solid mass of filth had accumulated from one to three feet in depth. None of the street wells were trapped; a slaughter-house emptied its refuse at the intersection of the sewers running through the two streets in the infected district. The main sewer at the time of the outbreak had not been flushed for twenty-one years." Immediately preceding the outbreak was a summer storm of unusual severity, which, flooding this obstructed sewer, suddenly forced its poisonous gases in unusual quantities into the houses-as the outlet of the sewer was under water, and the sewers unventilated except through the houses. The outbreak of diphtheria occurred in a few days after the storm-which, as stated, forced up the poisonous gases and also the solid filth of years' accumulation. In Boston, during the prevalence of diphtheria, from 1875 to 1877, a careful inspection showed a greater prevalence of the disease in certain of the better parts of the city, immunity in some of the filthiest; and a house to house inspection by experts "presented nothing objec tionable in point of drainage and general cleanliness in 47 per cent. of the houses in which the disease occurred." The inference has been widely drawn from this that filth has not the causative relation that has been claimed. This, however, will bear a different interpretation when all the elements of the case are taken into consideration. The sewers in certain portions of the city were in as bad a condition as those of Pittsburgh, and of course the whole city was connected by these underground channels. The ready transmission of diphtheria and scarlet fever through the medium of sewers is well established, even if they are not thus caused: not only do the specific germs find there the most favorable conditions for maintenance, but the discharges from the throat in diphtheria, and the branny scales in scarlet fever, are readily wafted from place to place by the warm, moist air of sewers. Thus, in Glasgow, the lowest death rate from diphtheria during three and onehalf years was in houses having no connection with the sewers, and the highest in those having water-closets and sinks. If the sewers in Boston had been well ventilated, to say nothing of having been flushed, and if there had been any disconnection between outside drains and house-pipes invariably, the evidence of no connection between the spread of the disease and sewer gas would have been more conclusive. The unsanitary conditions found in 53 per cent. of the houses leaves but a small part for infection and contagion to play-well-recognized factors in the spread of the disease. In ordinary conditions the germs of diphtheria trav

erse but small areas, but in epidemics may be wafted to a considerable distance from their focus. The prevalence so marked in some of the best drained and cleanliest portions of the city showed perhaps a greater amount of material for the disease to feed upon. In the slums, by law of survival of the fittest, many had become acclimated, so to speak, and the local nidus for the development of the disease in the individual was lacking. The whole illustrates in the most forcible manner how closely the portions of a town or city are allied in their interests, and that all portions must be in at least passable sanitary conditions, as well as one's immediate surroundings.

The importance of a thorough protection of the sleeping rooms of children by careful trapping and ventilation of the waste pipes cannot be overestimated. One of the most common defects is illustrated by the following sketch, which was accompanied by three deaths from diphtheria in one family; essentially the same conditions have been often observed in connection with prevalence of diphtheria.

B., pipe leading to basin in bath-room and sleeping rooms above, both untrapped; B. T., bath-tub; W. C., water-closet. The soil-pipe ran against the wall of the house to the third story. A few dollars in carrying it up through the roof would probably have saved these wasted lives.

One large trap in the cellar is supposed to be ample protection, and gives rise to a false sense of security. This was a lower ten

ement; the soil-pipe running to the third floor--and as it was not ventilated, nor the traps either, every time the bath-tub was used, the trap of the kitchen sink was syphoned, and every time the bath-rooms in the floors above were used, the trap in the cellar, as well as that under the sink was syphoned. The other pipes untrapped led to basins in bath room and sleeping rooms, and when the main trap was syphoned, acted as direct channels for the admission of sewer-gases to the sleeping rooms of the children. The other pipe running through the cellar was from the kitchen sinks above, and opened into an earthen tile which passed directly to the main soil pipe, undisturbed by any trapping; this, while preventing the sewer gases arising in that drain pipe, did not improve the air of the cellar at all. There was also another unsanitary arrangement in the situation of the bath room and water closet in the centre of the building, where ventilation was almost if not quite impossible. This situation of a bath room, etc., is too frequently seen, and often causes harm and death.

I might go on indefinitely enumerating the instances where, in all probability, diphtheria originated from filth. Enough, however, has been said to show that there are three points to be constantly borne in mind,-its possible origin and transmission by filth, that it is contagious or communicable, and infectious. In guarding against these elements of diffusion, we can hope to protect health and life from this foe.

The following table shows the deaths from the principal zymotic diseases by counties:

The increase in deaths from malarial diseases is very marked; typho-malarial fever is credited with seventy-six deaths against twenty-three last year, and the total from all forms of malarial fever, 146 in 1878, 73 in 1877-the increase mainly in New Haven, Hartford, and Fairfield counties. Cerebro-spinal meningitis ap

parently has become endemic, as the mortality is about the same, and diffused pretty uniformly over the State. The mortality in Fairfield county from malarial fever is confined to ten towns, mainly near the shore; in Hartford county, Hartford, East Hartford, and Wethersfield report four each, New Britain three. It appears to have become endemic in East Hartford, especially in the lowlands near the river. Nine towns report one death each; the remaining sixteen report no mortality from malarial fevers in 1878. From New Haven county fifty of the deaths from typho-malarial are reported. In Hamden and vicinity the greatest mortality is reported, and here malarial fevers of a pronounced type have been prevalent for several years. Thirteen deaths in Hamden and five in North Haven, all but two reported as typho-malarial, indicate necessarily a large sickness rate from malarial fevers. Five deaths from malarial fevers were reported in 1877 from Hamden, classed as congestive three, and typho-malarial two; two deaths are reported in 1876, one congestive chill and one intermittent fever. The first case originating in Hamden was reported in 1863, and was among the first in that region. I have not yet been able to learn when the first fatal case occurred there. The natural drainage of the immediate region was extensively interfered with by the flowing of large areas of land in 1860. Since then malarial fever has been endemic, affecting nearly every inhabitant, and has prevailed more extensively than anywhere else in the State. Whether this has been a focus from whence malarial fever has spread over certain portions of the State or not, is an interesting question, or whether there was any causative relation between the retained ground water and the malaria. There were eleven deaths reported from New Haven, ten from Derby, typho-malarial; Branford, Meriden, and Wallingford report five each. Ten towns out of the twentyfive reported no deaths from malarial fevers. The mortality reports are not guides for the existence of malarial fever, as judging from its development and spread in Connecticut since 1863, several years prevalence precede any direct mortality from this cause. As we have seen, it is only since 1877 that it has figured to any extent in the mortality lists.

The relation to typhoid fever is shown by the following table of the relative mortality for the past ten years, 1878 down to 1869:

Intermittent fever appears a few times since the registration reports were published, credited with one death previous to 1860. In 1861 three deaths are credited, and it thenceforth appears regularly until 1863, when it skips a year, then appears steadily until the present, averaging, including remittent fever, ten deaths from 1864 to 1869. The table shows their relative mortality

since.

The deaths from hydrophobia are about the same-seven, five of which are in Hartford county, one in New Haven county, one in Litchfield.

The deaths from accidental causes figure largely this year. The Tariffville disaster and the tornado at Wallingford swell the list considerably. A very unusual number of broken necks from falls down stairs, or otherwise, is a curious fact; also the number found dead in bed, drowning, and death from lightning, are noticeable, while the number of homicides and suicides is anything but creditable.

C. W. CHAMBERLAIN, M.D.