked by an event of far- 
reaching import to the campaign for the control 
of the venereal diseases. An article by Surgeon 
General Thomas Parran, U. S. Public Health Service, entitled “Why Don’t We 
Stamp Out Syphilis?” appeared in a popular magazine. This challenging 
question lifted the lid of censorship that had so long been clamped upon any 
discussion of the venereal diseases outside the scientific press and aided greatly 
in speeeding up state programs everywhere including that of the Massachusetts 
Department of Public Health. Here, the venereal disease control services were 
changed from a sub-divisional status under Communicable Diseases, and the 
Division of Genitoinfectious Diseases was established. 
Social Security funds permitted an immediate expansion of all activities, and 
efficient full-time case follow-up for the clinics—which had previously had only 
part-time service or none at all—was typical of the changes effected. Clinics and 
practicing physicians were supplied with arsenicals and the heavy metals (more 
recently the sulfonamides and penicillin were added). Treatment centers were 
improved and new ones organized as experience indicated their need, and the 
General Court amended the law to permit the State Department of Public 
Health to support existing clinics for the treatment of venereal diseases. Though 
the estimated total cost of treatment and services for syphilis and gonorrhea un- 
der this plan reached two-hundred thousand dollars a year, the financial burden 
could now be assumed by the Commonwealth. 
Patients no longer had to be identified to local boards of health in order to 
receive free treatment. It was also possible now to employ an epidemiologist— 
“female”—to give full-time attention to the follow-up for syphilitic pregnant 
women. Educational work was greatly accelerated, new literature was made 
available for distribution, and a lecture service was organized and radio broad- 
casting stepped-up. In anticipation of the Selective Service Act, plans were made 
with the U. S. Public Health Service and the military and naval authorities 
to meet the emergency involved in the military training of the National Guard 
and the civilian units at training camps throughout the Commonwealth. For the 
first time all selectees were examined serologically for syphilis and as a result 
of these tests, Massachusetts was found to have the second lowest syphilitic rate 
in the country. All infected men were followed-up to see that they received proper 
treatment. 
43 Crippled Children, Hospital 
Licensure, E. M. I. C., Et A1 
The variety and complexity of the independent 
activities undertaken by the Department of 
Public Health since the passage of the Social 
Security Act reflect in some measure the administrative burdens which present- 
day public health practice is imposing upon both State and municipal health de- 
partments. Simply to list a few of the State Department’s new activities—services 
for crippled children, hospital licensure, dental research and the Emergency Ma- 
ternity and Infant Care Program—will suggest even to the casual reviewer some- 
thing of the versatility which the modern health administrator must possess. 
Social Security funds enabled the Department of Public Health to expand 
and improve the limited services for crippled children which had been given since 
1925 at the Lakeville Sanatorium. The new services could not be placed on a 
statewide basis and the definition of a crippled child was broadened so that prac- 
tically all physically handicapped children who are medically indigent could be 
cared for. As the Department could not successfully carry out such a program 
of medical care without the active and sympathetic participation of the practicing 
physicians of the State, detailed plans for this service were presented to each of 
the district medical societies throughout the Commonwealth. Though this pro- 
cedure took several months, it was well worth the effort and the time, for it earned 
the good will of the members of the Massachusetts Medical Society. 
Physiotherapists and Social 
Workers Assigned to Districts 
The first clinic center for crippled children 
was established at Pittsfield late in 1936 and 
before the year was out ten others were under 
way. During this developmental period, all activities of the field staff were super- 
vised administratively and technically by the central office. As a result, these 
highly specialized services were rendered independently of other activities of the 
Department. Consequently, the staff of “Crippled Children” often were unaware 
of other departmental activities and many of the State Department’s other pro- 
fessional workers did not know what was being done for crippled children. More 
important still, the children themselves and their families did not receive the 
assistance of other departmental specialists such as public health nurses and 
nutritionists. This condition was corrected as soon as the health districts were 
reorganized, when the field staff of the Services for Crippled Children was trans- 
ferred to these district units so that complete care of the crippled child became 
an integral part of departmental activities. 
More than three thousand children have been accepted for care, nearly two- 
thirds of whom have been discharged because their crippling condition had been 
removed or improved, or because they had reached the age of twenty-one. 
There are now in excess of eleven hundred children on the active list and this 
number seems to have reached an equilibrium, the number of children discharged 
being about equal to the number admitted each year. Appliances have been 
liberally provided and all needed physical therapy treatments have been given. 
The children under the care of the service have had the unlimited aid of the pub- 
lic health social workers. As a result of this effort, and the work of the many 
non-official agencies rendering aid, no handicapped child need go untreated. 
Ample resources are available for the care of every needy child. Vigorous effort 
is made to locate untreated crippled children but few are now being found. 
44 Medical Social Service 
Prospers 
The growth of medical social service in the Depart- 
ment tells its own story. In the dim past when 
Chamberlain-Kahn funds were briefly available for 
venereal disease control activities, one medical social worker had been rather 
gingerly employed. The value of her services was so evident that she stayed on 
when Federal funds were no longer available. Then, when Dr. Bigelow became 
Commissioner, he appointed a supervisor of social service directly responsible to 
him—his goal, apparently, to develop a general service available to any division 
whose director might have the foresight to use it. The new supervisor began her 
work in the field of cancer, which was then being cultivated to meet the social 
needs of the patients in the State-aided clinics, and as the first fruit of her effort, 
a full-time, resident social worker was appointed for the Pondville Hospital. 
A year or two later we find two assistant social workers assigned to help meet the 
needs of this institution. 
Next, tuberculosis was to visualize the need of social service. Concerned 
about the long lists of patients awaiting admission to sanatoria, and particularly 
the number of persons seeking readmission, the Director of the Division asked 
for a social worker to assist with the solution of these problems in tuberculosis 
control. Two had been appointed in 1929. But it was at the time that State 
aid for crippled children was organized that the liveliest need for social service 
became fully evident. At first, only two qualified workers could be found; now 
there are many. Curiously enough, the most recent use of social services in a 
field where the need has long been felt seems to have been in one of the longest 
established projects, the child hygiene program. One worker was appointed 
in 1940 to survey the social needs, to consult with the local nurses and nursing 
agencies, and to participate in the teaching program. The point to be noted is 
that up to this time medical social service had been offered on a specialized 
basis. Then a radical change was made; all social workers except those in the 
institutions were officially assigned to the district offices for generalized service. 
Space permits only a sampling of the variety of functions of the Dental 
Hygiene Bureau. Oral hygienists inspect the teeth of preschool children at the 
well child conferences; school surveys to show dental deficiencies are made upon 
request; lectures on dental health are given at all State teachers colleges, at the 
Tufts Dental College and Harvard School of Public Health. More recently the 
Dental Hygiene Bureau has numbered among its diverse activities licensing of 
dental clinics, the Victory Dental Corps Program—which has promoted dental 
care for “high schoolers” during wartime—and the beginning of a five-year 
study of the result of the topical application of fluorine to children’s teeth. As 
an example of the strange combinations which intradepartmental cooperation 
may induce, we find the sewage experimental station staff collaborating with the 
oral hygienists. For, parallel with the Dental Bureau’s study of fluorine, the 
Experiment Station has developed a chemical water analysis for fluorine which 
requires only about 5% as much time as other methods. This test will make 
it possible for the Department to contribute its help to research if fluorine con- 
tinues to arouse as much scientific interest as it does at present. 
45 Public Health 
Nursing Systematized 
Through the years public health nursing suffered a 
Topsy-like growth. In the early days, nurses—usually 
called health educators or assistants to the district 
health officers—were employed by one division or another as the need became 
apparent. 
Some hint of the variety of activities which, in one way or another, became 
a part of public health nursing in the early may be caught in the reminiscent 
comment of Miss M. Gertrude Martin, R.N., who alone of the original eight as- 
sistants to the district health officers appointed in 1918, remains in the Depart- 
ment. In their districts the public health nurses promoted the Department’s 
many faceted communicable disease program through their inspired educational 
efforts. They knew their communities, and from their knowledge they formu- 
lated practical programs of generalized nursing service. They knew the nurses 
of their communities too, and visited with them in the homes, reviewing with 
them their achievements and problems. When “health weeks” were called for, 
the district nurses did the “leg work”; they arranged exhibits, gave talks, and 
saw to it that the press did not allow the “week” to go unnoticed. Well child 
conferences, tuberculosis diagnostic clinics, diphtheria immunization clinics and 
the like, all made their demands upon the “willing and able” services of the 
Department’s public health nurses. 
When the legislature handsomely opened the public purse for health work 
in the early twenties, the State was districted for public health nurses but their 
assigned areas bore little relation to the territories of the health officers. The 
nursing districts became smaller and smaller as the nurses increased in number, 
but this type of organization left much to be desired from the point of view of 
efficiency. When Social Security funds became available the entire district ad- 
ministration was reorganized. The nursing staff increased to seventeen, of which 
eight supervisory nurses were assigned to the district health offices and a gen- 
eralized nursing service undertaken. 
Hospitals Are 
Licensed 
Soon after the legislature enacted a law authorizing the De- 
partment to license hospitals and sanatoria, an Advisory Com- 
mittee consisting of practicing physicians, hospital adminis- 
trators and trustees was appointed. With the aid of this committee, regulations 
for the various phases of hospital management were established which, with the 
rules of the State Department of Public Safety, have done much to improve con- 
ditions under which the hospitals of the State are conducted. No hospital is 
licensed until it has been inspected by the Department representatives, certified 
by the local board of health as suitable, approved by the Department of Public 
Safety from the standpoint of accident hazard and fire protection, and by the 
Division of Sanitary Engineering of the Department of Public Health from the 
standpoint of water supply and sewage disposal. One of the beneficient results 
of this program has been the closing of a number of institutions which were en- 
tirely unsuitable for hospitals, or their conversion into nursing homes. In other 
instances hospitals which most surely would have been unfit have been pre- 
vented from opening. At the same time, it has been possible to encourage the 
establishment of hospitals where they were needed in communities otherwise 
without such facilities. All out-patient departments and clinics associated with 
hospitals are similarly inspected and licensed by the Department. 
46 Physicians and Department 
Collaborate for E.M.I.C.’s 
Success 
Certainly not least in its potentialities for far- 
reaching consequences—though listed last—is 
EMIC. Emergency Maternity and Infant Care, 
as planned by the Division of Child Hygiene and 
in conformity with the rules and regulations of the Children’s Bureau of the 
United States Department of Labor, includes free prenatal, delivery, hospital, 
and postnatal care for the wives and infants of servicemen in certain pay grades. 
Throughout its history, the Division of Child Hygiene had meticulously limited 
its activities to guidance of parents of well children, studiously avoiding all mat- 
ters of medical diagnosis and treatment, but now the Division found itself almost 
overnight deep in the ramifications of public medical care. The decision to 
adopt this program precipitated on the Department an avalanche of applicants. 
For the first week it took practically the entire time of all the staff of the Divi- 
sion of Child Hygiene, just to answer the questions of applicants who came to 
the State office in person. For the first month hundreds continued to come— 
many prospective mothers applying personally, accompanied by husbands in 
uniform. Indeed, so many in the last days of pregnancy continued to appear 
that an emergency obstretical kit was kept handy in the Division office. During 
the first thirty days more than two thousand applications were received, and 
during the first year a level of more than fifteen hundred per month was main- 
tained steadily. Approximately two thousand physicians and one hundred and 
thirty-three hospitals in the Commonwealth cooperated in this program during 
its first year. Two technical committees—one in pediatrics and one in obstetrics 
—are given assistance of the greatest value not only in the formulation of this 
program but in directing its policies. 
Local Health Administration— 
Newest Child of Departmental 
Family 
The last change in departmental organiza- 
tion, which the Federal grant made pos- 
sible, is the establishment of a Division of 
Local Health Administration. This Divi- 
sion is the inevitable outcome of the growth of the field activities of the De- 
partment. Through the years of growth each of the divisions employed more 
and more field workers who went about independently into local communities, 
each responsible only to his own division director. Often the district health 
officer had not even known of the visit. Sometimes local communities had 
found themselves in that distressing dilemma in which one State worker had 
recommended one mode of action and another had recommended a conflicting 
method. This unhappy situation was relieved when steps were begun to assign 
field personnel to districts and to place them under the supervision of the district 
health officer. In 1943 this realignment was accelerated and all eight districts 
were reorganized with administrative, professional and clerical staffs—all re- 
sponsible to the Division of Local Health Administration. 
A new position, that of district sanitary officer, was also made possible by 
Social Security funds. His duties are to work directly with local boards of health 
and local inspectors on problems of environmental sanitation—refuse and gar- 
bage disposal, private water supplies and private sewage treatment, milk sanita- 
tion and the inspection of eating places. As soon as appointments can be com- 
pleted, district sanitary officers will be assigned to each of the eight health dis- 
tricts. 
47 FEDERAL SECURITY 
AGENCY 
ADVISORY 
COMMITTEES 
COMMISSIONER 
DEPT. OF LABOR AND INDUSTRIES 
1 
JTJx&T] 
liamtMT | 
Vlado Cofflmiui«ntr 
i » 
OCCUPATIONAL 
HYGIENE 
CANCER AND OTHER I 
CHRONIC DISEASES * 
( CANCER I 
I CONTROL j 
| BERKSHIRE | 
1 COOPERATING | 
CLINICS | 
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH 
ORGANIZATION 
[personnel 1 
j RECORDS I 
BIOLOGIC 
LABORATORIES 
j BLOOD | 
| PROCESSINO j 
J STATISTICAL] 
I RESEARCH | 
f CONNECTICUT j 
| VALLEY j 
ADMINISTRATION 
j HEALTH I 
| INFORMATION | 
[antitoxin tj 
j VACCINE I 
VENEREAL 
DISEASES 
1 
|v.P.COWTROC| 
(hospital 1 
1 LICENSING | 
[jjcooniurwc] 
j CLINICS ] 
|NORTH CENTRAL | 
SANITARY 
ENGINEERING 
I LAWRENCE ) 
I EXP. STATION I 
SEWAOE j 
DISPOSAL j 
GOVERNOR 
AND EXECUTIVE COUNCIL 
1 
- COMMISSIONER 
[ FISCAL [ 
j WATER I I 
] LAaOflATORY[ j 
. 1 , 
WATER I 
| SUPPLIES ] 
| NUTRITION | 
| SOCIAL | 
) SERVICE ( 
DISTRICTS 
| SOUTH CENTRAL | 
LOCAL HEALTH 
ADMINISTRATION 
MATERNAL 
AND CHILD HEALTH 
I CRIPPLED 1 
I CHILDREN I 
j MATERNAL,I 
j PRESCHOOL j 
I PUBLIC HCAiml 
j NURSING I 
[sanitation! 
HEALTH 
j NORTHEASTtRN| 
| E.W.LC. | 
I SCHOOL | 
| HEALTH } 
I 
COMMUNICABLE 
DISEASES 
|«pio«miou>oy| 
NORTH 1 
{METROPOLITAN [ 
DEPUTY 
COMMISSIONER 
I'rOMDVIuiri 
HOSPITAL I 
FOOD AND DRUGS 
1 
I WESTFIELD j 
|LASORArORY| 
I INSPECTION 1 
j SERVICE j 
[DIAGNOSTIC! 
I LABORATORY j 
(rooo 4 ORUC I 
[lasor atopy] 
CLINIC 1 
service I 
I WESTFIELD"! 
j SANATORIUM | 
SOUTH 1 
I METROPOLITAN { 
I TUBERCULOSIS j 
[RUTLAND j 
SANATORIUM] 
j DENTAL HEALTH I 
[tukrculmm] 
I CONTROL I 
UoUTH EASTERN [ 
PUBLIC HEALTH L 
COUNCIL " 
|MO*T* RUTH*#] 
{SANATORIUM [ 
(LAKEVILLE I 
SANATORIUM! 
Jw>4 i. 1946. 
48 In the realignment of the health districts, several factors were taken into 
consideration; among them, total population in communities over 25,000, local 
health facilities, lines of transportation and area in square miles. The district 
health officers are assisted by a basic professional and clerical staff consisting, 
in general, of a public health nursing supervisor, an infant welfare field nurse, a 
sanitary engineer, a sanitary officer, a physiotherapist, a medical social worker, 
a public health education worker, a nutritionist and several clerk-stenographers. 
The district health officer, as representative of the Commissioner, is responsible 
for the entire program of the Department in his district. Who will challenge 
our assertion that this community localization of State health services is the 
most efficient, and should prove the most potent, influence for improving local 
health department programs? 
The story of today is tomorrow’s history. This recounting of the long 
years of service rendered to the Commonwealth by the Department during its 
three-quarter century of life, would not be complete without some final com- 
ment upon its present activities. Anyone who has followed this story to this 
point, and who is at all familiar with public health administration can create his 
own picture of the Department at work today by glancing at the accompanying 
organization chart. 
The organization chart testifies to the diversities of the day-to-day activities 
of the State Department of Public Health, but broad as is the coverage of its 
services, simply to list all the divisions and bureaus fails to picture the unusual 
functions which the complexity of modern living has placed at the door of the 
Department. 
A comparison of the two charts—191’5 and 1946—indicates some of the 
changes made in the organization of the Department. Since the time of the re- 
organization of 1915, its activities have more than doubled. New officers were 
appointed and new divisions created from time to time without complete co- 
ordination of their activities, and with the passage of the years arrangements 
originally beneficial have proved no longer of value, so it became necessary to 
alter these relationships. It seemed wise to change the names of some of the 
divisions, as will be noted in the charts. 
Sanatoria and 
Tuberculosis 
Merely to name the five great hospitals which the legislature 
placed under the direction of the Division of Sanatoria and 
Tuberculosis is sufficient to portray the extent of the adminis- 
trative obligations imposed upon this Division. But it performs many more 
services to the Commonwealth than these administrative activities. Conspicu- 
ous among them are the mobile and portable X-ray units, by means of which 
industrial employees, high school students and teachers—among other groups— 
are given chest X-ray examinations. More than one hundred thousand persons 
are given the benefit of these examinations each year. Although many active 
cases of tuberculosis are found through these industrial surveys, many tuber- 
culous persons so found refuse sanatorium care because of wartime demands for 
labor and the temptations of high wages. These people injure themselves, their 
families and their associates. Follow-up services to persuade reluctant patients 
to care for themselves and to induce persons in contact with open cases to protect 
themselves are some of the collateral activities growing out of the industrial 
services. • c* > 
49 Administration 
Under the Division of Administration are two bureaus which 
are essentially new in their present programs. In the Bureau 
of Health Information are centralized all the diverse activities which go to make 
up the present day public health education program. In addition to the prepara- 
tion of the accepted visual aids which state departments employ in health pro- 
motion, the Bureau has initiated health education programs in junior and senior 
high schools when this promotional service has been requested. In addition to 
the usual services which a health library carries out, the Department library— 
which is a part of this Bureau—acts as an agency for supplying new and unusual 
material to the district offices. 
The Hospital Licensing Bureau has extended its inspection and licensing 
function of dispensaries and clinics as well as to the hospital, for the improve- 
ment of which this Bureau was originally created. 
Biologic Laboratories Celebrating its fiftieth anniversary in conjunction with 
the Department’s seventy-fifth, the Division of Biologic 
Laboratories enters now upon its second half-century of service, continuing to 
produce its familiar list of biologies even though military demands have cur- 
tailed its personnel. In addition to the manufacture of vaccines and serums for 
physicians and institutions of the State, the Laboratory plans to undertake the 
important function of processing blood and providing plasma and fractions of 
plasma, which war experience has shown to be of such great preventive and 
therapeutic value. 
Cancer and Other 
Chronic Diseases 
The new divisional designation is a more realistic name 
than “Adult Hygiene” by which this Division was called. 
In addition to the State cancer clinics, which continue to 
enjoy an increasing attendance from year to year, and the tumor diagnostic 
service which also grows in scope, the Division has undertaken a series of cancer 
symposia in different sections of the State—the first project of this kind to be 
carried out on a local basis in the United States. 
The effect of the fifteen-year old cancer preventive program may be measured 
by the average interval between the onset of the first symptom of cancer and 
the first visit of the patient to the physician. Twenty years ago the interval 
between onset and first visit was over six months. Today it is three months. The 
thesis of this division is that the interval can, and will, be further reduced when 
the public is led to accept the teaching that the sooner the doctor can give treat- 
ment, the better is the chance of cure. 
Local Health 
Administration 
Youngest of all the Department’s family, having been created 
in May of 1944, is Local Health Administration. Some 
measure of the complexity of its activities will be gained 
from a review of the recent organization chart. Not only is this Division charged 
with the administration of the eight district offices, but it is responsible for the 
five bureau activities of Dental Health, Public Health Nursing, Nutrition, Social 
Service, and Sanitary Inspection. 
The activities of the Nutrition Bureau are concerned with the giving of 
advice to local nutritionists, but in addition assistance is given to municipalities 
for the improvement of school lunches, nutritional education programs and the 
training of new workers. 
50 Generalized public health nursing has long been the goal of Nestors of public 
health, but the generalized medical social service program of the Social Service 
Bureau is unique. The State Department’s experience has revealed that the 
results achieved by the medical social worker can be greatly enhanced through 
the cooperation of other staff members of her district. Local health and social 
agencies call for the services of these workers whose interests cut across such 
divisional activities as tuberculosis, crippled children services, maternal and 
child health, cancer and venereal diseases. 
Venereal Diseases To its conventional tripod—clinic service, casefinding and 
education—the Venereal Disease Division, newly released 
from “Genitoinfectious Diseases,” has undertaken promising ventures in the field 
of research. Penicillin is distributed to the cooperating clinics and certain 
hospitals throughout the State. Standards of treatment with the new drug for 
both gonorrhea and syphilis have been promulgated and a study of the collected 
experience of the several agencies should add to our knowledge of the therapeutic 
value of penicillin. Gonococcal culture service also is extended to all physicians 
in the Commonwealth. 
Communicable Disease In addition to the continuing epidemiologic aid to local 
boards of health which the name “Communicable Di- 
sease” implies, the division, handicapped as it has been by the loss of professional 
personnel to the armed services, has carried on two noteworthy activities. One 
has been the laboratory approval program by which local laboratory performance 
throughout the State has been greatly improved. All laboratories which examine 
specimens from cases of communicable disease may come voluntarily under this 
supervision. Associated with this as a collateral activity is the establishment 
of refresher courses for laboratory technicians; the course being given at the 
Pratt Diagnostic Hospital and supported by the Commonwealth Fund. Each 
year twenty students selected by the Division receive this training, and this 
program, too, has done much to improve laboratory performance. 
The change from the earlier name of “Child Hygiene” to 
that of “Maternal and Child Health” makes the title 
descriptive of the broad program of this division. E.M.I.C. 
is but one of the newer activities. In less than a year and a half fifteen thousand 
applications for maternity and pediatric care were processed, and by the end of 
the year 1944 over a million dollars had been expended in the Commonwealth for 
the care of wives and children of servicemen. 
Services for Crippled Children, recently transferred to the Division of 
Maternal and Child Health, continue to increase in volume and effectiveness. 
The outbreak of anterior poliomyelitis was responsible for part of the current 
increase, but much is due to the continuing search throughout the State for 
children needing care. The field staff for Crippled Children Services, consisting 
of six physiotherapists, a supervisor of public health nursing, a supervisor of 
speech therapy, the part time of six public health social workers, gave a total of 
over thirty-five hundred treatments and made over forty-three hundred visits 
pertaining to the welfare of these patients. 
Maternal and Child 
Health 
51 50 
45 
40 
• TOTAL PROSECUTIONS 
0 0 SLAUGHTERING IN ABSENCE OF INSPECTOR 
• • SELLING UNSTAMPED MEAT 
35 
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YEAR 
52 Sanitary Engineering The mention of the words “environmental sanitation” 
visualizes enormous numbers of water examinations 
completed, inspections of water and sewage treatment plants made, and stream 
surveys to detect pollution carried on throughout the State. But the present-day 
program of the Division of Sanitary Engineering covers a far wider range. Plans 
are approved for new water supplies and sewage disposal plants. The Division, 
among a host of other activities, investigates offensive trades, collects water 
samples from bathing beaches in the Metropolitan area, inspects waters where 
shellfish are grown, approves or prohibits the taking of shellfish from coastal 
waters depending upon whether they are safe or polluted. The oldest Division 
continues among the leaders in volume of services rendered. 
Food and Drugs Examinations of samples of milk, food and drugs, and the 
sanitary inspection of bakeries, soft drink plants, ice cream 
factories and pasteurizing plants, are the type of service one anticipates of the 
Division of Food and Drugs. It does all these well, but it carries on a wide 
variety of other examinations. The days are none too long to find time for 
court cases, dissuading venturesome souls from endangering health and life, and 
protecting the public from human carelessness. Among its unusual activities 
is the biological assay of Vitamin D in milk and of other vitamins in a variety 
of foods and drugs. That a goodly proportion of samples examined is still 
found deficient in the claimed vitamin content is an indication of the need for 
this venture in food and drug control. 
Although this story may seem to the reader unnecessarily detailed, no written 
account, however long, can do justice to the work of so wide-ranging an agency 
as the Massachusetts Department of Public Health with its fifteen hundred 
employees scattered from Barnstable to Berkshire. Really to know the Depart- 
ment it is necessary to “come and see” it. That is the invitation that the De- 
partment extends to all who collaborate with it. 
53 APPENDIX 1 
EXCERPTS FROM: 
REPORT 
of a 
GENERAL PLAN 
for the 
PROMOTION OF PUBLIC AND PERSONAL HEALTH 
Devised, Prepared and Recommended 
by the 
COMMISSIONERS 
Appointed Under a 
Resolve of the Legislature of Massachusetts 
Relating to a 
Sanitary Survey of the State 
Presented April 25, 1850 
Boston: 
Dutton & Wentworth, State Printers 
No. 37, Congress Street 
1850 
Report of the Commissioners 
The Commissioners appointed on the third day of July last “to prepare and 
report, to the next General Court, a plan for a Sanitary Survey of the State, 
embracing a statement of such facts and suggestions as they may think proper to 
illustrate the subject,” have considered the matters referred to them, and submit 
their Report. 
We believe that the conditions of perfect health, either public or personal, 
are seldom or never attained, though attainable; that the average length of 
human life may be very much extended, and its physical power greatly aug- 
mented; that in every year, within this Commonwealth, thousands of lives are 
lost which might have been saved; that tens of thousands of cases of sickness 
occur, which might have been prevented; that a vast amount of unnecessarily 
impaired health, and physical debility, exists among those not actually confined 
by sickness; that means exist, within our reach, for their mitigation or removal; 
and that measures for prevention will effect infinitely more, than remedies for 
the cure of disease. 
But whom does this great matter of public health concern? By whom is 
this subject to be surveyed, analyzed, and practically applied? And who are 
to be benefited by this application? Some will answer, the physician, certainly. 
True, but only in a degree; not mainly. It will assist him to learn the causes 
55 of disease; but it will be infinitely more valuable to the whole people. The people 
are principally concerned, and on them must depend, in part at least, the intro- 
duction and progress of sanitary measures. 
In a subject of such vast importance, on which so little is generally known, 
and so much ought to be universally known, and which is so full of interesting 
and useful illustrations, it is difficult to confine ourselves within the limits of a 
single report of reasonable length. Yet, in our judgment, it would be unworthy 
of Massachusetts, under whose authority we act, and it certainly would be un- 
satisfactory to ourselves, if we failed to make the attempt, at least, to present 
the subject so that the people of the state may know what we mean; so that 
they may be able, if they choose, to carry our recommendations into practical 
operation; and so that, if thus applied they will add to their physical power and 
increase their intellectual, social, and personal happiness. 
It should be born in mind, however, that this report is designed to suggest 
a plan for a sanitary survey of the state, and not to contain the survey itself. 
We were authorized, however, by the resolve, to embrace a statement of such facts 
and suggestions as we might think proper to illustrate the subject. We have 
accordingly been at no inconsiderable labor and expense to obtain the most recent 
authentic information concerning the history and present condition of the sanitary 
movement; and we shall proceed to give some of the results of the investigation, 
before presenting our plan for a sanitary survey of this state. 
The Sanitary Movement at Home 
Sanitary Police. Some historical notice of the sanitary legislation of Massa- 
chusetts seems proper, preliminary to any statements of its present condition. 
The subject seems to have received little attention from the General Court, during 
the old colonial charter. Two acts, which have some relation to it, we shall 
presently notice. Laws were passed by the provincial government, relating to 
nuisances, drainage, smallpox, and some other matters; many of which were 
special acts, or partial in their operation. But though imperfect, they are 
honorable to the state, and exhibit the care which the Legislature has ever wished 
to exercise over the people. To them we have been indebted for many excellent 
sanitary municipal regulations which have continued until the present time. 
Nuisances. In 1692 and 1708, acts were passed, providing that “in Boston, 
Salem, Charlestown, respectively, and other market towns in the province,” 
“slaughter-houses for killing of meat, still-houses, and houses for the trying of 
tallow, currying and dressing of leather be assigned by the selectmen to places 
where it may be least offensive,” and prohibited elsewhere. The Revised Statutes 
modified this act, and extended its provisions to any town in the state, at the 
option of the selectmen, and included “any trade or employment offensive to the 
inhabitants, or dangerous to the public health.” 
Drainage and Sewerage. In 1702, an act was passed providing “for ap- 
pointing commissioners of sewers, for the draining and removing of the banks 
and obstructions of the passage of waters in rivers, brooks, or ponds that oc- 
casion the overflow and drowning of meadows and low lands; and also for the 
draining and flowing of swamps and other unprofitable grounds, and drying 
of them.” 
56 Sickness. Legislation on this subject, principally with reference to the small- 
pox, has been frequent in the history of the State. As early as 1701, “an act 
providing in case of sickness,” was passed, “for the better preventing the spread- 
ing of infection.” 
Quarantine. In 1700, the masters of ships were required to furnish a list of 
all passengers to the selectmen of towns, and give security for the support of 
any “impotent, lame, or infirm person” who might be discharged. At a subse- 
quent period, not exactly known, a hospital was erected on Spectacle Island, by 
the town of Boston; in 1799 the whole quarantine regulations were transferred 
to the Boston Board of Health; and there it rested, as it always should have 
done, until the Revised Statutes were passed. 
(After reviewing a tragic century of epidemics of smallpox, cholera, scarlet 
fever, typhus, and yellow fever, all of “uncommon malignity” this section con- 
cludes with these paragraphs:) 
It is proved that causes exist in Massachusetts to produce premature and 
preventable deaths, and hence unnecessary and preventable sickness; and that 
these causes are active in all the agricultural towns, but press most heavily upon 
cities and populous villages. 
It is proved that measures,—legislative, social and personal,—do not at 
present exist, or are not so fully applied, as they might be, by the people, for the 
prevention, mitigation, or removal, of the causes of disease and death. 
It is proved that the people of this state are constantly liable to typhus, 
cholera, dysentery, scarlatina, smallpox, and the other great epidemics; and to 
consumption, and the other fatal diseases, which destroy so many of the human 
race in other parts of the world. 
It is proved that the active causes of disease and death are increasing among 
us, and that the average duration of life is not as great now as it was forty or 
fifty years ago. 
Plan for a Sanitary Survey of the State 
We now proceed to give an outline of a plan for the Sanitary Survey of the 
state which we propose for adoption. 
Our plan consists of a series of measures, which may be rendered permanent 
if desired, presented in the form of separate recommendations. They are divided 
into two classes, and are to be regulated and controlled by the agencies which are 
proposed to be established; one by the legislative authority of the State, and 
the municipal authorities of towns and cities, and the other by social organiza- 
tion and personal action. Some of these measures are of great magnitude, and 
would each furnish matter for a volume, if fully explained and illustrated. All 
we propose to do in this connection is, to name and define each, and to give a 
brief explanation and illustration of its character and design. These measures, 
it must be recollected, however, are only a series of plans by which a sanitary 
survey might be carried forward. The accompanying information is inserted 
merely to illustrate these plans. 
State and Municipal Measures Recommended 
We recommend that the laws of the state relating to Public Health be 
thoroughly revised, and that a new and improved act be passed in their stead. 
57 We recommend that a general Board of Health be established, which shall 
be charged with the general execution of the laws of the state, relating to the 
enumeration, the vital statistics, and the public health of the inhabitants. 
We recommend that the Board, as far as practicable, be composed of two 
physicians, one counsellor at law, one chemist or natural philosopher, one civil 
engineer, and two persons of other professions or occupations; all properly 
qualified for the office by their talents, their education, their experience, and 
their wisdom. 
We recommend that a local Board of Health be appointed in every city 
and town, who shall be charged with the particular execution of the laws of the 
state, and the municipal ordinances and regulations, relating to public health, 
within their respective jurisdictions. 
We recommend that local Boards of Health endeavor to carry into effect 
all their orders and regulations in a conciliatory manner; and that they resort to 
compulsory process only when the public good requires it. 
We recommend that the successive enumerations of the inhabitants of 
the state be so made, abstracted, and published, that the most useful and desirable 
information concerning the population may be ascertained. 
We recommend that the laws relating to the public registration of births, 
marriages, and deaths be perfected and carried into effect in every city and 
town of the state. 
We recommend that, as far as practicable, there be used in all sanitary 
investigations and regulations, a uniform nomenclature for the causes of death, 
and for the causes of disease. 
We recommend that the local Boards of Health provide for periodical house- 
to-house visitation, for the prevention of epidemic diseases, and for other sani- 
tary purposes. 
We recommend that measures be taken to ascertain the amount of sickness 
suffered in different localities; and among persons of different classes, professions, 
and occupations. 
We recommend that the causes of consumption, and the circumstances under 
which it occurs, be made the subject of particular observation and investigation. 
We recommend that nuisances endangering human life or health be pre- 
vented, destroyed, or mitigated. 
We recommend that a sanitary association be formed in every city and 
town in the state, for the purpose of collecting and diffusing information relating 
to public and personal health. 
We recommend that public bathing-houses and wash-houses be established 
in all cities and villages. 
We recommend that, whenever practicable, the refuse and sewage of cities 
and towns be collected, and applied to the purposes of agriculture. 
We recommend that local Boards of Health, and others, interested, endeavor 
to prevent the sale and use of unwholesome, spurious, and adulterated articles, 
dangerous to the public health, designed for food, drink, or medicine. 
We recommend that institutions be formed to educate and qualify females to 
be nurses of the sick. 
We recommend that persons be specially educated in sanitary science, as 
preventive advisers as well as curative advisers. 
We recommend that parents, and others to whom the care of those in infancy 
58 and childhood are entrusted, endeavor to understand and discharge their duties 
so that a good foundation may be laid for vigorous manhood and old age. 
Reasons for Sanitary Survey 
The sanitary reform we advocate is not like some of the popular reforms of 
the age. It rests upon no visionary theories, conceived alone in the closet, or 
by some impracticable enthusiast. It aims at the establishment of no abstract 
principle, with no definite, practical bearing or application. It is not radical 
in its character or tendency; does not seek to overturn nor upturn any social, 
political or religious sentiment or institution; nor abrogate any constitutional or 
statute law. 
Every person in every station, can do something to promote this reform; 
and every such effort, wisely directed, will increase the amount of his own 
individual enjoyment, and add to the aggregate enjoyment of the people of the 
whole Commonwealth. 
Massachusetts has always been eminent among the American states. Her 
metropolis has ever been the metropolis of New England. Her example has 
been imitated and her influence has been felt, wherever the sons of New England 
are found, or the name of New England is known. 
She established in the United States the first system for the public registra- 
tion of births, marriages, and deaths, by which the personal history and identity, 
and the sanitary condition of the inhabitants, may be ascertained. She founded 
the first Blind Asylum; the first State Reform School; and aided in founding 
the first Deaf and Dumb Asylum; and her money, public and private, has 
flowed freely in the support of all the noble charities and religious enterprises of 
the age. 
One of her sons first introduced into the United States the remedy of vac- 
cination for the prevention of smallpox, which has deprived that terrific disease 
of its power, whenever used, and rendered its approach generally harmless. 
Another of her sons has the honor of making the great discovery of etherization, 
by means of whose wonderful capabilities the surgeon’s instrument is deprived of 
its sting, and labor of its sorrow; the operator is permitted to pursue his work 
undisturbed while the patient remains passive, unconscious, and unmoved by 
the horrors which, without it, might be inflicted. 
On the pages of her history are recorded the noble deeds which have given 
her a good name and rendered her glorious. But her people demand at her hands 
a more full enjoyment of life, and a more abundant diffusion of its blessings; and 
no more noble and honorable and glorious page can anywhere be found, than 
that which shall record the adoption of some simple but efficient and compre- 
hensive plan of Sanitary Reform; by which the greatest possible amount of 
physical power may be produced, the greatest possible amount of physical suf- 
fering may be prevented, and the greatest possible amount of physical, social, 
and moral enjoyment may be attained. “This is the true glory which outlives 
all other, and shines with undying lustre, from generation to generation, impart- 
ing to its works something of its own immortality.” 
All which is respectfully submitted. 
Lemuel Shattuck, 
N. P. Banks, Jr., 
Jehiel Abbott, 
Boston, April 25, 1850 
Commissioners. 
59 APPENDIX II 
CHRONOLOGICAL LIST OF DATES 
RELATING TO 
PUBLIC HEALTH IN MASSACHUSETTS 
1630 Recording of births and deaths begun in Boston. 
1721 Smallpox inoculation begun by Zabdiel Boylston. 
1797 Law passed authorizing local boards of health. 
Householder to notify local board of health of dangerous diseases: small- 
pox specifically mentioned. 
1801 Benjamin Waterhouse introduced use of “Cowpox Vaccination.” 
1809 Law passed requiring appointment of Public Vaccinators. 
1827 Doctors required to report dangerous diseases. 
1837 Public Vaccinator law repealed. 
1846 First Vital Statistics Report for Massachusetts. 
1850 Report of the Sanitary Commission by Lemuel Shattuck. 
1855 Compulsory smallpox vaccination law passed. 
1869 Law enacted creating State Board of Health; Dr. Henry I. Bowditch 
named chairman. 
1871 In the “Offensive Trade” Act to regulate slaughtering, the Board of 
Health received its first executive power. 
Reports of prevalent causes of illness and death from selected correspond- 
ents. 
1873 First Annual Report of Boston City Health Department. 
1879 State Board of Health given general supervision of all streams and ponds. 
State Board of Health merged into State Board of Health, Lunacy and 
Charity. 
1880 Dr. Henry Pickering Walcott elected Health Officer of Board of Health, 
Lunacy and Charity. 
1882 First Food and Drug Law passed. 
1883 Smallpox made reportable to Board of Health. 
Manual of Health Laws first compiled (revisions in 1886, 1893, 1915, 
1922, 1929, 1938). 
Four chemists and two inspectors appointed to begin food and drug work. 
Chemical work done in private laboratories. 
1884 Massachusetts Drainage Commission formed. 
Diphtheria made reportable. 
1886 State Board of Health reestablished as independent agency. 
Department of Water Supply and Sewerage established by State Board. 
1887 Lawrence Experiment Station created by the State Board of Health. 
1888 Board recommends establishment of State vaccine laboratory. 
1889 Influenza outbreak. 
1890 Formation of Massachusetts Associated Boards of Health. 
First Trickling Filter. 
61 1891 Food and Drug Laboratory established by the Board. 
1893 “Dangerous diseases” made reportable (list did not include tuberculosis). 
Lawrence Water Filter. 
1894 Board undertook production and free distribution of diphtheria antitoxin. 
Completion of main part of North Metropolitan Sewerage System. 
Bacteriologic diagnosis of diphtheria by Worcester Board of Health. 
1895 Bacteriologic laboratory services begun by Dr. Theobald Smith at Anti- 
toxin Laboratory. 
Circular of information about tuberculosis issued by the Board. 
Massachusetts Hospital for Consumptives and Tubercular Patients au- 
thorized. 
Report on Metropolitan Water Supply Study. 
School Inspection in Boston, 
1896 The Vital Statistics of Massachusetts—a Forty-Year Summary—in annual 
report. 
1897 Diagnostic Bacteriology service begun in laboratory at State House. 
1898 First medical inspector appointed. 
First State sanatorium for tuberculosis in the United States opened at 
Rutland. 
1899 W. F. Whitney’s study of cancer authorized by Board. 
1901 Widal test made available to State. 
Board given powers to regulate shellfish industry. 
1903 Report on value and application of coliform tests as index of water pollu- 
tion. 
Vaccine lymph production and distribution authorized. 
1904 New building completed for Antitoxin and Vaccine Laboratory. 
Completion of main part of South Metropolitan Sewerage System, then 
the largest water supply reservoir in the country. 
1905 Systematic dairy inspection begun. 
Ophthalmia neonatorum made reportable. 
Completion of Wachusett Reservoir of Metropolitan Water System, then 
the largest water supply reservoir in the country. 
1906 Monthly Bulletin issued. 
1907 State inspectors of health appointed. 
Tuberculosis made reportable. 
Polio report issued. 
1909 Typhoid carriers first recognized. 
North Reading State Sanatorium opened. 
1910 Silver nitrate furnished for eyes of newborn. 
Emergency pasteurization put into use. 
Westfield and Lakeville State Sanatoria opened. 
1911 Slaughtering inspection transferred to State Board of Health. 
Outbreak of septic sore throat (1200 cases). 
First activated sludge experiments. 
1912 Special investigation of poliomyelitis; monograph issued. 
Typhoid vaccine production begun. 
62 1914 State Department of Health supersedes State Board. 
Systematic dairy inspection ceased due to law transferring this work to 
local Boards of Health. 
1915 Division of Hygiene began its educational projects, and child hygiene 
activities. 
State Wassermann Laboratory opened. 
Two public health nurses, called “educators,” appointed. 
Manufacture of arsphenamine begun by Food and Drug Division. 
1917 Framingham demonstration of community tuberculosis control. 
Pneumonia study; disease made reportable. 
Production of pneumococcic serum, Types I and II. 
“Health Instructor in Foods” appointed. 
Antitoxin and Vaccine Laboratory granted Federal License #64 authoriz- 
ing manufacture and interstate sale of biologic products. 
Harvard Cancer Commission volunteered to diagnose specimens of tissue 
suspected of malignancy. 
Child Conservation Committee appointed by Commissioner. 
1918 Venereal diseases declared dangerous to the public health. 
Manufacture and distribution of arsphenamine. 
Nursing assistants to District Health Officers appointed. 
Influenza outbreak. 
First toxin-antitoxin made at Antitoxin and Vaccine Laboratory. 
“Commonhealth” a quarterly journal of general health information issued. 
1919 Name changed to Department of Public Health; tuberculosis sanatoria 
taken over; leper hospital taken over. 
First supervisor and first health instructor in mouth hygiene. 
Fiftieth Anniversary celebration interrupted by Boston police strike. 
First state appropriation for prevention and control of cancer. 
1920 Division of Tuberculosis and Sanatoria joins control and treatment 
measures. 
Measures for protection of mothers and infants inaugurated. 
1921 Cape Cod Health Bureau started. 
Leper Colony transferred to Carville, Louisiana. 
School Hygiene Consultant and School Nursing Consultant appointed. 
1922 First venereal disease social worker employed. 
First Department radio program (over Westinghouse, Springfield). 
Research on role of public health in water purification and sewage treat- 
ment started. 
1924 Chadwick Clinics begun for the detection of childhood tuberculosis. 
1925 Cancer survey undertaken. 
Lakeville Sanatorium converted to treatment of extra-pulmonary tuber- 
culosis. 
Investigation of extent of contamination of tidal waters and authority 
to prevent taking of shellfish from contaminated areas, granted. 
1926 Extension investigation of summer camp sanitation. 
State cancer program, including Pondville Hospital, authorized. 
1927 Hinton test devised to supplant Wassermann. 
Investigations of cross-connection by Engineering Bureau. 
63 Pondville Hospital opened; six cancer clinics organized. 
Production of influenza bacillus anti-serum begun. 
Medical social workers added to cancer and tuberculosis services. 
1928 First shellfish purification plant at Newburyport. 
Lee septic sore throat epidemic, followed by increased use of pasteurized 
milk. 
Boston passed regulation requiring pasteurization or certification of milk; 
the first in Massachusetts. 
1929 Division of Hygiene changed to Division of Child Hygiene, and Division 
of Adult Hygiene created. 
Three-year Chronic Disease Survey started. 
Weekly Report of Communicable Diseases. 
1931 Pneumonia Control Project begun with Commonwealth Fund. 
Berkshire and Nashoba Health Districts formed under grant from Com- 
monwealth Fund. 
1933 First extensive investigation of outdoor bathing places. 
Industrial Disease Survey. 
Appendicitis campaign started. 
1934 First assistant engineer assigned to District Health Office. 
State Health Commission appointed by Governor (Report in 1936). 
Distribution of immune globulin begun. 
“Contact”, for school physicians and superintendents, issued. 
1936 Social Security expanded Child Health Services. 
Convalescent infantile paralysis cases admitted to Lakeville. 
First crippled children clinic center established. 
First sanitary health officer assigned to health district. 
Massachusetts Associated Boards of Health changed to Massachusetts 
Public Health Association. 
“Newsletter”, a monthly or bi-monthly budget of news, information and 
announcements for boards of health and others interested, issued. 
1937 Division of Genitoinfectious Diseases established. 
Hospitalization of arthritis cases begun. 
Cancer section opened at Westfield State Sanatorium. 
1938 Western branch of Food and Drug Division opened. 
Department given power to adopt rules and regulations regarding the 
control of communicable diseases. 
1939 Mosquito survey conducted. 
Approval of bacteriological and serological laboratories begun. 
Law passed requiring blood test during pregnancy. 
1940 Examination of industrial employees for tuberculosis begun. 
1941 Production of normal human serum albumin begun as war research. 
Hospital licensing begun. 
Nursing bureau established. 
Completion of Quabbin Reservoir of Metropolitan Water System. 
“Sanitalk” for water and sewage works operation issued. 
1942 Dental Unit established (Bureau in 1944). 
Laboratorj' for Biological Assay of Vitamins established in Food and 
Drug Division at Westfield. 
64 Production of immune serum globulin begun as war research. 
■''Laboratory Notes” for those in Laboratory Approval Program issued. 
“Department of Public Health News” (For staff members) issued. 
“Nursing News” for public health nurses issued. 
“Cancer Tidings” for Cooperative Cancer Committees issued. 
1943 District organization completed; field workers assigned to District Offices. 
Emergency Maternity and Infant Care Program begun. 
“Cancer Bulletin”, for physicians interested in Cancer, issued. 
1944 Nutrition Bureau established. 
Immune serum globulin made generally available. 
Bureau of Health Information established. 
Established Bureau of Sanitary Inspection. 
Supervision of district health offices and Bureaus of Dental Health, Nurs- 
ing, Nutrition, Sanitation and Social Service taken over by Supervisor 
of Local Health Administration. 
Speech Therapy first included in Services for Crippled Children. 
Weekly Report of Communicable Diseases enlarged to include text as 
well as morbidity statistics. 
1945 Division of Local Health Administration officially established. 
Blood Derivatives Program begun. 
1946 Division of Dental Health established. 
New building completed for blood derivatives program. APPENDIX III 
MEMBERS OF THE STATE BOARD OF HEALTH 
Name Occupation Service Began Service Ended 
Henry I. Bowditch Physician 1869 1879 
George Derby Physician 1869 1874* 
P. Emory Aldrich Lawyer 1869 1872 
William C. Chapin Manufacturer 1869 1871 
Warren Sawyer Business 1869 1873 
Richard Frothingham Historian 1869 1879 
Robert T. Davis Physician 1869 1879 
G. V. Fox Lawyer 1872 1873 
John C. Hoadley Civil Engineer 1874 1879 
Thomas B. Newhall Business 1874 1879 
David L. Webster Manufacturer 1874 1879 
Charles F. Folsom Physician 1874 1879 
MEMBERS OF THE STATE BOARD OF HEALTH, LUNACY AND 
CHARITY, COMMITTEE ON HEALTH 
Name Occupation Service Began Service Ended 
Henry I. Bowditch Physician 1879 1880 
Robert T. Davis Physician 1879 1884 
John C. Hoadley Civil Engineer 1879 1882 
Alfred Hosmer Physician 1881 1882 
Thomas Talbot Lawyer 1880 1884 
George P. Carter Business 1880 1883 
Henry P. Walcott Physician 1882 1883 
John Fallon Business 1882 1886 
Edgar E. Dean Physician 1883 1885 
Charles E. Donnelly Lawyer 1883 1886 
Reuben Noble Business 1883 1885 
Samuel A. Green Physician 1885 1886 
Edward Hitchcock Physician 1884 1886 
MEMBERS OF THE STATE BOARD OF HEALTH 
Name Occupation Service Began Service Ended 
Henry P. Walcott Physician 1886 1914 
Hiram F. Mills Civil Engineer 1886 1914 
Julius H. Appleton Manufacturer 1886 1890 
Frank W. Draper Physician 1886 1901 
Thornton K. Lothrop Lawyer 1886 1890 
Elisha M. Jones Physician 1886 1893 
James White Business 1886 1887 
Theodore C. Bates Manufacturer 1887 1888 
Joseph W. Hastings Physician 1889 1894 
John M. Raymond Lawyer 1890 1892 
Gen. Morris Schaff Soldier 1891 1892 
* Service terminated by death 
66 James W. Hull Insurance 1893 1911 
Gerard C. Tobey Lawyer 1893 1911 
Charles H. Porter Insurance 1893 191'1 
Julian A. Mead Physician 1895 1914 
John W. Bartol Physician 1902 1907 
Robert W. Lovett Physician 1907 1914 
Clement F. Coogan Business 1911 1914 
Joseph A. Plouff Lawyer 1911 1914 
C. E. McGillicuddy Lawyer 1911 1914 
Milton J. Rosenau Hygienist 1913 1914 
COMMISSIONERS 
Year of Year of 
Namp Appointment Ending Service 
(as Com.) 
Allan J. McLaughlin, M.D 1914 1918 
Eugene R. Kelley, M.D 1918 1925* 
George H. Bigelow, M.D 1925 1933 
Henry D. Chadwick, M.D 1933 1938 
Paul J. Jakmauh, M.D 1938 1943 
Vlado A. Getting, M.D. Dr. P.H 1943 
67 Members of the public health council 
1914-1944 
Name City or Town Occupation Service Began Service Ended 
William T. Sedgwick ....Boston Biologist 1914 1921 
George C. Whipple Cambridge Sanitary Eng. 1914 1923 
Milton J. Rosenau Brookline Hygienist 1914 1915 
William J. Gallivan Boston Physician 1914 1919 
David L. Edsall Boston Physician 1914 1921 
Joseph E. Lamoureux... Lowell Physician 1914 1924 
John T. Wheelwright ...Boston Lawyer 1915 1919 
Warren C. Jewett Worcester Retired 1919 1925 
Sylvester E. Ryan Springfield Physician 1920 1937 
Roger I. Lee Boston Physician 1921 1934 
Richard P. Strong Boston Physician 1921 1943 
James L. Tighe Holyoke Engineer 1923 
Francis H. Lally Milford Physician 1924 
Gordon Hutchins Concord Engineer (1926 1937 
(1940 
Richard M. Smith Boston Physician 1934 
Charles F. Lynch Springfield Physician 1937 1940 
George D. Dalton Wollaston Physician 1937 1940 
R. Nelson Hatt Springfield Physician 1940 1942 
Cecil K. Drinker Brookline Physician 1943 1946 
Elmer S. Bagnall Groveland Physician 1943 1945 
George L. Schadt Springfield Physician 1942 1943 
William H. Griffin Boston Dentist 1945 
Charles F. Wilinsky Boston Physician 1946 
* Service terminated by death 
68 DIVISION DIRECTORS 
1915-1946 
Division 
Director 
Began 
Service 
Ended 
Service 
Communicable Disease Eugene R. Kelley, M.D. 1915 1918 
John S. Hitchcock, M.D. 1918 1919 
Bernard W. Carey, M.D. 1919 1923 
George H. Bigelow, M. D. 1924 1925 
Wolfert G. Webber, M.D. 1925 1926 
(Acting Director) 
Clarence L. Scamman, M.D. 1926 1931 
Gaylord W. Anderson, M.D. 1931 1937 
Roy F. Feemster, M.D. 1937 1945 
Merrill E. Champion, M.D. 1945 1946 
(Acting Director) 
Roy F. Feemster, M.D. 1946 
Sanitary Engineering Xanthus H. Goodnough, C.E. 1895 1930 
Arthur D. Weston, C.E. 1930 
Division of Water & Sewage Harry W. Clark 1915 1933 
(Incorporated into Division 
of Sanitary Engineering in 1933) 
Food and Drugs Hermann C. Lythgoe 1915 1946 
Carl S. Ferguson 1946 
Hygiene Selskar M. Gunn, C.P.H. 1915 1916 
Lyman A. Jones, M.D. 1916 1918 
Merrill E. Champion, M.D. 1918 1928 
Maternal & Child Health M. Luise Diez, M.D. 1929 1942* 
Florence L. McKay, M.D. 1942 
Cancer & Other Chronic Diseases. .. Herbert L. Lombard, M.D. 1929 
Biologic Laboratories Milton J. Rosenau, M.D. 1915 1920 
Benjamin White, Ph.D. 1920 1933 
Elliott S. Robinson, M.D. 1933** 1942 
Geoffrey Edsall, M.D. 1942*** 
Tuberculosis & Sanatoria William J. Gallivan, M.D. 1920 1921 
Sumner H. Remick, M.D. 1921 1925 
Henry D. Chadwick, M.D. 1926 1927 
(Acting Director) 
Sumner H. Remick, M.D. 1927 1929 
Alton S. Pope, M.D. 1930 
Venereal Diseases Nels A. Nelson, M.D. 1937 1941 
Ernest B. Howard, M.D. 1941** 1942 
John B. Hozier, M.D. 1942*** 1944 
Harry G. Wyer, M.D. 1944*** 1944 
George E. Perkins, M.D. 1944*** 
69 1915-1946 
Local Health Administration Roy F. Feemster, M.D. 1945*** 1946 
(Acting Director) 
John J. Poutas, M.D. 1946 1946 
Robert E. Archibald, M.D. 1946 
Dental Health A. Lawrence Corbman, D.D.S. 1946 
(Acting Director) 
DIVISION DIRECTORS (continued) 
* Service terminated by death 
** Military Leave 
*** Military substitute STATE DISTRICT HEALTH OFFICERS 
Year of Year of 
Name Appointment Ending Service 
(as D.H.O.) 
Frank L. Morse, M.D 1915 1915 
William H. Coon, M.D 1915 1915 
Lewis Fish, M.D 1915 1916 
Lyman A. Jones, M.D (1915 (1916 
(1918 (1927 
William W. Walcott, M.D 1915 1917* 
Merrill E. Champion, M.D 1915 1918 
John S. Hitchcock, M.D 1915 1918 
Adam S. MacKnight, M.D 1915 1918 
Charles E. Simpson, MX) 1915 1925* 
Stanley H. Osborn, M.D 1916 1917 
Arthur A. Brown, M.D 1916 1919 
Francis E. Finnegan, M.D 1916 1922* 
Howard A. Streeter, M.D 1917 1919 
George T. O’Donnell 1917 1927 
Russell B. Sprague, M.D 1918 1919 
Charles W. Milliken, M.D 1918 1924 
James W. Keenan, M.D 19l9 1920 
Bertrand E. Roberts, M.D 1919 1920 
Oscar A. Dudley, M.D 1919 1944* 
Harold E. Miner, M.D 1920 1936* 
Leland M. French, M.D 1922 1929 
Richard P. MacKnight, M.D 1924 1938 
Edward A. Lane, M.D 1927 1929 
George M. Sullivan, M.D (1927 1920 
(1934 1935 
Wilson W. Knowlton, M.D 1929 1930 
Charles B. Mack, M.D 1920 1937* 
Frederick S. Leeder, M.D 1930 1931 
Robert E. Archibald, M.D 1930 1946 
Walter W. Lee, M.D 1931 
Henry M. DeWolfe, M.D 1935 1943* 
John J. Poutas, M.D 1936 1940 
Harold W. Stevens, M.D 1936 
Charles E. Gill, M.D 1937 1939 
1940 1942** 
1946 
Frank B. Carroll, M.D 1938 1941 
Ernest M. Morris, M.D 1940 1940 
Vlado A. Getting, M.D 1941 1942 
Morris Taylor, M.D 1941*** 1942 
Nicholas Fiumara, M.D (1942*** 1943** 
(1946 
A. Daniel Rubenstein, M.D 1942 
* Service terminated by death 
71 STATE DISTRICT HEALTH OFFICERS (continued) 
Year o£ 
Appointment 
Year of 
Ending Service 
(as DJ-LO.) 
Name 
Arthur E. Burke, M.D 1943*** 
Harry G. Wyer, M.D 1944*** 1946 
James W. Knepp, M.D 1945*** 1946 
Robert E. Ober, M.D 1946 
Walter J. Pennell, M.D. 1946 
Paul Richmond, Jr., M.D 1946 
* Service terminated by death 
** Military Leave 
*** Military substitute 
SUPERINTENDENTS OF SANATORIA 
1920-1944 
Service Began Service Ended 
Rutland 
Ernest B. Emerson, M.D 1920 1944 
Paul Dufault, M.D 1944 
Lakeville 
Sumner Coolidge, M.D 1920 1924 
Leon A. Alley, M.D (1924 1941** 
(1945 
Claire W. Twinam, M.D 1941*** 1943 
Arthur Kanserstein, M.D 1943*** 1943 
Donald A. Martin, M.D 1943*** l\)45 
North Reading 
Carl C. MacCorison, M.D 1920 1944 
Claire W. Twinam, M.D 1944 
Westfield 
Henry D. Chadwick, M.D 1920 1929 
Roy Morgan, M.D 1929 1946 
Donald A. Martin, M.D 1946 
Pondville—established in 1927 
Lyman Asa Jones, M.D 1927 1929 
George M. Sullivan, M.D 1929 1934 
George L. Parker, M.D 1934 
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