XIV PROCEEDINGS, MAY. 



reason — the other towns selected for comparison are so much 

 more populous, and have such very inferior climates. As far as 

 England is concerned, instead of London with a population larger than 

 that of all Australasia, it would be much fairer to institute a comparison 

 with health resorts such as Cheltenham, Hastings, and Eastbourne, and 

 notwithstanding the presence of numerous invalids and elderly 

 inhabitants, the result will be found the reverse of consolatory. In the 

 places mentioned, including their suburbs, the total death-rates are 17 '89, 

 17"49, and 1419, as compared with 24'70 in Hobart. Taking the 

 average percentage of deaths over 60 years to total deaths in England 

 these towns will show a health standard death-rate of 13'06, 1277, 

 and 10 '56 respectively, or in other words, a considerable improvement 

 on Hobart. I am awaie that the returns for these towns include a 

 certain amount of rural district round each, but in the three cases 

 I have taken, this outside population is very insignificant compared 

 with the towns themselves, a,nd further, the death-rate in towns of this 

 size in England approximates very closely to that of rural districts. 

 As far as regards the colonies themselves, it would be manifestly fairer 

 to compare our capital with towns enjoying climatic conditions more 

 like ours than the comparatively tropical cities of Queensland and New 

 South Wales, This means, of course, with such places as Christchurch, 

 Wellington, and Dunedin ; but I have been unable to obtain the 

 necessary statistics to do this. To show still more forcibly the immense 

 influence of density of population, of which Mr. Johnston is well aware, 

 and that absolutely nothing is learnt of their relative sanitary 

 condition by comparing small and large towns, 1 need only mention 

 tha'c while the death-rate of towns in England of about the same size as 

 Hobart varies from 12 to 18 per 1,000, that of the 20 largest towns varies 

 from 18 to 34 per 1,000, and these are towns with the same climate 

 and similar sanitary arrangements. We now come to the important 

 question of the seasonal variation in the typhoid curve, to which Mr. 

 Johnston pays so much attention in his paper, and which he considers 

 such a difficult problem, I am unable to see any necessity for invoking 

 a hidden cosmical influence to account for its periodical rise and fall. 

 (Hear, hear.) Local hygiene and a seasonal influence are quite sufficient 

 to explain it. As Mr. Johnston shows in his diagram, the months of 

 highest temperature are January and February, and the diarrhoea 

 curve shows a maximum mortality at exactly the same point, showing 

 conclusively the direct influence which heat has on this disease. 

 When we turn to the typhoid fevei curve, which I will try to show is 

 also directly influenced by excessive heat of weather, we find the 

 maximum death-rate to be a month or six weeks later, that is in the 

 month of March, and in accounting for this, I hope you will pardon me 

 if I digress lor a tew moments to explain the causation of this disease. 

 It has been proved beyond all cavil that typhoid fever is above 

 all fevers the fever of ffecal decomposition ; that it occurs only amongst 

 those who are exposed to the influence of defective drains or foul 

 overflowing cesspools, especially when these are so situated as to pour 

 their"'fetid gases into the interior of houses, or to contaminate by their 

 emanations, their soakage and their leakage, water and other articles of 

 food. Now, it has been observed over and over again, that these 

 excreta, which are probably at first wholly ineffective, become in the 

 course of putrefaction, through great heat, virulent in a high degree. 

 This process of fermentation or putrefaction of the germs has been ob- 

 served to take about a fortnight, and adding to this the incubative 

 period of the germs after they have been received in some way 

 into the human body, which is also about a fortnight, and as death in 

 the majority of fatal cases occurs about the end of the second week 

 from the onset ojE the disease, this makes altogether a period of six 



