Dr. George J. Holmes (of New Britain). Mr. President, there is one form of conjunctivitis which Dr. Peck did

not mention, and I presume it is incidental to certain localities. In New Britain we find Trachomatous-conjunctivitis among a class of immigrants who came there, mostly in Italian and Polish children. There is quite a large quantity of this trouble among that class of people. I have recently had a case where a young man had an abrasion of the cornea, and I found that he had also a trachomatous condition of the lid. The poison immediately infected the cornea and he has a resulting opacity with leucoma in the center of the field of vision. Trachoma should be recognized early, and I think this society should take more cognizance of it throughout the state. There is quite a good deal of trachoma among school children, especially among the classes mentioned and it is highly contagious, and means, as you know, much damage to the eyes of school children if not properly treated and sometimes blindness.

A NOTE ON THE PREVENTION OF TYPHOID

FEVER.

WILLIAM G. DAGGETT, M.D.,

NEW HAVEN,

The annual reports, year after year, of thousands of cases of a serious preventable disease, involving a large mortality and a huge economic loss, strongly suggest the imperfection or insufficiency of our prophylactic measures. This applies to typhoid fever in Connecticut. Twenty-five thousand cases, twenty-five hundred deaths, and an economic loss of twenty-five millions of dollars is the record for the decade ending with 1902.

Moreover, of the usual diseases, none, with the exception of tuberculosis, can compare with typhoid fever in importance. This is true not only because of its mortality, but also because it attacks by preference strong and robust individuals between the ages of eighteen and forty, and because it involves a disability measured by months rather than by weeks or days. Furthermore, we can no longer plead ignorance of its cause and methods of dissemination. These are well known to physicians, and the lessons taught by repeated epidemics are familiar to every tyro in the study of medicine. Eleven epidemics in our own state in the decade mentioned point the moral to us. What may be termed our working knowledge of the disease is ample, and may be briefly summarized as follows.

It is caused by the bacillus typhosus, an organism which exists in large numbers in the stools and urine of patients, and which may persist for months, or even years, in the urine after the patient is discharged as cured. It may also be harbored by healthy individuals.

Patients receive the infection by the mouth in water, milk, or food. Water is infected in wells or streams from the dejecta of some case; milk by the use of polluted water in dilution, or in washing the containers; oysters by being placed near the mouths of sewers to fatten; food, cooked or raw, by water, dust, or flies. Every case is potentially a focus from which hundreds of others may develop.

Further, as has been shown by Dr. John S. Fulton. while the disease is ubiquitous, it is essentially a rural disease, and its propagation "is in general from the country to the town, rather than from town to country." (Journal Am. Med. Ass'n., Jan. 9, 1904.)

To combat these conditions we establish filtration plants for the water-supplies of large centers of population; we encourage the domestic filtration of water; and in times of manifest danger advise the boiling of water used for drinking purposes. Our health officers search for the foci of epidemics and effectively isolate them. We preach and practice the disinfection of the excreta of every recognized case, and we disinfect too the bedding, clothing and utensils used by the patient. These measures are absolutely necessary and must be carried out with the utmost care.

But our system is seriously defective in that, except as regards the filtration of water, it deals with cases only after they have been diagnosed, and until they are thought to be powerless for harm. We should also consider these cases before precautions are commenced and after they have been discontinued; and in addition the very large number of unrecognized cases. To strike at the root of the matter we should not wait until sickness appears, but should anticipate the occurrence of infection. This can be done only by comprehensive rural sanitation. With the state thickly settled, with milk and vegetables brought from every direction to the towns and cities, and with the larger centers of population

reaching out farther and farther for their water supplies, we must now look upon even the remote rural inhabitant as a neighbor, and take a lively interest in his well, his yard, and in the brook that traverses his farm. By wag. ing an effective warfare at this hitherto neglected point we can prevent the pollution of water and milk, and the conveyance of infection by dust and flies. The rural privy is the original plague spot, although casual deposits of infectious excreta may at times play a part. The location of the privy is usually based solely on considerations of convenience of access and a moderate degree of privacy, little or no thought being given to the direction of the flow of the ground water. The building is seldom cleaned, rarely screened, and the vault is never disinfected. It should be very carefully located, thoroughly screened to keep flies away, and it should be disinfected daily whether or not there is sickness on the premises.

It is in truth a herculean task to accomplish a reform involving so much perplexing detail, but the task is insignificant when compared with the evil which its accomplishment would in a large measure avert. It must be done sooner or later, and when it has been put into effective operation the wonder will be that it was not sooner undertaken. Consider for a moment the trouble and expense which would readily be incurred by the state to prevent an equal financial loss to any single crop, or in any species of domestic animals. Consider the enormous amounts of money yearly expended by several states on levees for the protection of low lands. Surely a single human life is worth more than a flock of sheep, a bushel of wheat, or an acre of land.

The first step in bringing about the reforms suggested should be the formulation of the best practicable methods of keeping privy vaults in a sanitary condition. The next, the appointment of a number of civil engineers as a permanent force of State Sanitary Inspectors whose duty should be to make a complete sanitary survey of the