Officer or Health Committee to make a thorough sanitary inspection of the entire area under the jurisdiction of this Board at least once in each year and oftener if necessary. Such inspections shall include all matters affecting the public health; and a report of the sanitary conditions disclosed by the inspectors shall be made to this Board, and this Board shall communicate copies of said reports, or the substance of them to the State Board annually or oftener.

One of the satisfactory results of sending to the town boards. copies of the foregoing circular, was the immediate adoption of sanitary regulations of the same or similar character in about thirty towns in the State.

A very considerable correspondence in regard to the subject was also elicited by their promulgation.

The following communication is a type of a goodly number which were received from the small agricultural towns. This was in reply to an enquiry if the town board had enacted any sanitary laws:

C. A. LINDSLEY, M.D.,

Secretary of State Board of Health:

October 6th, 1888.

Dear Sir-No action in reference to sanitary regulations has been taken by this Board. We did not find it expedient to make any.

In your opinion, are any desirable in the absence of any epidemic, or known nuisance? Please state.

Dear Doctor-Your enquiry concerning the need of "enacting sanitary regulations" for your town, gives me occasion to say :

1st. That the enactment of judicious sanitary regulations in any town can do no harm.

2d. Like the ten commandments in morals and religion, they can be made the embodiment of the principles of hygienic living, which will be a source of profitable instruction to the community.

3d. There is no town in this state, nor in any other on the face of the earth, where there are not some members of the community who habitually or occasionally violate such regulations.

4th. When complaints of such violations are made to the Board of Health, as they are liable to be, and ought to be, it will save the Board much embarrassment, and defend them from the charge of acting from personal motives, if the Board are enabled to say, this nuisance must be abolished because it is against the written law of our town.

If no law exists the action of the Board in every instance of a nuisance, must be the official judgment of the Board in each case, upon the conduct or public duty of an individual fellow-citizen; and the element of personality cannot always be eliminated to the entire satisfaction of all who may be interested.

If, however, the nuisance is in violation of established law, the Board can simply say so, and that it has no discretion, but to require the law to be obeyed. Therefore replying directly to your question, my opinion is that "Sanitary Regulations" legally enacted are desirable in every I am very respectfully,

town.

C. A. LINDSLEY, Secretary.

SANITARY CONDITION OF THE STATE AND VITAL STATISTICS.

Previous to the year 1888 there was no lawfully authorized method of obtaining frequent and regular official reports of the mortality occurring in the State.

Not until the year was terminated and a sufficient time thereafter had expired for the Registrars of the towns to collect and record the statistics and prepare therefrom an abstract, did the State Board get any reliable information on the subject. Hence, heretofore, in the Annual Reports of the Board, the matter relating to births, deaths and marriages, that is, the Registration Report was a wholly separate report, and had reference to the year preceding that to which the Annual Report proper, applied.

But under the requirements of the recent laws the State Board is enabled to keep a systematic record of the deaths occurring monthly in every town in the State, and the causes of them.*

*Of the 167 Registrars in Connecticut only fourteen have failed during the year to make reports every month. Of these fourteen, the Registrar of Essex has failed four times. The Registrars of New Fairfield and North Stonington each twice. And of the following towns only one month's report is wanting from the Registrars of each: Beacon Falls, Canton, Chester, East Lyme, East Haven, Easton, Ellington, Essex, New Fairfield, Norfolk, North Stonington, Orange, Saybrook, Torrington. This statement is made to show how nearly complete the monthly reports of deaths have been, and how a little more attention on the part of a few delinquent Registrars would make them quite complete.

There have also been reported to the Board whatever epidemics of diseases have occurred in any localities in the State. From these data and from such monthly reports of sickness as have been voluntarily made by the sanitary correspondents of the Board in many different towns, it is possible to obtain an approximately correct knowledge of the movements of disease during the year and of the general state of health in the commonwealth.

The monthly statements of mortality in towns, includes not only the whole number of deaths, but the number dying from those diseases particularly which are most fatal, and which at the same time are most subject to man's power to control or escape from. Those specially reported are deaths from small-pox, measles, scarlet fever, cerebro spinal fever, diphtheria, croup, whooping-cough, erysipelas, typhoid fever,. the malarial fevers, puerperal fever and diarrhea, of the zymotic class; pulmonary consumption, of the constitutional class; and pneumonia, bronchitis and heart diseases of the local class. Also the total of those dying of diseases of the nervous system, the deaths from accident and violence and whatever deaths may have occurred from other causes. The monthly statement gives as separate items the number of these which were under five years of age, and the number of still-births.

Thus the State Board receives at frequent and regular intervals an approximate report from the most reliable sources of the number of deaths and the most important causes of them in every town in the State, and is thereby the better enabled to perform the duty imposed upon it by the Act which created it, to wit: to "take cognizance of the interests of health and life among the people of this State;" to "make sanitary investigations and enquiries respecting the causes of disease, and especially of epidemics, the sources of mortality, and the effects of localities, employments, conditions, ingesta, habits and other circumstances upon the public health;" to "collect such information in respect of those matters as may be useful in the discharge of their duties, and contribute to the promotion of health and the security of life in this State."

It is not intended that these monthly reports shall take the place of the more complete and accurate summary, known as the Annual Registration Report, made at the end of each year from the finished records. But they serve a most useful purpose

in affording a correct acquaintance with the general health of the State in all parts of it throughout the year.

The total number of deaths reported in the monthly returns during the year ending November 30th was 12,491. And occurred chronologically as follows:

It is not claimed that the monthly reports of mortality represent fully and completely the whole number of deaths occurring in the State. There are two sources of error, each of which contribute to give a result less than the true number. First, there are from one to five registrars, who in several of the months have neglected to make report for their respective towns; and

2d. There is still some disregard of the law respecting the rendering a certificate of death to the Registrar before the burial, so that it happens in some towns, that when the Registrar makes his monthly report to the State Board, he has not yet received certificates of all the deaths which have occurred in his town.

From these two sources of error probably 500 more should be added to the total mortality in the State during the year, making a total of about 13,000.

The total deaths for the previous twelve months, ending Nov. 30, 1887, were 12,384. If some allowance is made for increase of population, it would appear that the death rate among all the people in the State, taken as a whole, has not differed essentially during the last two years, to wit:-between 17 and 18 per 1,000.

As the death rate among a people is accepted as in some degree a standard of the measurement of the public health, Connec

ticut may be regarded as being comparatively healthy. The death rate in Massachusetts for 1887 was 20.27 per 1000.

The average death rate in Massachusetts for the last thirtyseven years, 1851-1887, was 19.43 per 1000 of the living population; in Rhode Island, 1860-1885, 26 years, it was 17.6. The death rate in Rhode Island for 1886 was 18.8. The average death rate in Europe for nineteen years (1865-1883) was 28.1; for Europe excluding Russia was 25.8.

The column in the foregoing table which gives the percentage of deaths in each month under five years of age, is probably incorrect, in consequence of the neglect of some of the Registrars who fail to take note of that point in their monthly reports. An average percentage of only 24.8 of infantile mortality would be exceptionally low, and indicate a high state of public hygiene. Since the State Board have had the superintendence of the Registration of Vital Statistics the infantile mortality has been over thirty per cent. of the total mortality.

Another accepted gauge of healthfulness is the percentage of deaths from zymotic diseases. As estimated from the monthly reports; this during the last year was 22.3. The average for the previous ten years was 21.7.

The average for the last ten years in Massachusetts was 21.5. The percentage in Rhode Island for 1886 was 21.9.

The proportion of deaths from this class of diseases to the whole mortality, is an indication of the general sanitary condition of a country, because they are the diseases which are most frequently epidemic, and because their excessive prevalence usually means neglect of the laws of public hygiene.

The above statements as a whole, lead only to the general conclusion, that there has been an average state of health during the year.

The total zymotic death rate is not high, and the general sanitary condition of the State is fair.

The local boards of health are most of them taking their first experience in sanatory work.

While there is very much that can be done to improve the sanitary status of most of the towns, yet it must be remembered that the towns of Connecticut are all old towns, whose residents are natives; who have lived and grown up with things as they are; who are jealous of innovations on old customs; who are doubtful *Registration Report, Mass., 1887, page 321.