178 PRESIDENT’S ADDRESS—SECTION H. 
of births, and of deaths under causes, within the same areas, 
together with regular prompt return of the observations as the 
are made to the chief medico-sanitary authority of the country 
for analysis, is the life principle of practical hygiene. The more 
preventable diseases are, if not of local origin, at all events of 
local immediate causation ; the measures to prevent them must, 
therefore, be of local application. Where this information is 
wanting, whatever the administrative and executive sanitary 
organisations may be, and whatever their possible efficiency, their 
efforts must In many most important respects be without system, 
diffused, wasteful, and must therefore yield results incommensurate 
with their cost in money, in labour, and in thought. It is possible 
to express the reason on which this statement rests in a sentence : 
Deaths are never distributed equally over districts. Preventable 
deaths occur where removable causes exist ; not elsewhere. 
Now, there is not in any province—I judge from official 
reports—the organisation here referred to ; the numbers of the 
people are estimated from year to year; and this, which is a 
hazardous process when applied to the population of a whole 
province, becomes simply deceptive when applied to cities, and 
especially to parts of cities; the sex and age-distribution are 
brought on from the decennial census enumeration in a similar 
way, and in districts, at all events, are therefore in realit 
unknown ; and the record, imperfect as it is, is not dealt with 
for purposes of local sanitation by the medical officer of any 
authority.* I will illustrate the result of this want of practical 
organisation—again a failure to refer to the fact, and so far a 
lack of scientific method—by a concluding comparison ; it shows 
that the work of central health authorities is done under 
difficulties, or rather, not to mince the matter, for want of this 
kind of direction exactly, remains practically fruitless in a most 
fertile field. I choose for the test the proportion of deaths from 
tilth-diseasest and enteric (or typhoid) fever, because it is now 
notorious that if sanitation. can certainly do anything at all— 
and it can do very much—at all events its first and easiest 
successes are against that class of diseases. That is now a well- 
established fact ; so that the efficiency of any sanitary organisa- 
tion may be fair ly g gauged by the proportion of deaths that occur 
among the people living under it from those diseases. M 
comparison is, of course, between Victoria and New South Wales; 
not only because those provinces are similar in population and 
in many other respects, but because they differ distinctively in 
the most important point—in sanitary law and organisation. 
But the two provinces are not comparable as wholes, because 
they carry a similar population on widely different areas. I 
therefore select the metropolitan areas in each case; and that 
* Dr. H. T. Whittell has for many years been Registrar-General for the province of 
South Australia, and for some time President of the Central Board of Health as well. 
j By filth-diseases, diarrhoea, dysentery, and cholera are intended. 
