oided without any serious effort either of intellect or
will.

The success with which medicine and sanitary science have laboured to
prolong life, to extirpate or diminish different forms of disease and to
alleviate their consequences is abundantly proved. In all civilised
countries the average of life has been raised, and there is good reason
to believe that not only old age but also active, useful, enjoyable old
age has become much more frequent. It is true that the gain to human
happiness is not quite as great as might at first sight be imagined.
Death is least sad when it comes in infancy or in extreme old age, and
the increased average of life is largely due to the great diminution in
infant mortality, which is in truth a very doubtful blessing. If extreme
old age is a thing to be desired, it is perhaps chiefly because it
usually implies a constitution which gives many earlier years of robust
and healthy life. But with all deductions the triumphs of sanitary
reform as well as of medical science are perhaps the brightest page in
the history of our century. Some of the measures which have proved most
useful can only be effected at some sacrifice of individual freedom and
by widespread coercive sanitary regulations, and are thus more akin to
despotism than to free government. How different would have been the
condition of the world, and how far greater would have been the
popularity of strong monarchy if at the time when such a form of
government generally prevailed rulers had had the intelligence to put
before them the improvement of the health and the prolongation of the
lives of their subjects as the main object of their policy rather than
military glory or the acquisition of territory or mere ostentatious and
selfish display!

There is, however, some reason to believe that the diminution of disease
and the prolongation of average human life are not necessarily or even
generally accompanied by a corresponding improvement in general health.
'Acute diseases,' says an excellent judge, 'which are eminently fatal,
prevail, on the contrary, in a population where the standard of health
is high.... Thus a high rate of mortality may often be observed in a
community where the number of persons affected with disease is small,
and on the other hand general physical depression may concur with the
prevalence of chronic maladies and yet be unattended with a great
proportion of deaths.'[4] An anaemic population, free from severe