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has occurred within comparatively recent years in these same countries. Thus, the average annual death rate in England and Wales, during the period from 1838 to 1875, was 22-3 per thousand. From 1876 to 1880, it was 20-8. But, for the six years from 1880 to 1887, the average has not exceeded 19*3; which means that about 500,000 persons in England and Wales were alive at the close of the year 1886 who would have been dead if the rate of mortality which prevailed between 1838 and 1875 had been maintained.[1] The average death-rate for the whole United States, for the census-year 1880, was between 17 and 18 per 1,000; which is believed to be a less mean rate than that of any European country except Sweden.

The results of the most recent and elaborate investigations on this subject, communicated, with data, by M. Vachee, to the "Bulletin de l'Institute International de Statistique," Rome, 1887, are, that the mortality of Europe has diminished from 25 to 33 per cent, and that the mean duration of life has increased from seven to twelve years, since the beginning of this century. This estimate of the rate of improvement for all Europe is higher than the English data would alone warrant, but may be correct. At the same time it is well recognized, that through the absence of reliable data it is impossible to speak with certainty as to the decrease in mortality, or as to the expectation of life in any country, except in respect to the last forty or fifty years.

Now, while improved sanitary knowledge and regulations have contributed to this result, it has been mainly due to the increase in the abundance and cheapness of food products; which in turn are almost wholly attributable to recent improvements in the methods of production and distribution. But whatever may have been the causes of these changes, they could not have occurred without an increase of vitality among the masses.

Again, if civilization is responsible for many new diseases, civilization should be credited with having stamped out, or greatly mitigated not a few that a century ago were extremely formidable. Plague and leprosy have practically long disappeared from countries of high civilization. For the five years from 1795 to 1800 the average annual number of deaths from small-pox in the city of London was 10,180; but for the five years from 1875 to 1880 it was only 1,408. Typhus and typhoid fevers are now known to be capable of prevention, and cholera and yellow fever of complete territorial restriction. Typhus fever, once the scourge of London, and especially of its prisons, is said to have now entirely disappeared from that city. No living physician has seen malignant syphilis as described in 1786 by the eminent English surgeon, John Hunter. Anæsthetics have removed the pain attendant upon surgical operations; and the use of antiseptics has re-

  1. It is also to be noted that by far the larger proportion of the increased duration of human life in England is lived at useful ages, and not at the dependent ages of either childhood or old age.