Of such circumstances some lie within your control, and affect masses of the people; but the more special causes of chronic disease lie rather out of your jurisdiction, and the option of avoiding them is a matter of individual will. Vicious habits and indiscretion; a life too indolent, or too laborious; poverty and privation; vicissitudes of weather and temperature; intemperance in diet; unwholesome and adulterated food; and, not least, inappropriate marriages tending to perpetuate particular kinds of disease; these words may suggest to you, briefly, that there are many influences, within the sphere of private life, by which the aggregate death-rate of a population is largely enhanced, but the control of which, if attainable, lies almost entirely at the discretion of the classes subject to their operation. Considering all these causes, and the needless waste of life occasioned by them, I can have little doubt that as much might be done by individuals, under the influence of improved education, to lessen the mortality from chronic disease, as by sanitary legislation to stay the sources of epidemic death. And regarding both classes of disease together--those, on the one hand, which are of endemic origin (arising in imperfect drainage, in defective water-supply, in ill-devised arrangement of buildings, in offensive and injurious trades, in the putrefaction of burial-grounds, and the like) and those classes, on the other, which arise in the circumstances of individual life, I can have no hesitation in estimating their joint operation at a moiety of our total death-rate, or in renewing an assertion of my last years’ Report, ‘if the deliberate promises of Science be not an empty delusion, it is practicable to reduce human mortality within your jurisdiction to the half of its present average prevalence.’ To revert, however, to your more special branch of the subject,--I have thought the present a convenient time for indicating to you the pressure of preventable death, arising in acute disease, because of the great addition which you have recently gained to your powers for enforcing prevention. That an average death-rate of nearly 25 _per_ thousand _per annum_ prevails in the City; that three-eighths of your mortality consists in a premature extinction of infant life; that fatal disease, in more than two-fifths of its visitations, is of a kind which operates endemically and preventably;--these are the facts to which I have appealed, as my evidence of the need for sanitary activity and perseverance. On other occasions I have endeavoured to set before you what are those agencies hostile to life, which affect the masses of an urban population; and during the last three years your Hon. Court has shown its recognition of these causes, and has devoted attention to the means of counteracting them by appropriate sanitary measures.