(JON SUM FT ION 
Ilf 
NEW ENGLAND AND ELSEWHERE, 
OR 
SOIL-MOISTURE ONE OF ITS CHIEF CAUSES. CONSUMPTION 
15 
NEW ENGLAND AND ELSEWHERE, 
OR 
SOIL-MOISTURE ONE OF ITS CHIEF CAUSES. 
BOSTON: 
DAVID CLAPP & SON, PRINTERS 334 WASHINGTON ST. 
1868. [These “ Prefatory and Historical Remarks,” prepared as an introduction to a small second 
edition of my address on “Consumption in New England,” have been printed separately, 1st 
because they contain the essential points of my whole argument for the existence of a law of 
s di-moisture as an import int c.iuse of Phthisis in New England and possibly elsewhere •, 
because they contain the latest facts upon the subject, viz , returns from England proving that 
artificial drying of the soil by subsoil drainage, t,c., has actually caused a deer ease ofthe 
death-rate by phthisis in places where such sanitary measures have been adopted. 
H. I. B-.] V\ 
PREFATORY AND HISTORICAL REMARKS. 
In 1862 I published the following address on Consump- 
tion in New England, as it was delivered at the annual meet- 
ing of the Massachusetts Medical Society, in the same year. 
In the preface I used the following language:—“ The force 
of facts presented to me by correspondents compels me 
to resign the commonly received opinion that consumption 
is equally diffused throughout New England, and to adopt 
the new one of the address, viz.: that there arc some spots 
which have very little of that scourge of the human race, 
while in other places and even in particular houses it prevails 
to a frightful degree ; and moreover that these spots may 
be perhaps within a very short distance from each other. 
Again: facts, as I believe, indicate that dryness of the soil in 
the surroundings of any place is the prominent characteristic of 
the former, or of places comparatively free from consumption ; 
while dampness of the soil characterizes the latter, or as they 
may be aptly called, consumption breeding districts.” 
Long before this publication, however, viz., in 1855, and 
again in 1856, I had made reports to the same Society to 
the same effect. 
During a visit to Europe in 1859, 1 laid these facts before 4 
several persons on that side of the Atlantic. Among these 
were Drs. Farr and Greenhow of London, and the members 
of the London Society for Medical Observation ; * Dr. 
Gairdner of Glasgow, Dr. Bennett and Sir James Y. Simp- 
son of Edinburgh, and Monsieur Louis at Paris. Some of 
these gentlemen expressed a deep interest in the results at 
which I had arrived. By conversation, I endeavored to 
induce the making of similar investigations in England. 
Subsequent to the publication of the address I received 
several letters, and from some of these I take the liberty of 
quoting in order to show the opinions expressed therein. 
That excellent man and wise physician, the late Dr. John 
Ware, wrote thus to me:— 
Pavilion, January 11, 1863. 
My Dear Dr.—I have but just had time within a few 
days to go over your pamphlet in sucli a way as to satisfy 
myself. I think you have made out your case as satisfacto- 
rily as any point in so obscure and complicated a subject as 
the causes of disease, can be made, and it is surprising to 
me that any one can hesitate to admit that you have made 
out a very strong case—at least strong enough to be made 
the foundation of advice in practice. I do not hesitate to 
act upon it, and should consider myself criminal not to do 
so. * * * * 
I am always very assuredly your friend, 
Dr. Henry I. Bowditch. John Ware. 
The following from the late Dr. Coolidge, of the United 
States Army, I deem of especial value, because in his very 
* As this statement may not he confirmed by the records of the Society, I 
think it right to say that, strictly speaking, I did not present my observations 
to the Society while in session, because the communication was not considered 
a legitimate subject to be laid before that body. But I was allowed to present 
it to some of its members previous to a regular session of the Society. 5 
able Army Medical Reports* he had arrived at similar con- 
clusions, deduced from Medical Reports that had been 
forwarded to the Surgeon General of the United States, from 
all the military posts of the Union. 
Surgeon General’s Office, 
Washington City, D. C., March 6, 1863. 
Dear Doctor,—* * * In tracing the connection between 
moist or wet soils and consumption you have gone one step, 
and an important step, beyond my own published conclusions, 
but my professional experience, and, I may add, my sad per- 
sonal experience, corroborate your views, and make me 
willing to endorse them fully. * * * 
Yours, with much respect, 
Richard H. Coolidge. 
Henry I. Bowditch, M.D., Boston, Mass. 
Dr. Farr, the eminent medical gentleman so long connect- 
ed with the Registration of England, I quote simply to prove 
that I laid the subject fully before him in the published ad- 
dress, as I had in 1859 verbally presented it to him. 
London, March 17, 1863. 
My Dear Dr. Bowditch,—I beg to thank you for your 
valuable address on Consumption. 
We have a series of tables in progress which will assist 
you in your researches. They show the mortality from con- 
sumption at different periods of life, in each district of Eng- 
land and Wales, during the years 1851-60. ***** 
I am respectfully yours, 
W. Farr. 
* Statistical Reports of the Sickness and Mortality in the Army of the United 
States, compiled from the Records of the Surgeon General’s office from 1839 
to 1854. By Richard H. Coolidge, M.D., Assistant Surgeon United States 
Army. Washington, D. C., 1856. Same from 1855 to ’59. Washington, 1860. 6 
Under date of June 18, 1863, I received very important 
testimony from the author of one of the ablest works on 
Climatology that has yet appeared in Europe, viz., A. 
Miihry, M.D., of Gottingen.* 
To Henry I. Bowditch, M.D., Boston. 
Sir,—You certainly have given the proof, that even in 
local distribution this almost “ ubiquitous ” disease prefers 
wet soil to dry soil, or, as I should like to express it, that 
the persons affected with tubercles of the lungs are exposed 
on moist and damp localities to the bad effect which such a 
soil inflicts in the greater part of the diseases, even if or though 
not producing them. This is a fact hitherto not sufficiently 
known and not taken into consideration in the treatment of 
the consumptives. It is in conformity with the geographical 
distribution of consumption. I take occasion to say that I 
now firmly believe in the wholesome effect of dry climates on 
the absence of phthisis; formerly I was unable to decide on 
this point, because in the East Indies the disease is rare, 
and the climate not dry (though in winter it may be called 
so). But I am now of opinion that though there may be 
exceptions, generally among the good effects of the dry cli- 
mates belongs the absence of phthisis. In the Sahara and in 
the interior of Asia it is very rare or wanting. I have given 
this as my opinion, in a book which was published some 
years after the Noso-Geography (1856), in “ Allgem. Geo- 
graph. Meteorologie,” 1860, p. 144, Note. * * * * 
I have the honour to be, Sir, Yours sincerely, 
A. Muhry. 
Gottingen, 18 June, 1863. 
From the tenor of the following remarks, in a review of 
my address, in the London Medical Times and Gazette, Feb. 
27, 1864, it will be evident that English Medical Opinion 
* Kliraatologishc Untersachungen, &c. A. Muhry, M.D. Leipsig et HeidqjL 
berg, 1858. 7 
had little confidence in the results to which I had arrived. 
After giving the title of the address, the writer says: 
“ This pamphlet, though received a number of months ago, 
from being accidentally laid aside, has not yet received a 
notice in this journal, for which apparent indifference we 
owe Dr. Bowditch an ample apology.” 
Then follows an analysis of the main features of the ad- 
dress. The writer closes in these words :— 
“ Whether our author’s zeal in the study of his subject has 
permitted him to overlook other causes that may influence 
the one in question or not, does not affect the value of his 
book, which will amply repay one for the time spent in its 
perusal.” 
My “ zeal,” to which the writer thus kindly alludes, was 
the result of a firm conviction that I had arrived at a great 
truth which I wished to impress upon my hearers and my 
readers—a truth, moreover, forced upon me by facts, and in 
opposition to my own previous views—a truth, as I thought, 
of vast importance to every village and township, nay, even 
to every family in New England, and possibly elsewhere. 
Scarcely two years ago, Dr. Martin, author of an admira- 
ble work on the influence of Tropical Climates, * wrote as 
follows: 
London, 37 Upper Brook Street W., 
December 20th, 1865. 
My Dear Sir,—* * * * I have much too long deferred 
thanking you for your great kindness in sending me a copy 
of your very interesting and important address on “ Con- 
sumption in New England.” 
* * Influence of Tropical Climates on European Constitutions. By James 
Ranald Martin, F.R.S. London: 1856. 8 
The subject is in a great measure new to us on this side 
of the water, and is therefore regarded with much interest, 
with a hope that it may be further investigated. * * * * 
I remain, my dear Sir, yours very faithfully, 
J. R. Martin. 
To Dr. H. I. Bowditch. 
Meanwhile, I obtained from time to time, from private 
individuals, facts confirmatory of my views, and the Rhode 
Island Registration sustained them. Little progress, how- 
ever, was made in the spread of them. 
Finally, observing that the first question proposed for 
discussion by the International Medical Congress that was 
to be held at Paris in August, 1867, was on the causation 
of phthisis, I thought I might possibly induce that body 
to appoint a Commission, composed of able men in different 
quarters of the globe, to investigate the question which 
I deemed settled for New England. I accordingly sent the 
following letter to the Secretary of the Congress. 
Boston, United States of America, May 27, 1867. 
To the Secretary of the International Medical Congress, 
called to meet at Paris during the month of August, 1867. 
Sir,—I see that one of the subjects proposed for discussion 
at the meeting is the causation of phthisis, or consumption 
as it is popularly called; its geographical distribution, &c. 
I beg leave to present, through you,, for the consideration 
of the Committee who may have to report on the geographi- 
cal distribution of this disease, the accompanying address 
and documents. 
The address was delivered by myself before the Massa- 
chusetts Medical Society at its Annual Meeting in 1862, and 
was printed in the Transactions of the Society (Vol. 6, 
Part 2, Second Series). 
Massachusetts is one of the New England States. These 
States are six in number, and are the most Northern and 9 
Eastern States of the Union. Massachusetts holds in the 
New England States a nearly central position—three of 
them lying north and two south of it. Situated as it is on 
the eastern coast of the Continent, its shores are bathed by 
the Atlantic and are. fully exposed to all the winds that 
come from the east over that ocean. 
It lies between 41° 15' and 42° 52' of North Latitude, 
and between 69° 54' and 73° 30' of Longitude west of 
Greenwich, England. Its coast, chiefly sandy or rocky, 
bends inward, forming numerous small harbors, and is be- 
tween 200 and 300 miles long when following the various 
curves—but is less than a hundred if a straight line be 
thrown between its southern and northern capes. It ex- 
tends into the continent in a nearly rectangular shape about 
two hundred miles from east to west, and is about ninety 
miles broad from north to south. Its surface is undulating 
with many lofty hills, but no very high mountains are found 
in it. The Connecticut River runs through nearly its centre 
from north to south, and it has a few more rivers of lesser 
size, which with numerous rivulets and ponds provide ample 
supplies of water. 
Every diversity of soil may be found, from the dry per- 
fectly arid sand, down to the moist meadow. 
The climate is very cold in winter—quite hot at mid- 
summer—chilly and damp in the spring—cool and more 
balmy in the autumn. 
It is the type of New England in its natural peculiarities; 
and its inhabitants, in their social and industrial relations, 
are second to none of its sister States. Comfort and thrift 
prevail generally in New England. Pauperism is rare 
among the native born population. 
Mr. Keith Johnston, in his chart on the Geographical 
distribution of Disease, marks New England as the place 
where consumption is peculiarly endemic. That writer 
makes no mention of this malady prevailing otherwise than 
equally in all parts of New England. Such was deemed to 
be a fact until the investigations, the results of which I wish 
to lay before the Congress, were made by me, aided by in- 
telligent physicians resident in all of the three hundred and 
twenty-five townships of Massachusetts. 10 
I myself certainly held firmly to that opinion, and it was 
only after returns had been made from numerous towns that 
I was led to doubt the truth of it. 
I now believe, 
1st. That phthisis is very unequally distributed in New 
England: 
2d. That there are some places which enjoy a very great 
exemption, if not quite as much exemption from its ravages 
as any portion of the globe can claim : 
3d. That there are some spots, nay even particular houses, 
which are frightfully subject to it: 
4th. That there is a cause governing this unequal distribu- 
tion of the disease; -a law not recognized before my investiga- 
tions, and still practically ignored by the majority of human 
beings, which, however, is one of the main causes, if not the 
sole cause of this unequal distribution in New England, and 
possibly elsewhere: 
5th. That this cause is intimately connected with and ap- 
parently dependent on moisture of the soil on or near which 
stand the towns, villages or houses in which consumption 
prevails. 
That this law of soil moisture is a cause of consumption 
certainly in New England, and possibly in other parts of the 
globe, is proved in the paper herewith presented, by the 
following data: 
A. By the Massachusetts State Registration Reports: 
Note. (It may be added that the Reports made, subse- 
quently to my investigations, by Registrars of Massachusetts, 
fully confirm my investigations relative to the unequal dis- 
tribution of the disease, although one proposes to modify 
somewhat the law as laid down by me.* The Registration 
of Rhode Island, a sister State immediately adjacent on the 
south, fully sustains my views. I beg leave to lay those 
reports also before your body): 
* 1 do not, however, admit the cogency of his argument. On the contrary, I 
deny entirely even its relevancy to the point at issue. The assertion, even if 
true, that consumption decreases from North to South in this country, is no 
proof for or against the question whether dampness of soil causes phthisis. See 
Twentieth Report of Births, Deaths and Marriages in Massachusetts in 1861, 
pp. 54-7, by Oliver Warner, Boston, 1863. 11 
B. By the Medichl Opinion of Massachusetts as embodied 
in returns made to me (as a Committee of the Massachusetts 
Medical Society), from physicians resident in all the towns 
of the State, one hundred and eighty-three of whom give 
specific details bearing upon the subject : 
C. By actual statistics of deaths received from such 
correspondents—the statistics being generally given before 
either my correspondents or I were aware of the prevalence 
of any law upon the subject, or in fact that there was any 
really unequal distribution of consumption within the limits 
of the State: 
D. By peculiarities of certain towns where consumption 
is either prevalent or of rare occurrence, such differences 
being most clearly connected with corresponding differences 
of soil-moisture: 
E. From statistics, sometimes reaching over half a cen- 
tury, in regard to families successively inhabiting certain 
well-known houses in Maine and Massachusetts—rather 
popularly celebrated as containing many consumptive pa- 
tients ; whole families having been, at times, cut down by 
the disease, while the reason for such mortality has never 
been suspected until after these investigations were com- 
pleted : 
F. By confirmatory facts and statistics from the sister 
States of Maine, New Hampshire, and Rhode Island, indicating 
that the same law exists over New England generally. 
It. From medical statistics from the United States Army 
Reports, strongly supporting the possibility of the prevalence 
of the same law over the whole territory of the United States.* 
H. From the results of my own medical practice since 
being convinced of the truth of the law; which results prove 
that persons, having only the early signs of phthisis, viz., 
hsemoptysis, cough, &c., and general prostration, and without 
marked physical signs, have decidedly improved and finally 
recovered after moving from wet localities to well-selected 
dry ones; that persons having well-marked crackling under 
the clavicle, &c., with the rational signs of phthisis, have at 
times rapidly improved, and have at length recovered wholly 
* Dr. Coolitlge’s Report, cited above. 12 
or in part, under the same circumstances of change; and 
finally, that cases of well-advanced phthisis have had pro- 
longed life given by following the same course. 
From the writings of various authors on the proper selection 
of a place of residence for consumptives, I have tried to find 
out whether or not the same law prevails over the entire globe. 
This part of the subject I have, of course, been obliged to 
treat very imperfectly for want of data. But on consulting 
the various authors alluded to, I find as follows. Pan, Villa 
Franca, Nice, Mentone, Malta, Egypt, Madeira, Canary 
Isles, the Azores, Bermudas and Bahamas, Undercliff (at the 
Isle of Wight), St. Croix, St. Thomas, West India Islands, 
and parts of Mexico and Peru, have each and all essentially 
dry soils, and, though some of them are liable at times to 
heavy rains, the soil, being porous, becomes very quickly 
dried up. All these places are well known places of resort 
for consumptives. On the contrary, Pisa, Naples, Milan, 
Mantua, Verona, Exmouth and Sidmouth, &c., are all stated 
by authors to be prejudicial to consumptives, and certainly 
public opinion never sends patients to them. These all 
have essentially moist soils. 
All these points I present with great deference to the 
Assembly of my honorable and accomplished associates at 
Paris. Although from the correspondence I have had with 
one or more eminent climatologists in Europe and America, 
I am aware that they are disposed to consent to my general 
deductions, I know that the subject has never been investi- 
gated in the broad manner that is proposed in the pro- 
gramme of the Commission that calls the International Con- 
gress into being. 
While thus presenting my views, I trust with becoming 
modesty, I should do injustice to my own firmest convictions 
if I did not earnestly press them with their accompanying 
proofs upon your candid consideration, inasmuch as I believe 
that in them are contained evidences of one of the primal 
laws of the development of phthisis, not only in New England 
but perhaps over the whole surface of the earth. This latter 
and equivocal part of the question I ask the Congress to 
take measures for settling either affirmatively or negatively, 
on the firm basis of actual observation and research. 13 
I regret extremely that circumstances beyond my control 
prevent me from joining personally in your deliberations. 
I therefore send this letter, and documents accompanying 
it, by the hand of the Commission appointed by the Suffolk 
District Medical Society (an integral part of the Massachu- 
setts Medical Society), to represent it in your body. 
I remain respectfully yours, 
Henry I. Bowditch, 
President of the Suffolk District Medical Society, 
Professor of Clinical Medicine in Harvard University, 
Member of the Society of Medical Observation at Paris.. 
The result of my efforts was simply an abortion. The 
Secretary and the Congress virtually ignored the whole 
subject—as the following letter will perhaps sufficiently 
indicate. 
Boston, Dec. 12th, 1867. 
To the Editors of the Archives Generates dc 'Medecine. 
Gentlemen,—In the October number of your excellent 
Journal, page 496, you use the following words: “En outre, 
la commission avait les travaux du Dr. Bowditch (de 
Boston), de Mons. Carnuff (d’ Ontario), sur la Tuberculisa- 
tion en Massachusetts et en Canada. Ces diverses travaux 
etablissent que les mauvaises conditions hygieniques, la 
mauvaise alimentation, le manque d’air, de lumiere, d’ex- 
ercise, sont les principales causes de la phthisie.” 
Your reporter could not have looked at my communica- 
tion, or at the papers which I forwarded to the Congress— 
otherwise I am sure lie would not have used the language 
given above. The sole object of my communication was to 
prove that in Massachusetts, and probably in all New 
England, and possibly in other parts of the world, a resi-. 
dence on, or near a wet soil, is one chief cause of phthisis. I 
desired that the question should be investigated with refer- 
ence to a'much larger extent of country, than I, or any one 
person could reach. 
I believe that this law of soil-moisUire, as a cause of 
phthisis, exists elsewhere than in New England, but it has 14 
not been thoroughly investigated by any one. I hoped that 
this investigation would have been undertaken by the Inter- 
national Congress. But your reporter has put me in the 
absurd position of one writing a formal communication to a 
learned body upon what seem to me self-evident proposi- 
tions. In my communication I made not a single allusion 
to any of the causes of phthisis mentioned in the above ex- 
tract. I know of no one who would deny the truth of each 
and all of them. 
I feel especial regret that the Congress took no notice of 
the suggestions contained in my communication, because I 
see that independent observations have recently been made 
in England by Dr. John Simon, medical officer of the Privy 
Council, and given in his last official report.* 
These observations, based on the official mortuary statistics 
of twenty-five towns in Great Britain, as investigated by Dr. 
Buchanan, prove that in these towns, which had been thoroughly 
drained so as to be comparatively dry, instead of wet places as 
originally, the most striking fact resulting is a marked dimi- 
nution in the number of cases of death from phthisis. 
This result in Old England, thus far, fully sustains what 
I had proved for New England, where I have found, First, 
that from twice to three times as many more phthisical cases 
occur in the wet than in the dry localities; and, Second, 
that about in proportion to the amount of damp soil near or 
in a locality will be the number of phthisical persons found 
in it. Statements similar to this I openly defended in an 
address delivered before the Massachusetts Medical Society 
in 1862, having made partial reports to the same effect 
several years previously to the same body. Under the cir- 
cumstances, may I ask you to correct the erroneous state- 
ments of your reporter ? 
Respectfully, yours, 
Henry I. Bowditch, M.D. 
P. S. By this mail I take the liberty of sending my 
address mentioned in this letter. 
* The Ninth Privy Council’s Report on Public Health- London, 1867. 15 
The English investigations mentioned in the preceding 
letter are referred to in an editorial review, in the London 
Medical Times and Gazette (Sept. 28, 1867), of the Ninth 
Report of the Medical Officer of the Privy Council, Dr. 
John Simon. The Report itself has not yet reached this 
country. 
It appears that Dr. Buchanan had been directed, in 1865 
and ’66, “ to investigate the effect of drainage works, and 
other sanitary regulations designed to promote the public 
health.” It was deemed important to prove to the popular 
mind the value of those works and regulations. “ Therefore 
twenty-five towns, containing an aggregate population of 
600,000 souls, were selected as the places where structural 
sanitary works had been most thoroughly done and had been 
longest in operation.” These were visited by Dr. Buchanan, 
and he has given with much patient detail the nature of the 
experiments with their results, as shown in the mortuary 
statistics of the different towns. Among the results are the 
following. He found a reduction of the death rate in the 
majority of the towns. He then examined with reference to 
various classes of disease, and observed various results, 
more or less curious and important, but which, as being 
not germain to our subject, I will not mention here, but pass 
immediately to that bearing upon the etiology of consump- 
tion. It was discovered that there had been but little 
apparent influence produced on the prevalence of all pulmo- 
nary affections excepting pulmonary phthisis. And upon 
this latter I prefer to quote the exact words used by Dr. 
Simon, when reporting to the Privy Council Dr. Buchanan’s 
results. 
u These facts appear to indicate a partial dependence of 
pulmonary phthisis on some of the unwholesome conditions 
which have been removed, and when detailed examination is 16 
made of the cases that give that indication, and they are 
compared with the different class where phthisis has not 
lessened in its amount, the novel and most important conclu- 
sion suggests itself that the drying of the soil (my italics) 
which has in most cases accompanied the laying of main 
sewers in the improved towns, has led to the diminution, 
more or less considerable, of phthisis. The facts which are 
yet in evidence seem most strongly to support this conclu- 
sion, which, should it be substantiated, will constitute a very 
valuable discovery, evolved by Dr. Buchanan from the inqui- 
ries here reported upon. It will be seen that the reduction 
of phthisis where certain works have been executed is far 
too large and far too general to be regarded as an acci- 
dental coincidence, and the fact that in some of these cases 
the diminished fatality of phthisis is by far the largest amend- 
ment, if not the only one, which has taken place in local 
health, becomes extremely interesting and significant (my ital- 
ics) when the circumstance is remembered that works of 
sewerage by which the drying of the soil is effected, must 
always, of necessity, precede, and sometimes indeed precede 
by years, the accomplishment of other objects (house drain- 
age, abolition of cess-pools, and so forth), on which the ces- 
sation of various other diseases is dependent.” 
Dr. S. considers the results so important that, by hi3 ad- 
vice, the Privy Council has directed further inquiry to be 
made on the subject. Thus, at last, it appears that the 
“very valuable discovery” and “novel and most important 
conclusion” has been arrived at in England, that by an 
artificial drying of the soil of towns the mortality-rates from 
phthisis is lessened! 
The Privy Council of England has now taken up the sub- 
ject, and we may confidently expect from that august body 
reports that will be deemed worth consideration by all. 
For myself, I rejoice that the authorities of at least one 
great nation have now fairly commenced the investigation of 
this question. The benign influences of such an investigation cannot be 
overrated. I believe it will be of immense importance to 
those now living, but of far greater good to future genera- 
tions, when what is now to most minds comparatively speak- 
ing a problem to be solved, shall have been adopted as the 
abiding thought and rule of action of the citizens at least of 
Old and of New England. At present, I think that every 
medical practitioner in New England, who, like Dr. Ware, 
conscientiously investigates the matter, ought to feel it 
•• criminal ” not to act upon the idea that a residence on a 
damp soil is liable to bring with it inevitable injury, a 
shortened life, and perhaps death itself, to the consumptive 
under his care. 
Henry I. Bowditch. 
113 Boylston Street, Jan., 1868.