The small pox charts (charts twenty-one and twentytwo) show that most of the time the death-rate from small-pox is at the zero line in all counties. Fairfield County is the only one that has small-pox every year, though in the years 1902 and 1903 there have been epidemics in Windham, Hartford and New London Counties. In spite of its yearly prevalence in Fairfield County, it is kept well under control and there have been no severe epidemics there.

In the past ten years there have been twenty-five deaths from small-pox in Connecticut, and two hundred and forty-eight cases reported; this gives a death-rate of one and eight-tenths, which is much lower than that of any other contagious disease we have considered.

In considering the prevention of contagious diseases in Connecticut one must admit that efforts at prevention have been lamentably inefficient for the year 1903, with a total of 1,487 cases of diphtheria and membranous croup and 2,418 of scarlet fever.

We attempt to limit these diseases by keeping the patient, if a child, from the public schools, by placarding the houses where the diseases are, and in certain places cutting off the books from circulating libraries. While these methods are good they fail to get at the root of the matter.

The disease is spread by mild unrecognized walking cases, by incomplete isolation of recognized cases

and by imperfect disinfection.

In examining the reports of Health Officers one sees frequently such statements as this, "Epidemic of diphtheria, primary case imported from a neighboring town," showing how frequently we find such patients not only in school, but also in public conveyances, and not only so but even up and about their work, and if perchance their work is in a dairy, we find an epidemic among the patrons of the dairy soon following, as was the case in an epidemic of scarlet fever in Norwalk in 1897.

The isolation of recognized cases is often impossible. A mother with a family of several children in caring for one child ill with scarlet fever, cannot but expose the others. Ansonia in 1895 had a case of scarlet fever of this kind in a tenement house. The disease quickly spread to other children of the same family and then spread to twelve other families, and ten deaths resulted. Finally there was a strict quarantine, and the disease was stamped out with an expense to the town of $1,302. In the Board of Health reports there is an account of a somewhat similar case in Groton in 1902. It is to the isolation of these recognized cases that our efforts should be directed. If this were done, there would be a great reduction in the cases of contagious disease.

Instances have been given of the frequent impossibility of isolating cases completely in the places where the patient is taken ill. As the case stands now, wherever a person is taken ill in the State, there he must stay until he gets well or dies. If in a hotel or boarding house, if in a school or college, if in a bakery or dairy, there he must stay until he recovers, for there is no other place for him. It may be that he is a great menace to the public health, it may be that his presence is ruining someone's hotel or dairy business, but he must remain there just the same. It may be that he has money and can pay for proper care, but there is no place to take him. He cannot be completely isolated and perhaps cannot secure a nurse to care for him. He will be the focus of an epidemic. But even such instances as this, which are fre quent enough, do not open the eyes of the public to the fact that this great loss of life, this interference with business, may be prevented if only it will build hospitals for receiving such cases.

Agencies are constantly multiplying for the spread of infectious disease. Every new church, school, theatre, railroad, means so much greater opportunities for the spread of epidemics. There is a striking likeness of epi

demics of disease to a great fire. A city may go for years without a large fire and then suddenly a large part of it be swept away in a single day. It would be a most reckless thing for a city to be without a fire department, though to the superficial observer the fire department would seem a useless expense. He only sees the firemen lounging idly in their houses and the horses standing useless in their stalls.

It is so with the contagious disease hospital. Much of the time it would have few patients, sometimes none, but who can tell the service it would be when we suffer, as we surely will, from epidemics of contagious disease. Then every dollar put into such a hospital will mean a life saved.

We cannot leave the subject without turning to the humanitarian side of it. We must all admit that there are no diseases that more need the watchful care of the physician and the trained nurse, than malignant cases of diphtheria and scarlet fever. We build hospitals that receive typhoid fever, tuberculosis, Bright's disease, etc., and consider them necessary in caring for such cases, but how much greater need there is that a child sick with scarlet fever or diphtheria should have hospital care. Surely no case more needs hospital treatment than the case of intubation. Such hospitals must be built centrally, easy of access for the patient and physician, well constructed with all modern conveniences, for isolating different kinds of disease, with walls and furniture easily sterilized, and with disinfecting plant. There is no greater blessing to the poor children of the city than such an institution.

Ten years ago the mortality from diphtheria in Boston was greater than that of any city in this country, and much greater than that of London, Paris, Berlin, Glasgow. That city recognizing its unenviable reputation laid plans for a large hospital for contagious diseases.

Nothing was spared to make its equipment complete. It was felt that patients with diphtheria and scarlet fever required the best care and treatment, and that only hospitals of the best construction were good enough for such

cases.

Since that time, partly no doubt due to a liberal use of anti-toxin, and also to a greater degree to the presence of the hospital, the mortality has been reduced so that in 1899 Boston had a death-rate lower than most other large cities, and from having the high st mortality from these diseases it was among those cities that had the lowest. Now the death-rate from diphtheria in the Boston City Hospital is twelve and nine one-tenths for every hundred cases, and although most of the cases that enter the hospital are quite virulent, the percentage of deaths is five less than that for Connecticut for 1903.

Your committee has sent circulars to each County Health Officer asking for information regarding the hos pitals for contagious diseases in their County. They have received no reply from either the Hartford or New London County Health Officers. But from the others they learn that there are no hospitals that receive scarlet fever or diphtheria in Litchfield, Windham, Tolland and Middlesex Counties. These counties have a total population of 176,816, in which there have been reported the past year two hundred and forty-four cases of scarlet fever, and one hundred and seventy-eight of diphtheria. Is it not time that some means were found in these counties to isolate such cases in a more perfect manner than can be done in tenements, boarding houses, hotels, etc.?

The cities which have hospitals for caring for scarlet fever and diphtheria cases are Bridgeport, Greenwich, Waterbury, Norwich and Hartford. New Haven has a building used for small-pex cases, but it is so far from all medical assistance, so impregnated with small-pox contagion, and so lacking in all proper facilities for caring for scarlet fever and diphtheria that we may truth

fully say that New Haven has no hospital for receiving such cases.

In those cities where there are such hospitals, it is to be regretted that they are not used more frequently. The Health Officers of such places should see to it that all patients that cannot be isolated should be removed to such hospitals. There should be attractive wards and good service, so that patients who can pay will take the private rooms.

Finally, disinfection of bedding, clothing, etc., is not sufficiently thorough. This is frequently shown by the return of the disease in other members of the family some months after the recovery of one of their number. Isolation is not sufficiently prolonged, and the patient is allowed to mingle with others before the infection is dead. These instances would be much less common if these cases were cared for in an isolation hospital.

The financial loss to the State from contagious diseases cannot be intelligently discussed. We cannot place a money value on the life of a child, neither can we represent the loss in money that results from contagious diseases in the impaired hearing and eyesight and in the retarded physical and intellectual development of children.

But before closing we want to suggest how much the education of healthy children is retarded by the presence of contagious disease. Many healthy children are kept from school because of a case of contagious disease in another family in the tenement where they live.

A superintendent of schools has said that nearly ten per cent. of the pupils of our schools are absent either because they are ill, or because someone in the same tenement is ill. One child ill with scarlet fever in a tenement often keeps five to ten healthy children from school for a period of from three to six weeks. As a result the public pays for the schooling of one hundred children, while only ninety of them receive it, and the other ten