WIPING OUT THE WAITING LIST.

In our last report, we laid emphasis on the need of more beds, and told of the indignation that the long waiting list of applicants for admission to our sanatoria, aroused throughout the State. In view of the completion, at that time, of the splendid sanatorium of the New Haven Hospital on the Allingtown Hills, we reasoned that an increase of 60 beds at Shelton, and 40 beds at Norwich, and 100 beds at a seaside sanatorium, would enable us to obliterate our waiting list and leave us a comfortable margin of safety.

The quick looming of the great war cloud, during the winter and spring of 1917, caused the General Assembly, then in session, to cut down our expected appropriation of $125,000 for the seaside sanatorium to $25,000, and the National Government took over the sanatorium at Allingtown for the use of tuberculous soldiers.

For the obliterating of the obnoxious waiting list, we had, therefore, to depend on the appropriation of $60,000 for completing the infirmary at Shelton, and $20,000 for erecting a new infirmary at Norwich. At the most, these were not expected to give us more than 100 new beds. And then to increase our perplexities, we found on opening the bids for the completion of the Shelton Sanatorium according to the original plans, that none of the bids came within our appropriation. It was necessary to materially reduce the size of the proposed addition. We have now completed the building at Shelton, according to the revised plans, and instead of the expected 60 new beds we have 86 new beds.

At Norwich, we found that it was not possible to be sure of even 20 beds in a new building that would cost less than $20,000. We appealed to the Board of Control and submitted our plans and bids, and our appropriation was raised to $25,000. With this small sum, thanks to the advice and hearty co-operation of local architects and builders, we have succeeded in erecting a fine two-story building with a capacity, not of 20 beds nor of 40 beds, but of 60 beds! This we consider something of an achievement. For some time to come, these 146 new beds will do away with most of the distressing delays in admitting patients, unless, as some of the authorities predict, there should be a great increase of tuberculosis in the community, due to the returning troops and to the influenza.

AT LAST A SEASIDE SANATORIUM.

As we have stated in previous reports, the tuberculosis experts of the world long ago observed that children afflicted with surgical tuberculosis, that is, tuberculosis of the bones and glands, recovered health and strength in a most marvelous way if they were permitted to live for a few months at the seashore.

The last International Tuberculosis Congress, after discussing the subject at great length, passed the following resolution: "In the view of the need that there is of treating surgical tuberculosis in special sanatoria, and in view of the success of the seaside treatment of surgical tuberculosis, this Congress solemnly resolves (emet le voeu) that there should be provided for cases of surgical tuberculosis, particularly for surgical tuberculosis in children, special sanatoria on the seacoast, and that the building of these seaside sanatoria should be done on as large a scale as possible, and with as little delay as possible."

Most of the civilized states of the world that possess a seacoast, France, England, Germany, the Scandinavian countries, Portugal, the countries of South America and our own neighboring communities of the Atlantic Seaboard, now have institutions of the kind described in this resolution.

Two years ago Connecticut had evidently become aroused on this subject. It then seemed to be the unanimous opinion that an institution of this kind should be provided and a bill was introduced in the General Assembly, asking for an appropriation of $125,000 for this purpose. The bill was favorably reported by the committee on humane institutions, but when it came to the committee on appropriations the demands of the State for money were so great that this committee did not feel justified in drawing so largely upon the State treasury for a new enterprise, consequently, the amount was cut down to $25,000. To carry out the wishes of the State expressed by this appropriation, this Commission continued its search for a suitable location for such an institution and finally purchased the so-called White Beach Hotel property at Crescent Beach, in the town of East Lyme, for the sum of $12,000. This property has an attractive beach, is well removed from the thickly settled portion occupied by summer residents, and consists of the hotel building with about 30 rooms, substantially finished, besides two acres of land, a small summer cottage and outbuildings. With the addition of a heating plant and some changes and repairs in the water and sewage systems, the property will be well adapted for a small institution of the

kind desired. A much larger appropriation is necessary, however, if the State is to accomplish what we believe it desires to do and what other States about us are doing for its children crippled with bone and glandular tuberculosis. Adequate provision should be made for the equipment and maintenance of such an institution.

NEED OF CO-OPERATION BY THE GENERAL HOSPITALS.

Again this year, we would call the attention of the General Assembly to the need of compelling the general hospitals of the State to provide a ward or separate building for the care of emergency and dying cases of tuberculosis.

In this new, after-the-war era, the public will no longer tolerate the view apparently entertained by some directors of general hospitals, that the functioning of these institutions can be restricted to such medical activities as interest the principal surgeons and physicians. The instant use of so many of the general hospitals of the State, during the recent influenza epidemic, and the surrendering of ward after ward to the care of patients sick with this terrible and contagious disease, afforded striking proof of the service that the general hospitals can give and must give to their communities. Yet, if in these same communities, the local visiting nurses discover a tuberculous father or mother, endangering his or her children, and too sick of fever or hemorrhages to be removed to the distant sanatoria, these same hospitals, that so splendidly helped in the influenza epidemic, will reply with an emphatic "No" to the request of the nurses that their tuberculous patient be admitted and cared for until such time as he or she dies or improves sufficiently to make a transfer to a sanatorium possible and desirable.

This attitude of the general hospitals is indefensible. It is due to the discarded panicky notion that the consumptive is of necessity and always a source of danger to his neighbors. There is nothing dangerous about a consumptive but his sputum, and that danger is so easily controlled in a hospital or infirmary ward, that these wards are now about the safest place in the world for the man or woman who is afraid of “catching” the disease.

This attitude of the general hospitals, and the length of the recent waiting lists at all the State's sanatoria, have forced some of the largest cities to a compromise, helpful but not satisfactory. These cities, New Haven, Hartford, and Bridgeport, have sent many of their waiting and emergency cases to buildings or wards

on their town farms. Of course, the ordinary citizen of Connecticut would not willingly himself, go to a town farm, nor would be permit his wife or children to go there, even to be treated for tuberculosis. And it is for the benefit of the ordinary citizen of Connecticut, bleeding or dying from tuberculosis, that we make this appeal to the general hospitals of Connecticut.

The expense of caring for these emergency cases ought to be borne in part by the State and in part by the town or city. It seems to us, that, after considering this matter and when considering requests for financial assistance from the various general hospitals of the State, the committee on appropriations could wisely formulate a bill defining the conditions under which the State would help to pay the hospitals for the care of these emergency cases of tuberculosis. The number of these cases would never be large in any one hospital, but the suitability of the care and treatment given ought to have the sanction of the State Tuberculosis Commission, and, of course, we would always be eager to receive into the sanatoria patients from the hospitals who showed any promise of improvement.

CONSUMPTION KILLS MORE CITY MEN AND MORE
COUNTRY CHILDREN.

Consumption kills more men than women, and more girls than boys. In the city consumption is less fatal to children of both sexes than in the country. The men of the country and the women of the country, and the women of the city die from tuberculosis at about the same rate. The men of the city die from tuberculosis at a rate twice as high as that of the women of the city or the men or women of the country.

These are the facts just published as the result of an elaborate and painstaking study of the vital statistics of England and Wales. The tuberculosis death rate of England and Wales. are very similar to those of Connecticut, and both rates have been diminishing in about the same way for the last sixty years.

The importance to us of these findings, if applicable to Connecticut, can hardly be exaggerated. We have endeavored to learn from our records in the office of the State Board of Health whether or not they told the same story as the British records. Our investigations have been very graciously assisted by the officials of the State Board of Health. For comparison we have. taken the record of the year 1917. It has been necessary not only to reclassify the returns according to age periods, and to sexes,

but also to correct the returns from the various towns by adding or subtracting the deaths from tuberculosis in the sanatoria and other public institutions and placing them in their proper places for tabulation. The results as shown by the appended map and chart are surprising and interesting. Of course, the fact that our digest of the tuberculosis conditions in Connecticut covers only one year makes it less important than the British digest, but the important fact is developed that in the year of 1917 tuberculosis picked its victims in Connecticut in about the same way that it has been accustomed to pick its victims in Great Britain for the last twenty years.

For purposes of classification, we have considered as "rural" all towns of less than 5,000, and as "urban" all towns of more than 5,000. This is a common classification. It is open, of course, to the criticism that in a few towns of less than 5,000 a large proportion of the adult males work in factories in their own or adjoining towns. Again, as will be seen from the figures in the map, the average density of population of the "rural" towns in some of the counties is higher than the average density of population of the "urban" towns of other counties.

CONNECTICUT DEATHS FROM TUBERCULOSIS IN 1917.
PER 100,000 LIVING.

The deductions from these findings will be various and conflicting, but all can agree that findings of this kind show how important it is that the fight against tuberculosis should be carried into the factories, stores and offices, where city men work. They demonstrate, also, how valuable a fighting force Connecticut has in the various anti-tuberculosis associations of employees in her factories, and stores and offices. Officered by enthusiastic and able men, whose only ambition is to be of service to their fellows, and not only giving financial and moral support to their sick, but also exercising a tremendous influence in securing such factory and office and store conditions as will best safeguard themselves and the public from the terrible disease, they deserve from Connecticut recognition and support.