200 
information of the outbreak of disease — and from the want 
of proper instruction and central assistance they are driven 
to make experiments in sanitation which by their failure or 
by their cost raise a formidable local opposition to all their 
efforts. 
It will be seen then that I entirely agree with Mr. Bax- 
endell in thinking that the present sanitary system is very 
defective” — but it by no means follows that it has done no 
good. 
In auditing carefully the several items of a profit and loss 
account, there may well be found an equipoise between the 
two sides of the account — or even a loss on the whole — and 
yet it may be possible to see that unless certain adverse cir- 
cumstances had occurred, such as a rise in wages, increased 
price of raw material, &c., the result would have been a 
decided gain. 
The general death-toll of a country is in truth under the 
influence of many most various conditions. It is only 
possible to discover the full effect of sanitary measures when 
all these conditions are taken into account. It would be a 
weak form of defence for these measures if we were to sav 
«/ 
that if they had not been taken “things might have been 
worse,” — for they might, perhaps, even have been better. 
But the argument changes its character altogether if it 
can be shown that the death rate certainly would have been 
heavier had not sanitary or other influences been active to 
counteract the increase of morbific agencies that have been 
at work. 
It is not difficult to prove that certain important causes 
of excessive mortality have of late years increased consider- 
ably in their pressure upon the populations of England and 
Wales; and I would especially advert to three of these: — 
1. The density and size of towns; 2. Intemperance; 3. The 
improper feeding and treatment of children. 
1. The Density and size of Towns. 
