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learn from it ? The prime fact, of course, is that out of so
many persons living, so many persons have died in a given
time. Experience has shown that in ordinary years deathrates
vary within comparatively narrow limits; that in the
presence of severe outbreaks of epidemic diseases deathrates
become augmented, and often very seriously augmented;
that in certain localities (such as large towns) which are
generally assumed to be of inferior healthiness the deathrates
are mostly higher than they are in certain other
localities (such as country districts) which enjoy the reputation
of comparative salubrity. And on these and other
"rounds it has been assumed that the death-rate is a
measure of the health of a population, and that the fluctuations
of the death-rate imply corresponding fluctuations of
health. To a certain extent this is true ; but it is true only
of the margin which remains after necessary deaths (if I
may use the expression) have been eliminated (and these
constitute the great bulk of a mortality) ; and after the
effects of all influences tending to disturb the due proportion
between the young, the middle-aged, and the old, the healthy,
the sick, and the dying have been investigated and allowed
for. On the effects of those deaths which I have termed
necessary upon death-rates I need not now enlarge.
"On the effects of the second class of causes, however,
I have something to say, especially as I believe that
they have a very important influence, and that this
influence has been very generally overlooked. The influence
of hospitals, of asylums, and of workhouses, and of any
institution receiving the aged and sick is well illustrated in
the present report, by the excessive mortality which the
presence of the workhouse and of two lunatic asylums gives