10 
FRIDAY, JANUARY 13TH, 1905. 
Social Gbolution and Public Health. 
BY 
Dr. A. NEWSHOLME, M.D., F.R.C.P. 
(Medical Officer of Health for Brighton). 
HE lecturer commenced by saying that a review of the 
last fifty years afforded ample ground for congratulation on 
the prolongation of average life which had been secured, and on 
the great improvement in average comfort and well-being. The 
death-rate in urban districts (always higher than in rural dis- 
tricts), was now lower than it was 50 years ago in rural districts, 
and had declined from 22°5 per 1000 in 1854 to 16°2 in 1902. 
The wage-earning classes, who form the large majority of the 
population, had shared in the general improvement, whether we 
considered amount of wages, cheapness of food, or improvement in 
housing. The public health policy of the last 50 years had not 
only neutralised the rise in the death-rate which increasing 
urbanisation would have caused, but had secured an additional 
saving of 28 per cent. 
The lecturer, albeit he congratulated himself on being an 
optimist as regards the efficacy of preventive medicine in improving 
the national health, could not shut his eyes to the fact thata large 
proportion of our population were still insufficiently fed, badly 
housed, and suffered from conditions producing ill-health and a 
shortening of life. 
Consideration was then given to the natural laws by which 
the present position had been reached, and the future trend of 
those laws. The doctrine that life had been evolved through pain 
and struggle (“The whole creation groaneth and travaileth in 
pain together until now,’’), stated very clearly by Malthus as 
regards man in 1798, in his “Essay on Population,” and 
extended by Darwin to the whole animal and vegetable kingdoms, 
was now accepted as supported by universal experience, as was 
likewise the necessary corollary that without such struggle strength 
could not be maintained and degeneration must set in. The 
struggle for existence was a struggle between the living organism 
and the environment—those best fitted to the environment 
tended to survive, others to perish. The ratio of the fitness of 
an organism to the strain imposed on it determined its survival, 
and the value of the ratio was constantly being changed in 
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