Now let its see how many of the above diseases are more or less preventable. and I how far we have already been successful in diminishing them. There are parts of Eng land in which, for each 1000 persons living, there die annually only while there are other harts that, of each 1000 persons, 30 or more} die annually. The 15 and the 80 me said to be the respective death-rates of these places. The average London death-rate is 25; and the most common death•rate in country districts end small towns broach all England earl Wales is 20. The registrar-general's return, published in Jan., 1868, Show ing the annual rate of mortality in the large towns of the United Kingdom for the year 18-37. iambics a eordparisen to be made of the death-rates in the last threeyears—lt.65 • being the first year of the publication of these results. Thus the average annual rate of 'nor tality per 1000 persons living in the great cities in each of the years 1865, 1860, and 1807 respectively, was as follows: Birmingham, which is one of the healtlnest sites in the kingdom, 25, 24,, and 24; the density of population (persons to an acre) In 1857 was 44. Hull, 27, 24, and 25; density, 80. Bristol, 24, 25, and 23; density, 85. Edinburgh, 28, 27, and 27; density, 40. Dublin. 26, 23, and 27; density, 33. Salford, 29, 29, end 29; density, 23. Glasgow, 33, 30, and 29; density, 87. '_Manchester, 33, 32, and 31; density, 81. Leeds. 31, 33, and 27; density, 11. Liverpool, 36, 42, and 30; densit•, 90. The annual Met•tally in Sheffield, in each of the years 1806 and 1867, was 28 and 25, density, ' 10. In Neweastle-on-Tyne the annual mortality in 1806 and 1807 respectively was I 32 and 31. The results fur London hi each of the three' yeers 1865-67 respectively were, annual mortality per 1000 of population, 25, 20. and 23; density, 40. In comparing the rate of mortality in one town with that of another, it should be borne in mind that of " the English towns. Bristol, Leeds, and Liverpool have each a medical health officer. Birmingham, Hull, Salford, Manchester, Sheffield, and Newcastle-on-Tyne hare no medical health officer; but most of these towns; however, have benefited from the efficacy of hygienic measures. It is obvious that if, by sanitary precautions, we could reduce all the death-rates to 15, or even to 20, an enormous saving of human life would result In the year 1805 Mr. Simon suggested that the time was come for attempting to ascertain the amount of benefit to the public health that had been derived from the works of sanitary improvement—especially of ' drainage and water-supply—t•at had been already completed, and he was author ized to institute the with time assistance of Dr. Buchanan as an inspector. The result of the inquiry, which relates to 24 towns,§' with an aggregate population of more than 000,000 persons, is now published, and we shall give a brief abstract of the results which have Been obtained. The numerical results are given in the accompanying table, page 131, where A shows at each place iu the list what difference there has been, since sanitary works were established, in the general dean-rate in 10.000 of the population. this number being taken iintiad of ROO to obtain more eceunee munericaf nsults. B gives the general death-rates of A. ueietas the inconstant ilium nee which has been exerted by the chief infantile epidemics; and slmilarly E gives the means of eliminating from A the influence of the cholera epidemics of 1848-49, 1854. and 1866. The columns C to G inclusive are for comparing the quantities of particular k:nds of deaths caused in each of the plates in the two compared periods. tacit "special death-•ates," used with caution, yield ;he most useful of all conclusions us to clumges wrought in the public health.
Front the table, which is fraught with the most valuable information, in the most condensed form. we learn that, omitting influence of eholent, there has been a diminution in the death-rate in all hot five cases, where the rate has been In four of the towns—viz., Cardiff. Newport (Mon ), Macclesfield. and Croydon—the reduc Von amounted to 24, 23, 20, and 184 per cent. With regard to the cri,tayinus diseases, small-pox, wl.ich is callable of being rooted oat by an efficient system of vaccination, is not noticed here, and typlam fear h is scarcely occurred in the towns selected for inquiry. The time has hardly conic for estimating the effect of works of :cwt.•age and water-sup ply upon measles, scarlatina, and whooping-cough, inasmuch as eihdendes of these dis eases may revolve in lung periois. Jle,asles and lchuoping-cough however, to have slightly declined. Typhoid has very much diminished with the ample supply of good water, tuyl the purification of the atmosphere from deeompo-ieg oreanic matter, by the abolition of cesspools, by draining, etc. In Salisbury. Strafford, Croydon, and Mer thyr the annual death-rate from typhoid .has diminished 75, 67, 63, and GO per cent respectively; mid in all the towns except three there was more or less diminution. In these exceptional cases it was found that sewage gases were, by a defect of the outfall arrangement, forced into the houses.* Did rrhot appears to have been reduced by purifica tion of air and water. Removal of subsoil water has Hitt affected it. While in tows s the death-rate from this disease has been diminished 50 per cent or more, in Ashby it has increased 100, and in Rugby 200 per cent. These anomalous results are ascribed to the,prevalence of the disease in the respective wort Cia.Wera epidemics appear, says Dr. Buchanan, to have been rendered practically harmless in the towns examined, as may he seen by the comparison of the death-rates per 10,000 in the three last epidemics: in certain of the towns, and the diminution seems due.fo the drying of the soil, which has in most cases accompanied the laving of main sewers; and the greater the influence of the sewerage in drying the sasoil is. so much the greater is the diminution of the death-rate front this di.-ease. At Salisbury it is 49 per cent of its former rate; at Ely, 47: at Rugby. 43; at Banbury, 41; and at Worthing, 36.
Failure to reduce consumption is most observable either where the soil already contained little water. or where-- the town water passing by the surface or in superficial drains— the deep drain age consisted of impervious pipes. laid down in compact eh:tenets, so that no extensive drainage of water could occur either through or alongside of them. It does not seem that the sewerage of towns, by the removal of CI:Crew and house-slops, has acted to reduce the amount of their death rate by consumption. Discuss of the limps other than consumption have undergone no regular reductimi. Dr. Buchanan concludes this most vain:11)1e report with the observation that the progress made by the inhabit ants of 11104 of the towns in deeeney, cleanliness, self-respect, and morality was at the least as striking as the improvement in their health, measured by the mortality returns.
In various articles on specisl disorders, as scurvy, smell-pox, and typhoid fever, we have pointed out how completely they are under the :sanitary dithetie mins ureq. In his excellent chapter " On the Prevention of Diseases in the Army," Dr. Parkes gives the following list of diseases, with the methods to lie adopted for their pre vention—viz.: (1) Specific Diseases—paroxysmal fevers. yellow fever. cholera, typhus exanthemans, Indio plague, typhoid fever, relapsing fever, bilious n mitten t fever, crop-. tire fevers, erysipelas, hospital gangrene; and (2) Son-spcc,fic Diaases—dysentery and diarrhea, liver disease, insolation, pbthisis, scurvy, military oplitlai'y-.)(1, (gray granula tions on the palpebral conjunctiva), and venereal diseases.* It is the miasmatic diseases which form the first order of the el ss of zymotic digeases, which seem most under our control. We have shown in a previous page that recent researches tend to show that various of these diseases owe their origin to fungi.We shall conclude this imperfect sketch of the history, progress, and results of sanitary science with a history of the recently discovered choleraf ngas, and with a notice of the other recent scientific investigations regarding the nature and prevention el this disease (which may ha regarded as a supplement to the article CHOLERA). At the international congress held at Weimar in 1867, the cholera-fun!.•us was the great ,center of interest. The subject had been investigated by professors Dallier and 1)e Bary, two of the leading German mycologists, and the latter drew up aseport, the following abstract of which is given by Mr. Simony: "Both observers find in cholera evacuations, and in the intes tinal mucus of the dead body, definite organic structures, zooglcea, consisting of exces sively fine granules, clustered more or less densely in the into-spaces of a jelly, which more or less abundantly surrounds them. The granules divide and subdivide themselves, to form beaded threads, which interlace, in immense numbers, into felted masses in the mucus. The further development of these organisms has yet to be determined. Dr. Thome, by sowing them, has got, after some time, larger, round. cell-like bodies, which rapidly multiplied, and also abundant filamentous fungi (cylindro &cilium), on which grew cylindrical spores, capable of developing again to filaments. Views as to the mutual relations of these cells, filaments, and spores, are for various reasons to he expressed only with reserve; and the study of them is so difficult, that definite results cannot at once be expected. The significance of these fungi would be greatly increased if they should he shown to exist in the blood as well as in the bowels of the sick; but this, though from some inquiries it seems probable, must at present be deemed questionable." It has been since ascertained that this fungus requires a high temperature (80° to 112' F.) for its fructification, and therefore cannot he. of European origin. " The doctrine of the cholera-fungus," says Mr. Simon—" the alleged discovery that the specific zymosis of cholera, the bowel-fermcntatiou in respect of which it is con tagious, has essentially associated with it, and perhaps as its immediate cause, a definite multiplying organic form—is not only of the utmost philosophical interest, hut, should it be substantiated, may also, hereafter, be found capable of very important practical application. For, as one reflects on the doctrine in all its bearings, upecially, as one considers prof. Dallies conjecture. (based on botanical considerations). that perhaps the cylindro-Imnium is originally a blight of rice, something like a clue is for the first time suggested for investigations, which may hereafter conduce to the prevention of cholera in its eastern centers of origination. But for its in Europe, meanwhile, the doctrine may absolutely sterile of results. In its broad signification, indeed, the discovery would not be a surprise to pathologists. The possibility has ftir some years past been recognized, that perhaps every fermentatory or putrefactive change of organic material has with it, and possibly as its cause, a characteristic molecular living thing; and how ever sure it may have become, that the choleraic zymosis answers to that possibility, it remains yet untried whether disinfection (which, after all, is but a doubtful, resource) can deal better with the process on that basis, than on the purely chemical basis which has hitherto been the ground of our proceedings." "It cannot," adds the same high authority, "he too distinctly understood that. the person who contracts cholera in thiscountry is zpsofaxto demonstrated, with almost absolute certainty to have been exposed to excremental pollution; that what gave him cholera was (inediately or immediately) cholera-contagium. discharged from another's bowels; that, in short, the diffusion of cholera among us depends eniirely upon the numberless filthy facilities. which are let exist, and specially in our larger towns,•for 'the fouling of earth, and air, and water, and thus, secondarily, for the in ft ctiom of man,with whomever COD UR:0011 be contained in the miscellaneous outflo•ings of the population.