result of a suppression of the urinary secretion, as a secondary effect of the disease, as in some cases under my care, it will be in two or three weeks from the outset of the diphtheria.

I have not observed diphtheria to be "influenced by the nature of the soil,”—for it has been scattered over the locality in which I reside under all the varying physical features that the place affords. I have not noticed that it paid any attention to circumstances of "social relations," or of "habitations; " for it has invaded the families of the most cleanly of my neighbors, where there were no special surroundings to provoke its appearance, as frequently and as ferociously as the families of those whose habits were less commendable, and whose habitations were less cleanly and comfortable. I do not mean by this that filthy surroundings and unventilated rooms will not aggravate the unpleasant symptoms, and render recovery in a given case less likely; but that the disease does and may appear where all sanitary measures have been sharply enforced, and with the most extreme malignancy. I have not observed that changes in the "weather" have influenced diphtheria; but have not paid particular attention to that point. As to "seasons," the disease, in the years when it has prevailed in my neighborhood, usually made its appearance in September, continued into February and March, and then mostly subsided until the returning fall. No reasons are known for its doing so.

I have sometimes thought that good results were obtained from "topical applications;" but looking back over a considerable experience, and remembering that I have seen cases where topical applications, of various kinds, faithfully applied, gave very little satisfaction; while in other cases, from one or another reason, no local treatment had been used, and the patients recovered,-I have doubts of the utility of efforts in that direction.

We have to remember that neither the fauces nor the nares are the points of deathly deposit, except in the comparatively smaller number of cases where there is inability to swallow. However thick and tenacious the false membrane about the palate, tonsils, and fauces generally; however fetid and vile the secretion in and discharge from the nostrils may be, if the larynx, trachea, and bronchial tubes remain unclogged, the patient escapes the chief cause of death in the vast majority of fatal cases, and will probably recover; and this main point of fatality, the windpipe, is beyond the reach of washes and gargles, unless you resort first to the operation of tracheotomy. If we consider the inhalation of vapors as topical applications, my experience suggests the vapor of slacking lime. This has sometimes appeared to afford relief; but I recollect no cases where I thought it had saved the life of the patient.

NEW HAVEN COUNTY.

To Chairman of Committee on Matters of Professional Interest, &c.

Of the eight counties which make up the State of Connecticut, New Haven County is the third in size, being about thirty miles in its greatest length and breadth, respectively. It lies between latitude 41° and 42°, while the 75th degree of longitude west from Greenwich crosses it near its middle. Its boundary lines are irreg ular, particularly that on the north which is notched in between Litchfield and Hartford County, reaching its more northern point at an apex in its middle, at the town of Wolcott. Its eastern boundary is indented about midway by Middlesex County, the upper half is a hilly range, while along the lower half runs the Hammonasset river. Long Island Sound lies along the whole southern face with its many indentations, the largest being New Haven Bay, which extends inward about three miles midway of the line. On the west the Housatonic river runs along the whole

length, separating it from Fairfield County. The county as a whole may be divided, for convenience of description, into three divisions according to locality, viz.: The New Haven division, which comprises the whole southern face and extends north as far as Mt. Carmel, in its middle and eastern side, while on the west it reaches as high as Derby. The Meriden division, which comprises the eastern half of the northern portion, and joins the New Haven division at Mt. Carmel. The Waterbury division, which comprises that portion of the western half which lies above the New Haven division, and is made up largely of the valley of the Naugatuck river. Beginning with New Haven region, the surface is comparatively level with a gradual ascent from the sea line northward. The geological formation of this division, according to Prof. Dana,* speaking for the immediate vicinity of New Haven, as relates to the soil, is made up of alternate layers of clay, sand, and gravel, while the rock is for the most part trap, with some sandstone, quartz, and gneiss. On either side of the city there rises East and West Rock 340 and 400 feet in height, respectively, formed by the bending of the crust of the earth in the Paleozoic age, and consequent eruption of these vast masses of trap, through the earlier formed sandstone. At the same time the veins of copper and

*Paper on The New Haven Region, by Prof. Dana, Yale College.

barytes were formed in Cheshire, and in fact, all the mountainous ranges of the county.

The, conformation is largely due to glacial action, which leveled down the movable bowlders and debris, and pushed the Sound outward from the base of East Rock to nearly its present position, while the floods of water produced by its melting brought down. material from above to make the northern slope of this region. The whole of this division was formed by the same general causes and partakes of the same geological features for the most part, but in the eastern portion the surface is more hilly and rough. In short, the whole county was subjected to a similar geological action, and is of the same general character.

Passing to the Meriden division, the city of Meriden lies at the head of the plane which slopes up from New Haven, here the surface is hilly and N. ME reach an altitude

995 feet vicinity the Hanging Hills

FEB

995 feet being continuation of the East Rock range. Monden is situate non low ground, surrounded by contiguous hills and is conspicuous for the number and magnitude of its manufactories Near Wallingford the surface is less hilly and is more a rolling ytract of country. The mountainous range which begins at West Rock, passes up through this division in the vicinity of Cheshire, and leaves the county.

Here are

In the Waterbury division is found the same high altitude and rough surface, particularly in the locality of Wolcott, and Southbury, and adjoining towns which partake of the well-known characteristics of Litchfield, purity and clearness of atmosphere; then as the Naugatuck river is approached, there opens up one of the most characteristic regions of the county; commencing at the city of Waterbury, which slopes from the surrounding hills down to a common center, the course of the river is followed downward guarded on either side by high hilly ranges: this is the Naugatuck valley, and all along lie flourishing and busy towns. found the high features of the hill combined with the conditions of the low lying valleys, and the local characteristics of the large towns. Running partially through the county are numerous small streams, but only four are worthy of the name of rivers, namely, the Naugatuck, which rises high up in Litchfield County, and empties into the Housatonic at Derby. The Quinnipiac, which courses through the whole county, and terminates at New Haven Bay, while the Hammonasset and Housatonic form boundary lines as before mentioned. The inhabitants of the county are largely

agricultural in their pursuits, but many are engaged in the various trades incident to its large manufactories in metal, and wood, rubber, woolen, and the like, and thus are subjected to the unhygienic influences of such occupations.

This, in brief, is a sketch of the topographical and local features of the county. Within its limits over 134,000 people are now living subjected to the influence of all these natural and artificial conditions, and the question which this report has to do with is this: How can the health of this varied mass of humanity be promoted and life be prolonged? and what, indeed to-day, is the status of public health in this section of the state, and what are the chief causes which deteriorate the physical condition of the people? The answer to this question must come from the individual medical man on the points most vital, for in the present state of registration only a limited amount of information can be obtained there. With this end in view, questions have been sent to every town as issued by the Committee, on Matters of Professional Interest, and the replies received, and whatever information has been obtained from statistics and observation, are here appended. The report of the State Librarian for 1875 not being, as yet, issued, these deductions are necessarily based upon the report of 1874. In the year 1874 there were 2,379 deaths registered in this county. It has been estimated by various authorities that for every death, two are sick; every death implies an average of 730 days of sickA person loses, on an average, 19 or 20 days by sickness, annually. In America there are 20 cases of sickness to 1 death. Statistics say that 11 per 1000 is the lowest general death-rate that has been obtained. Dr. Farr, Registrar General of England, estimates that 14 per 1000 is the lowest average rate reasonably to be expected there. According to the above, in 1874, there were 1,736,670 days of sickness, and 47,580 cases of sickness in this county, while the average death-rate, assuming the population to be 134,114, which is not far from being correct, was 17.6 per 1000. In '73, the death rate was 20.7 per 1000; In '72, 22.1; in '71, 18. 3; in '70, 21.5; the population and number of deaths being estimated for each year. This is shown graphically by the accompanying chart, as is also the death-rate for the various towns in 1874. The chart in addition makes apparent the defective registration of some towns, as indicated by their low death-rate.

ness.

Showing the comparative mortality of New Haven County per 1,000 by Towns, as returned, for the year 1874. Also the mortality of the County as a whole for each year from 1870 to 1874, inclusive. The continuous line indicates the Towns for 1874. The broken line, the County as a whole for each year.

To what are these deaths due, and may the rate be reduced? The great disparity during the five years would indicate even at first thought, some special cause either present or absent, and manifestly it must be an external cause, for none referable to the body alone would be sufficient to account for it, even for the various towns as indicated in the chart, the cause, therefore, must be local or atmospheric, and in a certain degree preventable. As a matter of fact let us see in what particular class of disease the rate may be reduced. 1st, Zymotics. Of the 2,379 deaths in 1874, 454 were of this class. Of this number, 149 were due to cholera infantum, or 6.2 per cent. of the whole; 109 to typhoid fever, 4.5