71 
annoying and disappointing when it is seen that they have 
so far signally failed to produce the results which their pro- 
moters so confidently anticipated. Occasionaly when a 
season or succession of seasons favourable to the public 
health has reduced the death rate for a time, sanguine 
officials have hastily and inconsiderately attributed the 
reduction to their so-called sanitary improvements and 
arrangements; but when a period is taken sufficiently long 
to eliminate the influence of changes in the seasons it is 
found that no reduction whatever has taken place, but that 
on the contrary the rate has still a slight tendency to in- 
crease. Thus the average death rate for all England and 
Wales during the ten years 1854-63 was 22T4, w^hile in the 
following ten years 1864-73 it was 22*45, or 1*4 per cent 
greater. 
That the present sanitary system is very defective and 
not likely to produce any material improvement in the 
public health is virtually admitted by many officers of 
health, who now frequently state in their reports that the 
deaths which have occurred in their districts were from 
causes over which the board or sanitary authority had no 
control, by which it is commonly understood that the dis- 
eases which caused the deaths were not contagious or infec- 
tious, or as they are now frequently termed, preventible,’" 
the operation of the present system being thus confessedly 
limited to a group of diseases which cause only about one 
seventh of the total number of deaths. But we have seen 
that during the last twenty years there has been no diminu- 
tion in the general death rate, and it is evident therefore 
either that sanitary measures have failed entirely to reduce 
the mortality from the so-called preventible diseases, or that 
any reduction they have effected has been counterbalanced 
by a corresponding increase in the mortality from the non- 
preventible class. With a view to determine which of these 
conclusions is the true one I have compared the rates 
