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fouling our rivers the poor farmer may have to pay a "waterrate" for providing an artificial water supply for his horses, cattle, sheep, and even poultry. Many diseases of animals are communicable to man, and it is daily becoming more evident that our health is very intimately bound up with the health of our animals, and that their sanitary condition is scarcely less important than our own.

From a financial point of view, water-carried sewage has not been encouraging. It has increased the rates, increased the cost of our houses, and put us to great expense for water. The "treatment" of sewage before it is finally discharged into our rivers is everywhere an expense and nowhere a source of profit, and we find that public sewers which cost millions to construct, cost thousands to keep in repair.

The sewers we have built with borrowed capital. We have seized all the glory and patronage of disbursing enormous sums, and have left posterity to pay the bills. This is a doubtful policy, and I think a most immoral one, but I feel it is little use to raise my feeble voice against the custom which is now so much encouraged of hanging a debt round the neck of our It may be defensible to raise a loan for building town halls, schools, and similar edifices, of which posterity will reap the benefit, but to raise loans for the purpose of wasting most valuable fertilising matter by means of works which will be a constant expense, and never a source of profit, is a very doubtful expedient.


I hope the custom will soon obtain of compelling each generation to bear the charge of its own sanitary experiments-and blunders. Sewers are constant sources of impoverishment to the soil, and the soil be it remembered is the only permanent and reliable source of wealth in any country. The waste of valuable matter which takes place in London and our big towns must make us blush. I wish the waste were limited to our big towns, but it is not so. It is common throughout the country, even in rural districts. Free trade has made food very cheap indeed, and cheap food, especially imported food, ought absolutely to increase the fertility of a country, for obvious reasons which I need not particularize. The fertility of this country is not increasing to judge by the agricultural distress. The farmers are crying out for "protection." The first kind of protection needed seems to me to be a protection from ourselves and from the sinful waste of fertilising matters which Local Boards, Municipalities, and Imperial Parliament equally foster.

If we made a proper use of our organic refuse we should enrich posterity. As it is we reap and we do not sow. If municipalities would bury organic refuse, and plant the seed of

some forest tree suited to the soil and situation (which in these days of cheap food stuffs would probably be the best branch of agriculture to pursue), they would earn the blessings, instead of the curses of posterity; and they would beautify the face of nature, instead of making it hideous with tall chimneys, pumping stations, and precipitating tanks. This piece of advice will I fear fall very flat, for of all agricultural arts, forestry seems the deadest in this country.

As a defence for gigantic sewage schemes, it is often said that you can do nothing well without co-operation, and this is the excuse for compelling all, whether they want them or not, to contribute towards the cost of sewers.

If co-operation be for a good end, the result is a great good; but if co-operation be for a bad purpose, the result is a great evil. I need say no more.

The last charge which I have to bring against water-carried sewage is a serious one, viz., that it encourages overcrowding in cities, which is universally admitted to be the greatest of all sanitary evils, and one which cannot be counterbalanced.

Water-carried sewage encourages overcrowding becauses it enables us to build houses with no outlet except a hole for the sewage to run through. The growth of London must be a source of alarm to sanitarians, and it is impossible not to admit that our system of sewers has been a most important factor in its production. Look at Charing Cross, where a street of gigantic clubs and hotels has arisen, each without curtilage of any kind, and where a handsome profit has been made by setting the first law of sanitation at defiance. You will find the same thing to a greater or less extent throughout the Metropolitan area.

It is difficult to say why we are so prone to crowd into cities. In former days we crowded behind walls as a protection from our enemies. Those days are at an end, but the crowding is greater than ever. The common cant of the day is that in this 19th century we have annihilated time and space. Certainly in cities both are excessively precious. The telegraph, the telephone, and the steam engine, ought to have diminished overcrowding, but they have not. The stream is still, mainly from the country towards the town, the attraction being the making of money and the spending of it.

It may be well to glance at the effect of this overcrowding in this city.

It is a common remark that London is a very healthy city, and as a proof of this assertion persons point to the death-rate, which certainly of late has not been excessive. The London of the Registrar-General however is a very extensive place, and many of the outlying parts are almost rural in character, so

that if you want to find the effect of living in a crowded city, it is not fair to take London as a whole.

I am no believer in the healthiness of London. It is true that our death-rate has not been raised by any great epidemic of late years, but London is undoubtedly a city where an abundance of second-rate health exists. The crowds that throng the doors of hospitals increase, and in my profession there is a great outcry about "hospital abuse," which means, I take it, that decent folk are not able to cope with the amount of chronic disorders with which they are beset. Again, the mobility of the population in the present day makes our vital statistics very uncertain. Many a healthy person is imported into London, and being wounded in the battle of life, returns to the country to die or recover as the case may be. There is a scarcity of very young and very old people, and in order to appreciate the vital statistics of London, great allowances have to be made for the abnormal age distributions.

In order to judge of the effect of over-crowding, let us look at the vital statistics of the "Strand" Registration District, which is about the centre of London, and from which one would have to walk very many miles to reach the country in any direction.

The "Strand" enjoys many advantages. It is mainly a wealthy district, extending in irregular form from Temple Bar to Buckingham Palace. It includes the whole of the Green Park and half St. James's Park. It has a gravel soil, and slopes gently, with exposure to the south, to the fringe of (potentially) the noblest river in the country. The worst and poorest parts are at the north-east corner.

The true death-rate of a London district is difficult to get. The British Medical Journal, however, has been in the habit for the last nine quarter-years of publishing the "true" death-rates of the London districts after complete distribution of deaths occurring in public institutions. I have compiled a table from the nine tables which have appeared in the British Medical Journal, so that I am able to compare "The Strand" with the whole of London for nine quarters. and with Dorset (for ten years, 1871--80).

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I have chosen the county of Dorset for comparison because it is a "healthy district," and if we are to do any good we must always aim at a high standard. Again, the Dorsetshire labourer has always been a favourite stalking-horse for cockney politicians, and it may be well to show how much healthier he is than the Londoner, notwithstanding his supposed condition of chronic


This table is very interesting. Dr. Letheby said "a high death-rate means a high birth-rate, and a high birth-rate is the invariable concomitant of prosperity." This dictum does not evidently apply to the Strand.

Dr. Farr, on the other hand, pointed out that "a low birthrate implies a small proportion of young adults and a large proportion of the aged." This dictum again does not apply to the Strand, as we shall see by a reference to the next table, in which I have endeavoured to make corrections for the abnormal age-distribution which obtains in that district, and which Dr. W. Ogle rightly insists is absolutely necessary before you can arrive at just conclusions. The table, I think, speaks for itself.

"The Strand"-Mean population 1871-8037,461.

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From this table it appears that there was in the Strand during the decade 1871-80 a deficit of 3,812 children under 15, and of 453 of persons over 65, while there was a surplus of 4,233 persons between 15 and 65.

This abnormal distribution ought, according to Dr. Farr, to give a high birth-rate, and a low death-rate. The very reverse is the case, and a critical examination of the figures seems to show that the death-rate in the Strand is more than double what it is in Dorsetshire.

It may be said that this high death-rate is due to the presence in the Strand of two hospitals (Charing Cross and King's College), and doubtless these have some material effect in producing the terrible adult mortality.

Hospitals however are generally placed where they are most needed, and I would point out that these institutions can hardly account for the enormous infant mortality; and certainly not for the deaths of infants under one year. Against the fact that the Strand contains two hospitals, is to be placed the not less important fact that it contains no workhouse. This institution is at Edmonton, where it helped to raise the death-rate from 15.8 to 16.9.

It need not surprise us that a population situated in the very centre of the vastest city the world has ever seen should have a high death-rate, and it may be well to look to the causes of death and again to compare the rates from different causes with those in Dorsetshire.

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No good would be got by extending this table. Suffice it to say that there is no single cause of death in the RegistrarGeneral's tables which is not more active in the Strand than it is in Dorsetshire.

I would particularly draw attention to the fact that the death rate for whooping cough and tubercular and respiratory

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