But while it is admitted that the streets of a town may be cleaned, the condition of the poor improved, and diseases, under the most favorable circumstances, prevented, it may be doubted whether the sanitary condition of populous towns can be materially changed, and the death-rate greatly reduced. Yet in England, where sanitary science is enthusiastically cultivated, there is not only no doubt that large towns can be thus improved, but that the mortality of London itself may be no greater than that of the country. Already, indeed, the London _Times_ boasts “that the average of health throughout the City of London is higher than the average of health throughout all England, taking town and country together. The mortality in all England is at the rate of 22.8 in every 1,000 of the population; in the City of London it is at the rate of 22.3 for every 1,000 inhabitants! The improvement has been progressive; it has been slow, but steady and sure. Gradually the mortality has decreased, until the yearly death roll of 3,763 has been reduced to 2,904 within a period of nine years, during which the city has been under the rule of the Sanitary Commission. The deaths this year--22.3 per 1,000, or one in every forty-five of the inhabitants--are nine per cent below the general average, and represent a saving of 286 lives. And secondly, this gratifying result has been obtained in the face of obstacles which seemed to be almost insurmountable.” Liverpool affords a striking example of the power of sanitary measures, rigidly enforced to improve the public health. It was formerly the most unhealthy city of England, being the very home of typhus, smallpox, and allied preventable diseases. But it adopted vigorous measures of reform, improving its poorer districts, and the death-rate has fallen eight in 1,000. Macclesfield, Salisbury, and many other English towns have had their mortality reduced 8, 10, and 15 in 1,000 by the vigorous prosecution of sanitary improvements. All the populous towns of that country are moving in this reform, and, as a result, the general death-rate of towns is approximating that of the country. [Sidenote: Cleanliness Preserves from Epidemics]