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created it, have had the gratification to witness the first of these 

 causes yielding to an exceeding solicitude on the part of the mem- 

 bers of the medical profession to discuss and develop this question, 

 so that at the present hour there is scarcely a medical journal, so- 

 ciety, or well educated man, who is not fully aroused to its import- 

 ance. For much of this newly inspired zeal, they are doubtless in- 

 debted to the preliminary efforts of the American Medical Asso- 

 ciation, which has thus exhibited in its very inception, the great 

 advantages which are likely to flow from its continuance, and the 

 department indulges the hope that under its auspices the sanitary 

 condition of the union may be fully developed, human life prolonged, 

 and the desolations of disease curtailed. 



Before, however, any considerable advances can be made, it will 

 be necessary to make medical men aware of the operations of the 

 injurious agencies constantly affecting human life, even in the most 

 favoured localities, because until they are prepared to admit the 

 existence of these evils, they will not be in a state of mind to detect 

 and scrutinize them with sufficient accuracy to render their obser- 

 vations of any practical utility. The simultaneous movement in 

 England, which has been attended with developments of the most 

 extraordinary character, has, in some degree, prepared the way 

 for these admissions; but the department has reason to know that 

 the medical profession in this country, as a general rule, has many 

 preconceived prejudices to overcome, in order to prepare it to enter 

 into the inquiry with that spirit of philosophic research, which can 

 alone make its deductions practically useful. 



The department would not presume to dictate to this highly 

 honorable body, but as the pioneer in this sanitary movement, it is 

 exceedingly desirous of interchanging sentiments with an association, 

 which is destined hereafter to play so important a part in the de- 

 velopment of a question in which they both take so deep an inte- 

 rest, — a question second in importance to none other which can 

 occupy the deliberations of either. 



The United States may be considered as a country in which no 

 legislative enactments exist, regulating its sanitary condition, for 

 with the exception of some municipal regulations, forced from the 

 necessity of circumstances upon the large cities, and a few of the 

 first steps of legislation in one or two of the States of the Union, 

 each individual is permitted to exercise his own free will in regard 

 to hygienic measures, too frequently either from ignorance of its 

 laws, or cupidity, at the expense of great sacrifices of human life. 



