question of the proof or otherwise of the existence of a Great Primal Law in the Development of Consumption in Massachusetts, and probably New England, and possibly of a still wider scope, not hitherto distinctly recognized. Attention to this law by our ancestors, and by ourselves at the present hour, would, as I believe, have saved, and would still be saving, hecatombs of human beings that are now annually sacrificed. Holding most firmly to this opinion, you will readily understand my eager anxiety to convince not only you, my associates and efficient collaborators in this investigation, but, through you, the whole community, of its vital importance to the present and still more to future generations in New England, and possibly other parts of our country.

But in addition to the intrinsic worth of the subject to be discussed, I claim your candid, and, if possible, close attention to the remarks I shall make, for another reason, viz.: The inferences I shall make, and the Law of Consumption Development I shall try to support, are merely the summing up of data furnished to me by yourselves. I stand, therefore, now before you the exponent of your own (unconscious, perhaps, it may be on the part of many of you) medical opinion. For you are all aware that to the courtesy and to that fine esprit de corps I have always found in the Massachusetts Medical Society, spread as it is over all the Old Bay State, from beyond the Berkshire Hills to the Atlantic Coast, I owe all the chief facts and statements upon which this opinion is founded.

The two following propositions contain the essential points of this address:

First. A residence on or near a damp soil, whether that dampness be inherent in the soil itself, or caused by percolation from adjacent ponds, rivers, meadows, marshes or springy soils, is one of the primal causes of consumption in Massachusetts, probably in New England, and possibly in other portions of the globe.

Second. Consumption can be checked in its career, and possibly, nay probably, prevented in some instances, by attention to this law.

The essential truths thus enunciated I am ready to defend against all mere assertions of individual opinion, however much those assertions may appear to sustain the reverse of these propositions. I pray you not to judge hastily, but if any remarks I make seem not warranted by the present state of medical knowledge, suspend awhile your judgments, and look not only at my facts, but open your own eyes and your intellects to a fair and thorough examination of similar facts, that may be really occurring within the rounds of your daily professional life. If you do this, it may happen, as it has happened to myself, and also to one who was, at first, a very decided opponent, an aged and very excellent practitioner in New Hamphsire. We both became convinced, in spite of our own preconceived notions, solely by the evidence of actual phenomena, occurring, as it were, under our very eyes.

I lay down now before you, as among my Medical Axioms, the following statements:

1st. Consumption is not, as some writers have contended, endemic equally in every part of New England; but there are some localities where it is very rife, and others where it is vastly less destructive than in the State at large.

2d. There is a law, hitherto scarcely noticed, or but vaguely hinted at by one or two individual writers, but (as I believe) never proved until now, which is one of the main causes, if not the sole cause, of this unequal topographical distribution of consumption in New England.

3d. This law is intimately connected with, and apparently dependent on, the humidity of the soils, on or near which stand the towns, villages, or even single houses, where consumption prevails.

4th. The existence of this law of soil-moisture, as one of the prime causes of consumption in New England, can be proved, as I think, by several lines of argument, resting on actual facts obtained either from public or private records, statistical data, or the opinions of physicians, practising medicine in various parts of New England.

These lines of proof, or of argument, are drawn from the following sources:

I. Massachusetts State Registration Reports. II. Medical Opinion of Massachusetts, as embodied in the returns made to me, as a Committee of this Society these returns consisting of written

reports from resident physicians of one hundred and eighty-three towns.

III. Actual Statistics of deaths by consumption, received from such correspondents. Some of these statistics are but incidentally mentioned, while others are from towns, districted and carefully examined with reference to the relative prevalence of consumption in the different districts. In some of the most important of these, the examination was made without my correspondent or myself being aware of the existence of any law such as that which I shall present at this time.

IV. Peculiarities of certain towns and of villages in the same townships, in some of which consumption is quite prevalent, and in others much less so; these differences being connected most closely with corresponding differences in the amount of moisture of the soil of said places.

V. Certain well-known houses, which, in various towns, are known by the inhabitants and physicians to have been long noted as the abode of consumption, and in some of which several families have been, during the past fifty years, cut off by the disease, without the least suspicion, on the part of the occupants, of the fatal position in which the houses were placed.

VI. Confirmatory facts, statistics and opinions from Rhode Island, Maine and New Hampshire.

VII. The medical statistics given in the Report on the health of the United States Army, strongly supporting the idea of the existence of the same law, and the operation of it over the whole of the United States.

VIII. Results of my own practice since I first became convinced of the truth of the law-said results consisting of (a) Statistics from my private medical records; (b) Results actually derived from my choice of localities for consumptive patients, based on a belief in the law.

IX.

Apparent exceptions to the law.

It will, of course, be impossible to do anything more than briefly allude to each of these various lines of proof; and while doing so, I must ask you to believe in the truthfulness of what I quote from the voluminous manuscript reports and letters, received chiefly from yourselves and from some excellent and zealous physicians in Maine, New Hampshire and Rhode Island.

These reports and these letters should be kept among other valuable manuscripts of the Society. They embody not only the present medical opinion about consumption and its causes, in Massachusetts, but much incidental matter of importance to Public Hygiene. I hope, at some future time, the Society will have portions of them published.

I. STATE REGISTRATION REPORTS.

The following table is mainly founded on statistics of four years, or between 1849 and 1852, inclusive. The last column, containing the proportion of deaths by consumption to the population, includes five years, viz., 1849-53 inclusive.*

* State Registration, Report 11th, pages 70–136, and Report 12th, p. 162.