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The Project Gutenberg eBook of A Comparative View of the
Mortality of the Human Species, at All Ages
This eBook is for the use of anyone anywhere in the United States and
most other parts of the world at no cost and with almost no restrictions
whatsoever. You may copy it, give it away or re-use it under the terms
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Title: A Comparative View of the Mortality of the Human Species, at
All Ages
Author: William Black
Release date: July 2, 2019 [eBook #59846]
Language: English
Other information and formats: www.gutenberg.org/ebooks/59846
Credits: Produced by Susan Skinner and the Online Distributed
Proofreading Team at http://www.pgdp.net (This file was
produced from images generously made available by The
Internet Archive)
*** START OF THE PROJECT GUTENBERG EBOOK A
COMPARATIVE VIEW OF THE MORTALITY OF THE HUMAN
SPECIES, AT ALL AGES ***
Mortality of the Human Species, at All Ages
This eBook is for the use of anyone anywhere in the United States and
most other parts of the world at no cost and with almost no restrictions
whatsoever. You may copy it, give it away or re-use it under the terms
of the Project Gutenberg License included with this eBook or online at
www.gutenberg.org. If you are not located in the United States, you
will have to check the laws of the country where you are located
before using this eBook.
Title: A Comparative View of the Mortality of the Human Species, at
All Ages
Author: William Black
Release date: July 2, 2019 [eBook #59846]
Language: English
Other information and formats: www.gutenberg.org/ebooks/59846
Credits: Produced by Susan Skinner and the Online Distributed
Proofreading Team at http://www.pgdp.net (This file was
produced from images generously made available by The
Internet Archive)
*** START OF THE PROJECT GUTENBERG EBOOK A
COMPARATIVE VIEW OF THE MORTALITY OF THE HUMAN
SPECIES, AT ALL AGES ***
Page 4
COMPARATIVE VIEW
OF THE
MORTALITY
OF THE
HUMAN SPECIES,
&c. &c.
A
Comparative View
OF THE
MORTALITY
OF THE
HUMAN SPECIES,
AT ALL AGES;
AND OF THE
DISEASES AND CASUALTIES
By which they are destroyed or annoyed.
ILLUSTRATED WITH
CHARTS AND TABLES.
OF THE
MORTALITY
OF THE
HUMAN SPECIES,
&c. &c.
A
Comparative View
OF THE
MORTALITY
OF THE
HUMAN SPECIES,
AT ALL AGES;
AND OF THE
DISEASES AND CASUALTIES
By which they are destroyed or annoyed.
ILLUSTRATED WITH
CHARTS AND TABLES.
Page 5
By WILLIAM BLACK, M.D.
ONE OF THE ROYAL COLLEGE OF PHYSICIANS IN LONDON:
MEMBER OF SEVERAL LITERARY SOCIETIES, &C.
Published at the unanimous Request of the Medical Society of London.
LONDON:
Printed for C. Dilly, in the Poultry.
1788.
ONE OF THE ROYAL COLLEGE OF PHYSICIANS IN LONDON:
MEMBER OF SEVERAL LITERARY SOCIETIES, &C.
Published at the unanimous Request of the Medical Society of London.
LONDON:
Printed for C. Dilly, in the Poultry.
1788.
Page 6
DEDICATION.
TO
HIS ROYAL HIGHNESS
George Prince of Wales.
May it please your Royal Highness,
A Young and celebrated Prince, before his first Military Expedition,
interrogated one of his experienced Relations and Instructors, How he
should conduct himself to be respected and obeyed by his Army?—“To
know more of the Profession than any of your Soldiers,” was the sage
Reply; and to the renowned Cyrus, the Conqueror of the Babylonians. This
Maxim is, in some Degree, applicable and pertinent throughout all the
Gradations and Scale of Society. A Prince, born to the Throne of a mighty
Empire, pre-eminent in its Political Constitution, and in the universal Range
of the Arts and Sciences, is urged by his Personal Dignity and Public Duty,
to aspire to the intrinsick Qualifications of Human Supremacy.
In the present small Tribute of Duty and Respect, I am not submitting to
your Royal Highness a dry, technical Analysis of Diseases. An enlarged
Survey of Medicine is intimately interwoven with most of the sublime
Objects, not only of Philosophy, but, in our original Chart and Model, of
Politicks also and Legislation, both in Peace and War. It transcends the
British Poet’s Limitation of Human Studies, the Knowledge of Man: it
embraces a Scope of Natural Knowledge far beyond any other of the
learned Professions; encompassing in its spacious Orbit most of the grand
Divisions of Science. A total Ignorance in this, would leave a dreary Chasm
in Literature; and, like the ancient Geography, the Map and Globe of
intellectual Discoveries would be half unexplored.
TO
HIS ROYAL HIGHNESS
George Prince of Wales.
May it please your Royal Highness,
A Young and celebrated Prince, before his first Military Expedition,
interrogated one of his experienced Relations and Instructors, How he
should conduct himself to be respected and obeyed by his Army?—“To
know more of the Profession than any of your Soldiers,” was the sage
Reply; and to the renowned Cyrus, the Conqueror of the Babylonians. This
Maxim is, in some Degree, applicable and pertinent throughout all the
Gradations and Scale of Society. A Prince, born to the Throne of a mighty
Empire, pre-eminent in its Political Constitution, and in the universal Range
of the Arts and Sciences, is urged by his Personal Dignity and Public Duty,
to aspire to the intrinsick Qualifications of Human Supremacy.
In the present small Tribute of Duty and Respect, I am not submitting to
your Royal Highness a dry, technical Analysis of Diseases. An enlarged
Survey of Medicine is intimately interwoven with most of the sublime
Objects, not only of Philosophy, but, in our original Chart and Model, of
Politicks also and Legislation, both in Peace and War. It transcends the
British Poet’s Limitation of Human Studies, the Knowledge of Man: it
embraces a Scope of Natural Knowledge far beyond any other of the
learned Professions; encompassing in its spacious Orbit most of the grand
Divisions of Science. A total Ignorance in this, would leave a dreary Chasm
in Literature; and, like the ancient Geography, the Map and Globe of
intellectual Discoveries would be half unexplored.
Page 7
In early Ages, when Medicine had not reached beyond the Merit of a few
Empirical Cures, the Consultation in consecrated Temples of Medical
Oracles was ingrafted with Divinity and Objects of Worship. The Rays of
Majesty were not then obstructed from cherishing this tender Shoot. From
the encouragement of Alexander, Aristotle’s Natural History had its Origin.
From the Patronage of his Successors to the Egyptian Throne, the Ptolemys,
first arose Human Anatomy, together with the magnificent Alexandrian
Library. Many of the first Miracles of Christianity are a Display of Medical
Omnipotence. By several of the Asiatic and Roman Emperors, their
Physicians were admitted to a Familiarity, and to their Tables: their
Archiaters, or Royal Physicians, held the Second Rank in the Empire; and
even, so late as Constantine, were created Counts. The Arabians,
Mahomet’s Successors, were unbounded in their Rewards and
Encouragement of Medicine. With the Destruction of the Roman Empire,
Science lay many Centuries buried in its Ashes. But on the Recovery from
Feudal Anarchy, and the Revival of Literature after the Crusades, those
raised to the Degree of Doctor in any of the learned Professions, contended
Precedence with the most respectable then in any European State, with
Military Knighthood.
In Britain, and most other Kingdoms of Europe, Italy excepted, Literature
of any Sort, of Native Growth, is but a modern Plant. Medicine in this
Island is an Exotic, until within the last Three Centuries; and since that
Period, seems to have scrambled into Consequence and Emolument, from
its own intrinsic Merit, and the public Encouragement. For Truth compels
me to observe, that the Favours and Honours of Majesty have been
measured out, even to the Benefactors of Science and of Mankind, in this
Profession, with a parsimonious and partial Hand. I do not presume to
arraign the Wisdom or Justice of your Royal Ancestors, but of their
Counsellors and Ministers; in whom there seems a Sort of epidemical or
entailed Infatuation and Bigotry to lavish the first Honours of the State
upon the Memory of dry Laws, and the specious Accomplishments of
Logick and Rhetorick.
Your Royal Highness is at present, through the bountiful Beneficence of
Nature, and the variegated Acquisitions of Education, endowed with most
of the preliminary Embellishments requisite in your exalted Station, and to
a Summit of Celebrity and Admiration. The Rudiments, Difficulties, and
Empirical Cures, the Consultation in consecrated Temples of Medical
Oracles was ingrafted with Divinity and Objects of Worship. The Rays of
Majesty were not then obstructed from cherishing this tender Shoot. From
the encouragement of Alexander, Aristotle’s Natural History had its Origin.
From the Patronage of his Successors to the Egyptian Throne, the Ptolemys,
first arose Human Anatomy, together with the magnificent Alexandrian
Library. Many of the first Miracles of Christianity are a Display of Medical
Omnipotence. By several of the Asiatic and Roman Emperors, their
Physicians were admitted to a Familiarity, and to their Tables: their
Archiaters, or Royal Physicians, held the Second Rank in the Empire; and
even, so late as Constantine, were created Counts. The Arabians,
Mahomet’s Successors, were unbounded in their Rewards and
Encouragement of Medicine. With the Destruction of the Roman Empire,
Science lay many Centuries buried in its Ashes. But on the Recovery from
Feudal Anarchy, and the Revival of Literature after the Crusades, those
raised to the Degree of Doctor in any of the learned Professions, contended
Precedence with the most respectable then in any European State, with
Military Knighthood.
In Britain, and most other Kingdoms of Europe, Italy excepted, Literature
of any Sort, of Native Growth, is but a modern Plant. Medicine in this
Island is an Exotic, until within the last Three Centuries; and since that
Period, seems to have scrambled into Consequence and Emolument, from
its own intrinsic Merit, and the public Encouragement. For Truth compels
me to observe, that the Favours and Honours of Majesty have been
measured out, even to the Benefactors of Science and of Mankind, in this
Profession, with a parsimonious and partial Hand. I do not presume to
arraign the Wisdom or Justice of your Royal Ancestors, but of their
Counsellors and Ministers; in whom there seems a Sort of epidemical or
entailed Infatuation and Bigotry to lavish the first Honours of the State
upon the Memory of dry Laws, and the specious Accomplishments of
Logick and Rhetorick.
Your Royal Highness is at present, through the bountiful Beneficence of
Nature, and the variegated Acquisitions of Education, endowed with most
of the preliminary Embellishments requisite in your exalted Station, and to
a Summit of Celebrity and Admiration. The Rudiments, Difficulties, and
Page 8
Acclivities are surmounted, and leave you an uninterrupted Range through
Parnassus, in the Fruition of the luxurious Feasts furnished by Apollo and
the Muses. In a political View, and in their public Administration
throughout all the Professions, and Medicine notoriously, there are
numerous Defects and Abuses originating from the Ignorance and
Inexperience of former Ages, the Corruptions and Innovations of Time, and
from various other Causes. With thousands of these remediable Diseases,
the most enlightened Nations are yet over-run and contaminated; and a
Monarch who would emulate a Trajan or an Aurelius, will find glorious
Employment as a Political Physician. He will have the divine Consolation
and Reflection of circulating his Knowledge through innumerable
Channels, to the Benefit, Happiness, Nurture, and Preservation of Millions
of Mankind.
I have the Honour to remain,
with profound Respect and Esteem,
Your Highness’s
most humble and obedient Servant,
WILLIAM BLACK.
Parnassus, in the Fruition of the luxurious Feasts furnished by Apollo and
the Muses. In a political View, and in their public Administration
throughout all the Professions, and Medicine notoriously, there are
numerous Defects and Abuses originating from the Ignorance and
Inexperience of former Ages, the Corruptions and Innovations of Time, and
from various other Causes. With thousands of these remediable Diseases,
the most enlightened Nations are yet over-run and contaminated; and a
Monarch who would emulate a Trajan or an Aurelius, will find glorious
Employment as a Political Physician. He will have the divine Consolation
and Reflection of circulating his Knowledge through innumerable
Channels, to the Benefit, Happiness, Nurture, and Preservation of Millions
of Mankind.
I have the Honour to remain,
with profound Respect and Esteem,
Your Highness’s
most humble and obedient Servant,
WILLIAM BLACK.
Page 9
CONTENTS.
Page
The station and rank of our planet amongst the celestial orbs, 1
The solar system and stars, 3
The earth’s figure, magnitude, motion, 4
Of the moon, 7
The investing elements of the earth,
Heat and light, 8
Atmosphere and winds, &c. 10
Rain, snow, &c. 11
Electrical emanation, 12
The earth’s division into land and water, and into continents, 13
The situation of the human species upon the earth, 14
The number of the human species, 15
The multiplication of the human species, 19
The distinction of the human species into classes, 21
Mankind diversified by civilization, 22
The inhabitants of cities, towns, and country, constitute other groups
24
of society,
The human species diversified by their ages, 25
The distinction of the sexes into male and female, form two
27
important groups,
The comparative produce of marriages in city and country, 28
The general proportion of births to the mortality in various
30
kingdoms,
The comparative births of males and females, 32
Of public registers, of births, burials, and diseases, 35
Page
The station and rank of our planet amongst the celestial orbs, 1
The solar system and stars, 3
The earth’s figure, magnitude, motion, 4
Of the moon, 7
The investing elements of the earth,
Heat and light, 8
Atmosphere and winds, &c. 10
Rain, snow, &c. 11
Electrical emanation, 12
The earth’s division into land and water, and into continents, 13
The situation of the human species upon the earth, 14
The number of the human species, 15
The multiplication of the human species, 19
The distinction of the human species into classes, 21
Mankind diversified by civilization, 22
The inhabitants of cities, towns, and country, constitute other groups
24
of society,
The human species diversified by their ages, 25
The distinction of the sexes into male and female, form two
27
important groups,
The comparative produce of marriages in city and country, 28
The general proportion of births to the mortality in various
30
kingdoms,
The comparative births of males and females, 32
Of public registers, of births, burials, and diseases, 35
Page 10
The primary orders of medical architecture not yet established, 37
The mortality of the human race in city and country, and from birth
38
to the extreme of existence,
Of longevity, 43
Comparative mortality of males and females, 44
Comparative mortality of husband and wife, 45
Comparative longevity in the married and single state, 47
Comparative mortality of the seasons, 48
A general abstract of human mortality in city and country, and
49
throughout the globe,
The probabilities or expectation of life, 51
A general chart of mortality in city and country, and in different
54, 55
kingdoms,
The probable prospects or expectations of life at all ages, 55
Of the mortality by different diseases, 56
Of the London bills of mortality, 57
The chart of London diseases may serve as a general scale and
index of diseases and casualties to Britain and Ireland, or to
60
the whole globe; with exceptions: a sort of medical geometry
and trigonometry,
The number and proportion of diseases not to be estimated by the
63
mortality of each,
A medical catalogue of all the diseases and casualties by which
65
mankind are destroyed or annoyed,
A chart of all the diseases and casualties in London, during 75 years,64, 65
Of diseases in general, 70
Of the fatal epidemicks in England during two centuries; and
72
comparison of sickly years in city and country,
Of fevers, 75
Intermittent fevers, 78
Remittent fevers, 84
Nervous and putrid fevers, 90
Inflammatory fever, 97
The mortality of the human race in city and country, and from birth
38
to the extreme of existence,
Of longevity, 43
Comparative mortality of males and females, 44
Comparative mortality of husband and wife, 45
Comparative longevity in the married and single state, 47
Comparative mortality of the seasons, 48
A general abstract of human mortality in city and country, and
49
throughout the globe,
The probabilities or expectation of life, 51
A general chart of mortality in city and country, and in different
54, 55
kingdoms,
The probable prospects or expectations of life at all ages, 55
Of the mortality by different diseases, 56
Of the London bills of mortality, 57
The chart of London diseases may serve as a general scale and
index of diseases and casualties to Britain and Ireland, or to
60
the whole globe; with exceptions: a sort of medical geometry
and trigonometry,
The number and proportion of diseases not to be estimated by the
63
mortality of each,
A medical catalogue of all the diseases and casualties by which
65
mankind are destroyed or annoyed,
A chart of all the diseases and casualties in London, during 75 years,64, 65
Of diseases in general, 70
Of the fatal epidemicks in England during two centuries; and
72
comparison of sickly years in city and country,
Of fevers, 75
Intermittent fevers, 78
Remittent fevers, 84
Nervous and putrid fevers, 90
Inflammatory fever, 97
Page 11
Small pox, 102
Measles, 111
Scarlet fever, 113
Plague, 115
Sweating sickness, 121
Of the predisposing and occasional causes of all the preceding
121
fevers,
Of general febrile prognosticks, 127
Of the local phlogistic fevers, 133
Inflammation of the brain, 134
Angina, inflammatory and putrid, 136
Pulmonic inflammation, 142
Hepatic inflammation, 150
Inflammation of the stomach, 152
Erysipelas, 153
Rheumatism, acute and chronic, 155
Gout, 159
Internal suppuration and gangrene in the thorax and abdomen, 166
Diseases of the lungs and organs of respiration, 168
Pulmonary hemorrhage, 172
Pulmonary phthisis, 174
Other species of consumption, 177
Asthma, 183
Dyspnœa and coughs, 190
Catarrh, 192
Hooping cough, 195
Croup, 198
Headach, 200
Night mare, 202
Apoplexy, 203
Measles, 111
Scarlet fever, 113
Plague, 115
Sweating sickness, 121
Of the predisposing and occasional causes of all the preceding
121
fevers,
Of general febrile prognosticks, 127
Of the local phlogistic fevers, 133
Inflammation of the brain, 134
Angina, inflammatory and putrid, 136
Pulmonic inflammation, 142
Hepatic inflammation, 150
Inflammation of the stomach, 152
Erysipelas, 153
Rheumatism, acute and chronic, 155
Gout, 159
Internal suppuration and gangrene in the thorax and abdomen, 166
Diseases of the lungs and organs of respiration, 168
Pulmonary hemorrhage, 172
Pulmonary phthisis, 174
Other species of consumption, 177
Asthma, 183
Dyspnœa and coughs, 190
Catarrh, 192
Hooping cough, 195
Croup, 198
Headach, 200
Night mare, 202
Apoplexy, 203
Page 12
Lethargy, coma, and carus, 207
Vertigo, 209
Palsy, 210
Epilepsy, 212
Tetanus, 217
Spasms and cramps, 221
St. Vitus’s dance, ibid.
Catalepsy and extacy, 222
Fainting and asphyxy, 223
Palpitation of the heart, 226
Polypus of the heart, internal aneurism, and ossification, 227
Hypochondriasm, 229
Insanity, 232
Diseases of the external senses, 251
Vision, 252
Hearing, 257
Smell, 258
Taste, ibid.
Voice and speech, 259
Sterility of the sexes, ibid.
Morbid irritability of the genitals, 260
Impediments in deglutition and manducation, 262
Diseases of the stomach and intestines, and organs of digestion, 263
Of the stomach, 268
Cholera morbus, 272
Dysentery, 274
Diarrhœa, 275
Colick, 277
Gall stones, 282
Jaundice, 284
Worms, 286
Vertigo, 209
Palsy, 210
Epilepsy, 212
Tetanus, 217
Spasms and cramps, 221
St. Vitus’s dance, ibid.
Catalepsy and extacy, 222
Fainting and asphyxy, 223
Palpitation of the heart, 226
Polypus of the heart, internal aneurism, and ossification, 227
Hypochondriasm, 229
Insanity, 232
Diseases of the external senses, 251
Vision, 252
Hearing, 257
Smell, 258
Taste, ibid.
Voice and speech, 259
Sterility of the sexes, ibid.
Morbid irritability of the genitals, 260
Impediments in deglutition and manducation, 262
Diseases of the stomach and intestines, and organs of digestion, 263
Of the stomach, 268
Cholera morbus, 272
Dysentery, 274
Diarrhœa, 275
Colick, 277
Gall stones, 282
Jaundice, 284
Worms, 286
Page 13
Hemorrhoides, 288
Vomiting of blood, 291
Poisons, 293
Hydrophobia, 294
P. S. Costiveness, and nasal hemorrhage, 297
Diseases of the urinary organs, 298
Inflammation, and calculi in the kidneys, 299
Inflammation, and calculi in the bladder, 301
Incontinence of urine, and diabetes, 305
Ulcers in the kidneys and bladder, and bloody urine, 307
Dropsy, 309
Of the brain and spine, 311
Thorax, 312
Abdomen, 314
Anasarca, 317
Hydrocele, 318
The predisposing and occasional causes of dropsy, 320
Tympany, 322
Excess of fat and corpulency, 323
Female diseases, 324
The proportion of menstrual obstruction and excess, and of
325
hystericks, to other diseases,
Morbid and irregular menstruation, including chlorosis,
328
obstruction, suppression,
Uterine relaxation, including excessive menstruation and fluor
330
albus,
Final cessation of menstruation, 334
Hystericks, 335
Childbed, the proportion of mortality, 339
Abortives and twins, the proportion, 340
Vomiting of blood, 291
Poisons, 293
Hydrophobia, 294
P. S. Costiveness, and nasal hemorrhage, 297
Diseases of the urinary organs, 298
Inflammation, and calculi in the kidneys, 299
Inflammation, and calculi in the bladder, 301
Incontinence of urine, and diabetes, 305
Ulcers in the kidneys and bladder, and bloody urine, 307
Dropsy, 309
Of the brain and spine, 311
Thorax, 312
Abdomen, 314
Anasarca, 317
Hydrocele, 318
The predisposing and occasional causes of dropsy, 320
Tympany, 322
Excess of fat and corpulency, 323
Female diseases, 324
The proportion of menstrual obstruction and excess, and of
325
hystericks, to other diseases,
Morbid and irregular menstruation, including chlorosis,
328
obstruction, suppression,
Uterine relaxation, including excessive menstruation and fluor
330
albus,
Final cessation of menstruation, 334
Hystericks, 335
Childbed, the proportion of mortality, 339
Abortives and twins, the proportion, 340
Page 14
Conception and pregnancy, 343
Parturition, natural, laborious, preternatural, and complex, 350
The principal diseases in consequence of pregnancy, and also
362
after parturition,
Abortion and uterine hemorrhage, 366
Convulsions, 370
Irregularity of the lochia, comprehending excess, obstruction,
371
and suppression,
Inflammation of the womb, 373
Puerperal fever, 375
After-pains, weed, milk fever, inflammation of the breasts, 378
Infant diseases, 380
The general causes of infant diseases, 383
Convulsions and inward spasms, 385
Dentition, 387
Rickets, 389
Thrush, 391
N. B. Their other diseases are before described, 392
Venereal disease, 393
Scurvy, 398
Scrofula, 403
Leprosy, 406
To the Reader: an apology for breaking off abruptly, 407
Executed, 408
Of the London bills of mortality; their defects; easy and important
improvements recommended, 414
Parturition, natural, laborious, preternatural, and complex, 350
The principal diseases in consequence of pregnancy, and also
362
after parturition,
Abortion and uterine hemorrhage, 366
Convulsions, 370
Irregularity of the lochia, comprehending excess, obstruction,
371
and suppression,
Inflammation of the womb, 373
Puerperal fever, 375
After-pains, weed, milk fever, inflammation of the breasts, 378
Infant diseases, 380
The general causes of infant diseases, 383
Convulsions and inward spasms, 385
Dentition, 387
Rickets, 389
Thrush, 391
N. B. Their other diseases are before described, 392
Venereal disease, 393
Scurvy, 398
Scrofula, 403
Leprosy, 406
To the Reader: an apology for breaking off abruptly, 407
Executed, 408
Of the London bills of mortality; their defects; easy and important
improvements recommended, 414
Page 15
A
Comparative View, &c.
Comparative View, &c.
Page 16
INTRODUCTION.
A Sketch of our Planet’s Station, Rotation, and Rank amongst the other
Celestial Orbs; and of its Investing Elements:—of the Habitable Parts
of our Planet: the Number of the Human Species, and their Division
into various Classes, Genera, Groups, and Gradations: their
Comparative Births.
THERE are two methods of promoting Medical Knowledge: one by
negative information, or criticisms on the numerous errors of preceding
authors: the other by direct instruction, and improvement on former models.
The first method is worn out in hackneyed chimes: the second is
encumbered with infinitely more difficulties; and its merits paramount in
the superlative degree. However unequal I have imposed upon myself the
latter task. But, previous to the discussion of the general theme, it will
conduce to order, and to the anticipation of explanatory digression and
illustration, to glance at the station, rotation, and rank of our Parent Planet
amongst the other celestial orbs; at its investing elements; and at the
number, groups, and recruit of mankind. A navigator or historian, who
undertakes the description of any island, kingdom, or continent, commences
with their geographical outlines and climate, penetrating afterwards
thorough a scrutiny of the inhabitants. Upon a similar, but more majestic
model, our Introductory Preface is founded. Throughout the whole of this
intricate, sublime, and inexhaustible subject, if I do not delay sufficient time
to fix, I shall at least hope to start the reader’s attention to a variety of grand
objects, inseparable from a comprehensive knowledge of Medicine; and of
which I shall touch the fundamental keys and chords.
The Solar System consists of the Sun, of seven Planets surrounded by ten or
more Moons, and of the Comets. The other siderial lights with which the
vault of Heaven is studded, and which are denominated Fixed Stars, have a
very distant affinity with our planetary sphere: they are infinitely too remote
to be enlightened by our luminary; and therefore astronomers, with good
reason, imagine each star to be a sun to encircling planets, though invisible
to us; and to constitute throughout boundless space thousands, or perhaps
A Sketch of our Planet’s Station, Rotation, and Rank amongst the other
Celestial Orbs; and of its Investing Elements:—of the Habitable Parts
of our Planet: the Number of the Human Species, and their Division
into various Classes, Genera, Groups, and Gradations: their
Comparative Births.
THERE are two methods of promoting Medical Knowledge: one by
negative information, or criticisms on the numerous errors of preceding
authors: the other by direct instruction, and improvement on former models.
The first method is worn out in hackneyed chimes: the second is
encumbered with infinitely more difficulties; and its merits paramount in
the superlative degree. However unequal I have imposed upon myself the
latter task. But, previous to the discussion of the general theme, it will
conduce to order, and to the anticipation of explanatory digression and
illustration, to glance at the station, rotation, and rank of our Parent Planet
amongst the other celestial orbs; at its investing elements; and at the
number, groups, and recruit of mankind. A navigator or historian, who
undertakes the description of any island, kingdom, or continent, commences
with their geographical outlines and climate, penetrating afterwards
thorough a scrutiny of the inhabitants. Upon a similar, but more majestic
model, our Introductory Preface is founded. Throughout the whole of this
intricate, sublime, and inexhaustible subject, if I do not delay sufficient time
to fix, I shall at least hope to start the reader’s attention to a variety of grand
objects, inseparable from a comprehensive knowledge of Medicine; and of
which I shall touch the fundamental keys and chords.
The Solar System consists of the Sun, of seven Planets surrounded by ten or
more Moons, and of the Comets. The other siderial lights with which the
vault of Heaven is studded, and which are denominated Fixed Stars, have a
very distant affinity with our planetary sphere: they are infinitely too remote
to be enlightened by our luminary; and therefore astronomers, with good
reason, imagine each star to be a sun to encircling planets, though invisible
to us; and to constitute throughout boundless space thousands, or perhaps
Page 17
millions, of habitable worlds. Numbers of those stars, most luminous and
proximate, are arranged into arbitrary clusters, called Constellations, or
Signs; and serve to mark the several stages of the rotating orbs in our
system.
The Sun, whose magnitude far surpasses that of the seven planets united, is
placed in the center, suspended in the immense celestial expansion and
firmament. Surrounding him, at different distances, and in the following
order, are the planets Mercury, Venus, the Earth, Mars, Jupiter, Saturn,
Georgium Sidus. These planets are incessantly revolving from west-by-
south to east, and within certain intervals of time, make a complete circle
round the Sun; which is the length of each planet’s year; and is larger and
longer in proportion to their respective distances. The velocity of their
revolution in their annual orbits, together with their gradations of light and
heat, are also in proportion to their solar proximity. From the Sun, the
Planets, with their surrounding moons, derive heat and light; and when this
is intercepted by any planet, or its satellite, an eclipse or darkness ensues. In
what periods those tremendous celestial bodies, named Comets, revolve
round the Sun, is not yet exactly adjusted.
One of the seven planets, the Earth, this small domain of restless mortals,
and to which all our future observations shall be directed, is distant from the
Sun 95,173,000 miles. In shape, it has more resemblance to a turnip than to
a globe. Its diameter is 7,970 miles: its circumference 360 degrees; which
amounts to 24,840 English miles. Geographers divide the globe of our
planet into two equal parts, or hemispheres, the northern and southern, by
an imaginary girdle, or ring, named the Equator. Two other imaginary
girdles surrounding the earth, and distant from the equator on each side 23½
degrees, north and south latitude, are named the Tropicks of Cancer and
Capricorn; comprehending between them the torrid zone. From these
tropical circles the zones, called Temperate, extend on each side 43 degrees:
and at their extreme boundaries, we reach the polar circles 23½ degrees
distant from each pole. The north and the south poles are in the middle of
each hemisphere of the earth; and the distance of each from the equator is
90 degrees.
The earth has several incessant motions: one in which it turns, like a
suspended wheel upon its own axis, from west to east, every twenty-four
hours, which is the length of its day and night: the second, where it is
proximate, are arranged into arbitrary clusters, called Constellations, or
Signs; and serve to mark the several stages of the rotating orbs in our
system.
The Sun, whose magnitude far surpasses that of the seven planets united, is
placed in the center, suspended in the immense celestial expansion and
firmament. Surrounding him, at different distances, and in the following
order, are the planets Mercury, Venus, the Earth, Mars, Jupiter, Saturn,
Georgium Sidus. These planets are incessantly revolving from west-by-
south to east, and within certain intervals of time, make a complete circle
round the Sun; which is the length of each planet’s year; and is larger and
longer in proportion to their respective distances. The velocity of their
revolution in their annual orbits, together with their gradations of light and
heat, are also in proportion to their solar proximity. From the Sun, the
Planets, with their surrounding moons, derive heat and light; and when this
is intercepted by any planet, or its satellite, an eclipse or darkness ensues. In
what periods those tremendous celestial bodies, named Comets, revolve
round the Sun, is not yet exactly adjusted.
One of the seven planets, the Earth, this small domain of restless mortals,
and to which all our future observations shall be directed, is distant from the
Sun 95,173,000 miles. In shape, it has more resemblance to a turnip than to
a globe. Its diameter is 7,970 miles: its circumference 360 degrees; which
amounts to 24,840 English miles. Geographers divide the globe of our
planet into two equal parts, or hemispheres, the northern and southern, by
an imaginary girdle, or ring, named the Equator. Two other imaginary
girdles surrounding the earth, and distant from the equator on each side 23½
degrees, north and south latitude, are named the Tropicks of Cancer and
Capricorn; comprehending between them the torrid zone. From these
tropical circles the zones, called Temperate, extend on each side 43 degrees:
and at their extreme boundaries, we reach the polar circles 23½ degrees
distant from each pole. The north and the south poles are in the middle of
each hemisphere of the earth; and the distance of each from the equator is
90 degrees.
The earth has several incessant motions: one in which it turns, like a
suspended wheel upon its own axis, from west to east, every twenty-four
hours, which is the length of its day and night: the second, where it is
Page 18
rolling progressively in its great annual circle, or journey round the Sun: the
third, the alternate inclination of its poles towards the sun at different times
of the year: the fourth, the small circle which it describes monthly round the
common center of gravity, or balance, with its moon. The earth’s diurnal
revolution upon its axis, is at the rate of fifteen degrees, or 1,035 miles
hourly. But the rapidity with which it is whirled in its annual orbit, is,
hourly, 68,243 miles: whereas the swiftness of a ball discharged from a
cannon is, in the same time, only 480 miles. Projected through the vacuity
of heaven with this amazing velocity, in the space of 365 days, 5 hours, and
49 minutes, the earth completes its annual circle; which is the length of our
year. The earth’s rotation every twenty-four hours upon its axis, is the cause
of day and night, or of light and darkness. In this successive rotation, one
half of its globular surface is always enlightened; the other half being then
obscured in nocturnal gloom, except when enlivened by the reflected rays
of the moon, or of one of the planets, or by the fainter glimmering of the
fixed stars. The alternate spiral inflection and declination of the earth’s
poles during its annual journey round the Sun, is the cause of the different
lengths of Days and Nights; of the Seasons; of Summer and Winter; of the
Equinoxes, and Solstices: and as each pole inclines or recedes, it is summer
and winter, alternately, in their respective hemispheres. The effects of this
compound terrestrial circumvolution on the animal and vegetable creation,
would alone be a magnificent theme for many volumes.
One Moon only is allotted to our earth; from which it is distant 240,000
miles. The moon’s diameter is nearly one fourth less than that of the earth,
which it obsequiously accompanies throughout its annual circuit; and round
which it makes a perpetual revolution, from west to east, every lunar month.
The constant agitation and periodical surges of the ocean, are greatly
influenced by the moon, assisted, however, by the centrifugal force of the
earth’s motion. It is also ascertained, that in some diseases, the human body
is considerably under the lunar influence; and its energy is still more
conspicuous at periodical changes, during the month and the year. Many
arguments might be suggested to invalidate and overturn the ancient
astrological systems, and to prove that the celestial influences upon us are
not, in any considerable degree, derived from sources more remote than the
solar confines.
third, the alternate inclination of its poles towards the sun at different times
of the year: the fourth, the small circle which it describes monthly round the
common center of gravity, or balance, with its moon. The earth’s diurnal
revolution upon its axis, is at the rate of fifteen degrees, or 1,035 miles
hourly. But the rapidity with which it is whirled in its annual orbit, is,
hourly, 68,243 miles: whereas the swiftness of a ball discharged from a
cannon is, in the same time, only 480 miles. Projected through the vacuity
of heaven with this amazing velocity, in the space of 365 days, 5 hours, and
49 minutes, the earth completes its annual circle; which is the length of our
year. The earth’s rotation every twenty-four hours upon its axis, is the cause
of day and night, or of light and darkness. In this successive rotation, one
half of its globular surface is always enlightened; the other half being then
obscured in nocturnal gloom, except when enlivened by the reflected rays
of the moon, or of one of the planets, or by the fainter glimmering of the
fixed stars. The alternate spiral inflection and declination of the earth’s
poles during its annual journey round the Sun, is the cause of the different
lengths of Days and Nights; of the Seasons; of Summer and Winter; of the
Equinoxes, and Solstices: and as each pole inclines or recedes, it is summer
and winter, alternately, in their respective hemispheres. The effects of this
compound terrestrial circumvolution on the animal and vegetable creation,
would alone be a magnificent theme for many volumes.
One Moon only is allotted to our earth; from which it is distant 240,000
miles. The moon’s diameter is nearly one fourth less than that of the earth,
which it obsequiously accompanies throughout its annual circuit; and round
which it makes a perpetual revolution, from west to east, every lunar month.
The constant agitation and periodical surges of the ocean, are greatly
influenced by the moon, assisted, however, by the centrifugal force of the
earth’s motion. It is also ascertained, that in some diseases, the human body
is considerably under the lunar influence; and its energy is still more
conspicuous at periodical changes, during the month and the year. Many
arguments might be suggested to invalidate and overturn the ancient
astrological systems, and to prove that the celestial influences upon us are
not, in any considerable degree, derived from sources more remote than the
solar confines.
Page 19
The first Element in pre-eminence and subtility, without which all would be
lifeless chaos in our system, is Heat and Light. Cold is a negative quality,
and merely a comparative diminution of heat. The middle regions of the
earth being repeatedly more exposed to the Sun’s vertical rays, are
consequently most heated and scorched. From the equator to the poles, are
all the gradations of heat and cold; but for reasons too prolix to enumerate,
these gradations are not in exact measurement with the geographical
distances from the equator; neither in the same continent, nor in different
continents. By the scale of Farenheit’s thermometer, water boils at 212,
freezes at 32; and blood-heat, or that of the human body, is about 97. The
most intense heat of the tropical regions, as measured by the same
thermometer, is frequently many degrees above the human temperature; and
the most intense cold of the polar regions, often many degrees below 1 or 0
of the same scale. Neither of these noxious extremes of pestilential heat, nor
of deadning blasts from boreal snow, could be long endured by the human
species, were their bodies not protected and skreened by fences of nature or
of art. Atmospheric heat, equal even to that of the human body, is felt
intolerably scorching and suffocating. Every one also knows, by personal
experience, that in different latitudes, and in summer and winter, the
degrees of heat and cold, the duration, recurrence, and changes, are
extremely variable. But within the equatorial limits, these variations are
much less conspicuous, both in the thermometer and barometer. From this
main spring and soul of animated nature, blessings and bounties are
diffused, in thousands of channels, to every order of the creation; and from
its extremes and vicissitudes, a multitude of evils and diseases are inflicted
upon man.
Between the earth and celestial vacuum is interposed an element, called the
Atmosphere, or Air. This invisible elastic fluid is floating equally round our
planet, to the distance of at least forty-five miles perpendicular elevation. It
has been compared by some philosophers, to packs of wool heaped on each
other: that nearest the ground is most dense, compact, and ponderous; and
as we ascend, it becomes gradually more rare, light, and cold. The
prodigious gravity, or pressure, of this atmospherick column, appears
incredible to those who are ignorant of experimental philosophy, and of the
air-pump and barometer. Upon a man’s body, of middle stature, its weight is
equal to thirty-two or thirty-three thousand pounds: but in rainy and
variable weather, and especially on the summit of high mountains, there is a
lifeless chaos in our system, is Heat and Light. Cold is a negative quality,
and merely a comparative diminution of heat. The middle regions of the
earth being repeatedly more exposed to the Sun’s vertical rays, are
consequently most heated and scorched. From the equator to the poles, are
all the gradations of heat and cold; but for reasons too prolix to enumerate,
these gradations are not in exact measurement with the geographical
distances from the equator; neither in the same continent, nor in different
continents. By the scale of Farenheit’s thermometer, water boils at 212,
freezes at 32; and blood-heat, or that of the human body, is about 97. The
most intense heat of the tropical regions, as measured by the same
thermometer, is frequently many degrees above the human temperature; and
the most intense cold of the polar regions, often many degrees below 1 or 0
of the same scale. Neither of these noxious extremes of pestilential heat, nor
of deadning blasts from boreal snow, could be long endured by the human
species, were their bodies not protected and skreened by fences of nature or
of art. Atmospheric heat, equal even to that of the human body, is felt
intolerably scorching and suffocating. Every one also knows, by personal
experience, that in different latitudes, and in summer and winter, the
degrees of heat and cold, the duration, recurrence, and changes, are
extremely variable. But within the equatorial limits, these variations are
much less conspicuous, both in the thermometer and barometer. From this
main spring and soul of animated nature, blessings and bounties are
diffused, in thousands of channels, to every order of the creation; and from
its extremes and vicissitudes, a multitude of evils and diseases are inflicted
upon man.
Between the earth and celestial vacuum is interposed an element, called the
Atmosphere, or Air. This invisible elastic fluid is floating equally round our
planet, to the distance of at least forty-five miles perpendicular elevation. It
has been compared by some philosophers, to packs of wool heaped on each
other: that nearest the ground is most dense, compact, and ponderous; and
as we ascend, it becomes gradually more rare, light, and cold. The
prodigious gravity, or pressure, of this atmospherick column, appears
incredible to those who are ignorant of experimental philosophy, and of the
air-pump and barometer. Upon a man’s body, of middle stature, its weight is
equal to thirty-two or thirty-three thousand pounds: but in rainy and
variable weather, and especially on the summit of high mountains, there is a
Page 20
diminution in its pressure of many thousand pounds. This great mass of air,
as well as the waters of the ocean and of rivers, is in constant agitation;
sometimes gliding in gentle calms; sometimes, with wild uproar, raging in
storms and hurricanes, and dispersed in a variety of currents, over different
parts of the earth and ocean in Winds, constant, periodical, variable, and
irregular. Without the concurrent support of air, animal and vegetable life
would soon be annihilated. On them great and sensible effects are produced
by the atmosphere and winds: by the air’s noxious impregnation, stagnation,
want of elasticity, heat, cold, moisture, dryness; by the points from whence
winds blow, their constancy, irregularity, recurrence, velocity.
The earth is the cistern, and one principal fountain of another still grosser
element. From the Sun’s heat, and from the successive streams of air and
winds, a prodigious evaporation is carried on from the surface of the ocean,
from the land, and from vegetables. Whether part of the atmospherick air is
also converted into vapour, is a question too intricate and diffuse for our
present inquiry. The critical analysis and history of a single element, would
alone far exceed the limits of this Dissertation. It is sufficient for us to
observe, that these vapours, terrestrial and aerial, are collected into clouds,
condensed, and again discharged upon the earth in Dews, Mists, Fogs,
Rains, Snow, and Hail. The precipitation likewise of this accumulated
vapour upon different parts of the globe, is periodical, regular, and variable.
In quantity, duration, recurrence, and extent, these aqueous modifications
are greatly diversified by the climate and soil, the vicinity to mountains and
sea-coasts; the points from whence winds blow; and by many other causes,
of which a detail cannot be here expected. From this source also ensue
salutary and baneful effects, innumerable to animal and vegetable life.
Another subtile and active agent in the secret machinery of nature, is the
Electrical Emanation; which, somewhat perhaps analogous to the aqueous
evaporation and congestion before mentioned, is collected into clouds, and,
with loud explosion, again discharged and dispersed into the air and earth:
the fabulous thunderbolts and artillery of Omnipotence.
We now alight upon that solid mass, Earth, the most fixed and substantial of
all the elements. The surface of our planet is composed of dry land and
water; of which the ocean, without including lakes and rivers, occupies by
much the largest extent. But the partition of the dry land into four
continents, Europe, Asia, Africa, and America, is not well founded. Nature
as well as the waters of the ocean and of rivers, is in constant agitation;
sometimes gliding in gentle calms; sometimes, with wild uproar, raging in
storms and hurricanes, and dispersed in a variety of currents, over different
parts of the earth and ocean in Winds, constant, periodical, variable, and
irregular. Without the concurrent support of air, animal and vegetable life
would soon be annihilated. On them great and sensible effects are produced
by the atmosphere and winds: by the air’s noxious impregnation, stagnation,
want of elasticity, heat, cold, moisture, dryness; by the points from whence
winds blow, their constancy, irregularity, recurrence, velocity.
The earth is the cistern, and one principal fountain of another still grosser
element. From the Sun’s heat, and from the successive streams of air and
winds, a prodigious evaporation is carried on from the surface of the ocean,
from the land, and from vegetables. Whether part of the atmospherick air is
also converted into vapour, is a question too intricate and diffuse for our
present inquiry. The critical analysis and history of a single element, would
alone far exceed the limits of this Dissertation. It is sufficient for us to
observe, that these vapours, terrestrial and aerial, are collected into clouds,
condensed, and again discharged upon the earth in Dews, Mists, Fogs,
Rains, Snow, and Hail. The precipitation likewise of this accumulated
vapour upon different parts of the globe, is periodical, regular, and variable.
In quantity, duration, recurrence, and extent, these aqueous modifications
are greatly diversified by the climate and soil, the vicinity to mountains and
sea-coasts; the points from whence winds blow; and by many other causes,
of which a detail cannot be here expected. From this source also ensue
salutary and baneful effects, innumerable to animal and vegetable life.
Another subtile and active agent in the secret machinery of nature, is the
Electrical Emanation; which, somewhat perhaps analogous to the aqueous
evaporation and congestion before mentioned, is collected into clouds, and,
with loud explosion, again discharged and dispersed into the air and earth:
the fabulous thunderbolts and artillery of Omnipotence.
We now alight upon that solid mass, Earth, the most fixed and substantial of
all the elements. The surface of our planet is composed of dry land and
water; of which the ocean, without including lakes and rivers, occupies by
much the largest extent. But the partition of the dry land into four
continents, Europe, Asia, Africa, and America, is not well founded. Nature
Page 21
has in reality formed only three great insulated continents, exclusive of the
smaller islands. Europe and Asia are contiguous, and cemented together as
England and Scotland; or as France and Germany; and their boundaries
artificial: whereas Africa, except the slender neck of land near Alexandria,
is surrounded by sea. Of these four continents, Europe is the most
diminutive. Asia and America stand dignified, above all the others, in
superior magnitude. The dry land in Europe, Asia, and America, stretches to
a great northern latitude, considerably within the arctick, or polar circles;
and, spreading also in that part to a wide extent, east and west, forms nearly
a complete bridge between Asia and America. Within the tropical circles are
included the belly and bulge of Africa, and of South America, with a
considerable portion of the broken southern extremities of Asia; together
with most of the principal islands in the Pacific and Atlantic oceans. In all
the hemisphere south of Capricorn, the land is greatly disproportioned to
the ocean. The conical south point of America is but 55, and that of Africa
only 35 degrees distant from the equator. A vast orbicular segment of this
extreme of our planet, furnishes habitation for fishes only. The dry land is
also diversified by elevations and plains; but in no part of the earth’s
circumference do those stately monuments of nature’s workmanship ascend
to five miles perpendicular elevation.
The Creator has bountifully stored the earth and the ocean with animals and
vegetables. Our attention is here circumscribed to the most exalted class,
the Human Species; leaving to the naturalist a description of quadrupeds,
birds, fishes, insects, and vegetables. By far the largest proportion of the
human species are stationed to the north side of the equator, and even to the
north of the tropick of cancer. The populous continents of Europe and Asia,
comprehending most of the powerful kingdoms in our planet, are in the
northern hemisphere. Within the tropical circles and furnace of the earth,
are stationed the next considerable hive of mankind. To the south of
Capricorn there are few inhabitants. Some wretched human beings are also
scattered through those dreary wastes of ice and snow within the northern
polar circles.
Calculators differ enormously respecting the number of the Human Species.
Some sink the collected herd so low as three hundred million, whilst others
exaggerate them to treble and quadruple that amount. It forms no part of my
scheme to investigate the comparative population of the earth, one, two, and
smaller islands. Europe and Asia are contiguous, and cemented together as
England and Scotland; or as France and Germany; and their boundaries
artificial: whereas Africa, except the slender neck of land near Alexandria,
is surrounded by sea. Of these four continents, Europe is the most
diminutive. Asia and America stand dignified, above all the others, in
superior magnitude. The dry land in Europe, Asia, and America, stretches to
a great northern latitude, considerably within the arctick, or polar circles;
and, spreading also in that part to a wide extent, east and west, forms nearly
a complete bridge between Asia and America. Within the tropical circles are
included the belly and bulge of Africa, and of South America, with a
considerable portion of the broken southern extremities of Asia; together
with most of the principal islands in the Pacific and Atlantic oceans. In all
the hemisphere south of Capricorn, the land is greatly disproportioned to
the ocean. The conical south point of America is but 55, and that of Africa
only 35 degrees distant from the equator. A vast orbicular segment of this
extreme of our planet, furnishes habitation for fishes only. The dry land is
also diversified by elevations and plains; but in no part of the earth’s
circumference do those stately monuments of nature’s workmanship ascend
to five miles perpendicular elevation.
The Creator has bountifully stored the earth and the ocean with animals and
vegetables. Our attention is here circumscribed to the most exalted class,
the Human Species; leaving to the naturalist a description of quadrupeds,
birds, fishes, insects, and vegetables. By far the largest proportion of the
human species are stationed to the north side of the equator, and even to the
north of the tropick of cancer. The populous continents of Europe and Asia,
comprehending most of the powerful kingdoms in our planet, are in the
northern hemisphere. Within the tropical circles and furnace of the earth,
are stationed the next considerable hive of mankind. To the south of
Capricorn there are few inhabitants. Some wretched human beings are also
scattered through those dreary wastes of ice and snow within the northern
polar circles.
Calculators differ enormously respecting the number of the Human Species.
Some sink the collected herd so low as three hundred million, whilst others
exaggerate them to treble and quadruple that amount. It forms no part of my
scheme to investigate the comparative population of the earth, one, two, and
Page 22
three thousand years ago. Europe, in all probability, since the era of Roman
grandeur, has, together with advancement in civilization, likewise added to
the number of its inhabitants. Those parental nurseries of the arts and
sciences in Asia and Africa, have no doubt undergone various revolutions in
population. If we were to draw any inferences from the numerous Asiatic
armies, during the successive despotism of Assyrian, Babylonian, Medean,
and Persian monarchies, we should conclude that, in remote ages, the south
of Asia abounded in men. The extensive empire of China, at this day,
resembles an industrious beehive, and is gorged with mankind. We have
still more aversion to plunge into the mysterious archives of Africa, and
with critical affectation to pronounce upon the population of that quarter
before the decay of its political, commercial, and literary fame with Thebes,
Carthage, and Alexandria. That modern-discovered transatlantic continent,
from the cruelties and desolation of its first conquerors, and of a loathsome
infectious disease exchanged for another, has probably suffered
considerable diminution of its original feeble hive, notwithstanding the
recruit from Europe; and in the scale of population, as yet ascends to a very
subordinate rank amongst the other continents. The most probable
calculations estimate the whole human race at eight hundred million: of
which number, Europe boasts of little more than one hundred million. The
great swarm is in Asia; amounting to between four and five hundred
million. Africa is supposed to contain one third or fourth of the latter
number. Over the fertile wilderness of America are scattered not altogether
twenty million.
But if in London alone, where registers of various kinds may be consulted,
calculators are, notwithstanding, at variance respecting its population
upwards of one hundred thousand, and in the whole island more than a
million; it may be reasonably suspected, that in forming a gross estimate of
the aggregate terrestrial inhabitants, we may err perhaps, one, two, or even
three hundred million. As well might we expect a correct list of the lions,
crocodiles, and monkies of Africa, as of the outcast human race in those
burning and illiterate regions. To determine the exact amount of inhabitants
in any civilized kingdom, the most certain method would be, to make an
universal and arithmetical numeration throughout every dwelling. This is
often done in several kingdoms; and in none more culpably neglected than
in this island. English calculators, therefore, have been under the necessity,
by other laborious processes, to form at least plausible conjectures of the
grandeur, has, together with advancement in civilization, likewise added to
the number of its inhabitants. Those parental nurseries of the arts and
sciences in Asia and Africa, have no doubt undergone various revolutions in
population. If we were to draw any inferences from the numerous Asiatic
armies, during the successive despotism of Assyrian, Babylonian, Medean,
and Persian monarchies, we should conclude that, in remote ages, the south
of Asia abounded in men. The extensive empire of China, at this day,
resembles an industrious beehive, and is gorged with mankind. We have
still more aversion to plunge into the mysterious archives of Africa, and
with critical affectation to pronounce upon the population of that quarter
before the decay of its political, commercial, and literary fame with Thebes,
Carthage, and Alexandria. That modern-discovered transatlantic continent,
from the cruelties and desolation of its first conquerors, and of a loathsome
infectious disease exchanged for another, has probably suffered
considerable diminution of its original feeble hive, notwithstanding the
recruit from Europe; and in the scale of population, as yet ascends to a very
subordinate rank amongst the other continents. The most probable
calculations estimate the whole human race at eight hundred million: of
which number, Europe boasts of little more than one hundred million. The
great swarm is in Asia; amounting to between four and five hundred
million. Africa is supposed to contain one third or fourth of the latter
number. Over the fertile wilderness of America are scattered not altogether
twenty million.
But if in London alone, where registers of various kinds may be consulted,
calculators are, notwithstanding, at variance respecting its population
upwards of one hundred thousand, and in the whole island more than a
million; it may be reasonably suspected, that in forming a gross estimate of
the aggregate terrestrial inhabitants, we may err perhaps, one, two, or even
three hundred million. As well might we expect a correct list of the lions,
crocodiles, and monkies of Africa, as of the outcast human race in those
burning and illiterate regions. To determine the exact amount of inhabitants
in any civilized kingdom, the most certain method would be, to make an
universal and arithmetical numeration throughout every dwelling. This is
often done in several kingdoms; and in none more culpably neglected than
in this island. English calculators, therefore, have been under the necessity,
by other laborious processes, to form at least plausible conjectures of the
Page 23
national population. One of their methods is, by collecting the number of
houses, and allotting five, or four and a half inhabitants to each house;
which, at a general medium, was found near the standard of truth, in a
multitude of large towns and open districts in England, Holland, Germany,
Switzerland, and Italy; as may be seen recorded in the writings of Short,
Susmilch, Price, and many others. In some particular cities, however, such
as Berlin, Vienna, Paris, and Edinburgh, where several families are crowded
into one house, this rule would lead into error. Besides, in ours, and many
other large kingdoms, we are not yet supplied with an authentick register of
all the dwellings. And in Asia and Africa, whose political institutions and
customs are so different from us, this scale of mensuration may be still
more erroneous. Another method, but still more complex and uncertain, of
computing the population is, by the annual christenings and burials. When
these are equal, and consequently there is no increase or decrease of the
inhabitants, we are directed to multiply the usual prospect or decrement of
life, or in the mathematical phrase, the expectation of an infant at birth in
that city, town, or district, by the general medium of christenings; which
will be the total local amount of the inhabitants. But as the christenings and
burials are rarely equal, or a correct list of either can be ascertained from
the imperfect registers, this process is very defective.
The Multiplication of the human species depends greatly on society. There
are more inhabitants concentrated into one large metropolis of Asia or
Europe, than could be collected in many thousand miles of the North-
American wilderness on its first discovery. The population of the earth is by
no means regulated by the extent of country. If, on the one hand, high
refinement and large cities are obstacles to population, a wild state of nature
is still more detrimental. A few tribes of North American natives, prowling
like hungry wolves, can scarce find precarious subsistence in a wide extent
of uncultivated desarts. Their infants, from necessity, are suckled several
years; and after rearing two or three, the period of propagation is nearly
over. A medium state between the vicious extremes of refinement and rude
savageness; or the middle stages between the iron and golden ages of the
ancient philosophers, is most favourable to the increase of our species. But
the causes conducive to population and depopulation, are of infinite
compass; and are of a compound nature, medical and political. They are
connected with the state of government, religion, climate, genius, industry,
riches, poverty, taxes, luxury, refinement, wars, colonization, emigration,
houses, and allotting five, or four and a half inhabitants to each house;
which, at a general medium, was found near the standard of truth, in a
multitude of large towns and open districts in England, Holland, Germany,
Switzerland, and Italy; as may be seen recorded in the writings of Short,
Susmilch, Price, and many others. In some particular cities, however, such
as Berlin, Vienna, Paris, and Edinburgh, where several families are crowded
into one house, this rule would lead into error. Besides, in ours, and many
other large kingdoms, we are not yet supplied with an authentick register of
all the dwellings. And in Asia and Africa, whose political institutions and
customs are so different from us, this scale of mensuration may be still
more erroneous. Another method, but still more complex and uncertain, of
computing the population is, by the annual christenings and burials. When
these are equal, and consequently there is no increase or decrease of the
inhabitants, we are directed to multiply the usual prospect or decrement of
life, or in the mathematical phrase, the expectation of an infant at birth in
that city, town, or district, by the general medium of christenings; which
will be the total local amount of the inhabitants. But as the christenings and
burials are rarely equal, or a correct list of either can be ascertained from
the imperfect registers, this process is very defective.
The Multiplication of the human species depends greatly on society. There
are more inhabitants concentrated into one large metropolis of Asia or
Europe, than could be collected in many thousand miles of the North-
American wilderness on its first discovery. The population of the earth is by
no means regulated by the extent of country. If, on the one hand, high
refinement and large cities are obstacles to population, a wild state of nature
is still more detrimental. A few tribes of North American natives, prowling
like hungry wolves, can scarce find precarious subsistence in a wide extent
of uncultivated desarts. Their infants, from necessity, are suckled several
years; and after rearing two or three, the period of propagation is nearly
over. A medium state between the vicious extremes of refinement and rude
savageness; or the middle stages between the iron and golden ages of the
ancient philosophers, is most favourable to the increase of our species. But
the causes conducive to population and depopulation, are of infinite
compass; and are of a compound nature, medical and political. They are
connected with the state of government, religion, climate, genius, industry,
riches, poverty, taxes, luxury, refinement, wars, colonization, emigration,
Page 24
commerce, agriculture, the unequal distribution and monopoly of property
and farms, the plenty, scarcity, and cheapness of food; and, with many other
causes, closely allied to our future medicinal investigation. Under
governments and nurture, directed with political and moral, together with
medical prudence and circumspection, the earth and ocean would probably
afford ample nutriment, and their population might be multiplied to three
times eight hundred million.
Extending our views over the surface of the globe, we perceive striking
distinctions between the human species; not only in the four great
continents, but also in different parts of the same continent. These
differences are principally manifest in the colour of the skin; in the
complexion, countenance, physiognomy, hair, form, and stature. We attend
here merely to corporeal distinction, without including the intellectual.
These great Classes of mankind may be divided into the Laplander, the
Tartar, the Chinese, the European, the African-negro, and the native
American. The modern-discovered inhabitants in the islands of the Pacific
ocean, seem to have no remarkable cast of countenance or figure to sever
them into a separate class. But throughout a considerable extent of the
globe, from conquest, emigration, colonization, and commercial
intercourse, many nations are now blended and assimilated into one; and
their elementary characteristic features more faintly imprinted. Besides,
every one’s experience and observation will instruct him, that in populous
kingdoms those classes branch out into innumerable intermixtures, orders,
and genera; and that the species and varieties are as numerous as the
individuals of the human race. Amongst the ab-origines, and stationary
inhabitants of most kingdoms, there are indeed some prominent features
peculiar to each community; which are, in some degree, conspicuous in the
corporeal, and still more in the mental outlines. Mankind, exclusive of their
original mould, as issued from the mint of the Creator, are afterwards
diversified by climate, soil, diet, government, religion, association,
occupation, and habit.
By Civilization, mankind are arranged and connected into an infinite series
of descending and dependent links. In a state of nature there are few
gradations in society; few professions or mechanical arts. Mr. Voltaire
makes two great divisions of mankind; the oppressors, and the oppressed.
Descending the mole-hill and ladder from the throne to the cottage, we may
and farms, the plenty, scarcity, and cheapness of food; and, with many other
causes, closely allied to our future medicinal investigation. Under
governments and nurture, directed with political and moral, together with
medical prudence and circumspection, the earth and ocean would probably
afford ample nutriment, and their population might be multiplied to three
times eight hundred million.
Extending our views over the surface of the globe, we perceive striking
distinctions between the human species; not only in the four great
continents, but also in different parts of the same continent. These
differences are principally manifest in the colour of the skin; in the
complexion, countenance, physiognomy, hair, form, and stature. We attend
here merely to corporeal distinction, without including the intellectual.
These great Classes of mankind may be divided into the Laplander, the
Tartar, the Chinese, the European, the African-negro, and the native
American. The modern-discovered inhabitants in the islands of the Pacific
ocean, seem to have no remarkable cast of countenance or figure to sever
them into a separate class. But throughout a considerable extent of the
globe, from conquest, emigration, colonization, and commercial
intercourse, many nations are now blended and assimilated into one; and
their elementary characteristic features more faintly imprinted. Besides,
every one’s experience and observation will instruct him, that in populous
kingdoms those classes branch out into innumerable intermixtures, orders,
and genera; and that the species and varieties are as numerous as the
individuals of the human race. Amongst the ab-origines, and stationary
inhabitants of most kingdoms, there are indeed some prominent features
peculiar to each community; which are, in some degree, conspicuous in the
corporeal, and still more in the mental outlines. Mankind, exclusive of their
original mould, as issued from the mint of the Creator, are afterwards
diversified by climate, soil, diet, government, religion, association,
occupation, and habit.
By Civilization, mankind are arranged and connected into an infinite series
of descending and dependent links. In a state of nature there are few
gradations in society; few professions or mechanical arts. Mr. Voltaire
makes two great divisions of mankind; the oppressors, and the oppressed.
Descending the mole-hill and ladder from the throne to the cottage, we may
Page 25
trace a multitude of gradations in the scale of polished communities. We
descend thro’ nobility and gentry of independent fortunes, in lands or
money; through literary professions, including divinity, medicine, law, and
various other branches of active or speculative science: all of which united,
constitute, even in the most opulent nations, but a small portion of the
community. We next descend to a fertile hive of husbandmen and artizans,
laborious drudges in mechanical trades, arts, manufactories, and commerce:
to a numerous class of retailers or venders of merchandize, and of the
necessaries of life: to soldiers, sailors, domestick servants: to no
inconsiderable multitude buried under ground, and occupied in digging
metals and fuel from the bowels of the earth: to infirm, cripples, diseased,
puerperal, aged; and to many other links and gradations, which must be
greatly diversified by the variety in governments, religion, climate, national
genius, and other causes which will occur to philosophers, and to gentlemen
of reflection. It is of essential importance, not only in an enlarged political,
but also in a medicinal view, to contemplate these constituent portions of a
community.
The inhabitants crowded into Cities and towns, and those dispersed in small
villages, and in the Country, constitute other large groups of society. If the
result of Susmilch’s researches and materials, collected throughout
Germany can be depended upon as a criterion for other European nations,
the inhabitants in the country are to those in cities and towns as 3½ to 1.
Great cities, if we except Rome and Constantinople, are of modern date in
most kingdoms of Europe. In the ninth century, a few towns had been built
in Germany; but in England, corporations and considerable towns are
posterior to the Norman invasion. Cities, associated communities, and
towns, during the religious frenzy of crusading, and after the termination of
this epidemical distemper, were asylums from aristocratic tyranny; and
when of moderate size, are seats of politeness, refinement, emulation, arts,
and society; but when overgrown, they check population; they are drains of
the human species, the graves of infants, and nurseries of vices.
Unfortunately also for succeeding generations, numerous cities, towns, and
harbours, have been founded upon low, unhealthy situations, surrounded by
morasses and hills. Most cities seem to have grown to maturity by accident
and time: their streets are narrow, irregular, not sufficiently ventilated; and
the inhabitants absurdly and perniciously thronged together. There are
moderate-sized towns, and even country districts, whose situations are so
descend thro’ nobility and gentry of independent fortunes, in lands or
money; through literary professions, including divinity, medicine, law, and
various other branches of active or speculative science: all of which united,
constitute, even in the most opulent nations, but a small portion of the
community. We next descend to a fertile hive of husbandmen and artizans,
laborious drudges in mechanical trades, arts, manufactories, and commerce:
to a numerous class of retailers or venders of merchandize, and of the
necessaries of life: to soldiers, sailors, domestick servants: to no
inconsiderable multitude buried under ground, and occupied in digging
metals and fuel from the bowels of the earth: to infirm, cripples, diseased,
puerperal, aged; and to many other links and gradations, which must be
greatly diversified by the variety in governments, religion, climate, national
genius, and other causes which will occur to philosophers, and to gentlemen
of reflection. It is of essential importance, not only in an enlarged political,
but also in a medicinal view, to contemplate these constituent portions of a
community.
The inhabitants crowded into Cities and towns, and those dispersed in small
villages, and in the Country, constitute other large groups of society. If the
result of Susmilch’s researches and materials, collected throughout
Germany can be depended upon as a criterion for other European nations,
the inhabitants in the country are to those in cities and towns as 3½ to 1.
Great cities, if we except Rome and Constantinople, are of modern date in
most kingdoms of Europe. In the ninth century, a few towns had been built
in Germany; but in England, corporations and considerable towns are
posterior to the Norman invasion. Cities, associated communities, and
towns, during the religious frenzy of crusading, and after the termination of
this epidemical distemper, were asylums from aristocratic tyranny; and
when of moderate size, are seats of politeness, refinement, emulation, arts,
and society; but when overgrown, they check population; they are drains of
the human species, the graves of infants, and nurseries of vices.
Unfortunately also for succeeding generations, numerous cities, towns, and
harbours, have been founded upon low, unhealthy situations, surrounded by
morasses and hills. Most cities seem to have grown to maturity by accident
and time: their streets are narrow, irregular, not sufficiently ventilated; and
the inhabitants absurdly and perniciously thronged together. There are
moderate-sized towns, and even country districts, whose situations are so
Page 26
noxious, as to make the burials exceed the births. We need not travel to new
uncultivated continents and islands, nor to rank tropical climates for proofs:
we have only to consult Dr. Short’s Registers of several parts in this
kingdom.
The assemblages of the human race are greatly diversified by their Ages.
During nine months only of uterine incubation, and from the most minute
tadpole, an infant at birth has grown to between sixteen inches and two feet;
and from five to ten pounds in weight. After birth, the increase is slower;
and it proceeds to shoot upwards a few inches annually, but not always in
successive progression, and to make additions to its weight and dimensions.
Between puberty and twenty-one years of age, man has generally attained
to the summit of his altitude; females, rather earlier; and those still earlier
who inhabit warm climates. Excluding that fragment of pigmy mortals, the
Laplanders, between five and six feet in height is the most universal and
mean standard of the human race; and their gravity in various gradations,
from eight to twenty stone; in both which respects, females usually fall
short of males. Nature, however, is not limited to one model of altitude or
gravity; she sometimes deviates into extravagancies, producing human
giants, from nine, down to diminutive dwarfs of two feet; together with
shapeless monsters wallowing in fat, and weighing upwards of forty stone.
Let us next endeavour to form arithmetical estimates of the human race, at
different ages. Davenant calculates the inhabitants of England (not
including Scotland) at five million and a half; and their sundry ages as
follows:—Under one year of age, 170,000; under five years of age,
820,000; under ten years of age, 1,500,000; under sixteen years of age,
2,240,000: from sixteen years of age to the extreme of existence, 3,260,000;
of which number he estimates 600,000, or about one ninth part of the whole
community, to have passed sixty years of age; and of which veteran group
the males constitute 270,000; the females, 330,000. Dr. Price supposes
nearly an equal proportion living under 16, and above that age; but that the
latter are the most numerous class: Davenant states the medium at 20. Dr.
Halley supposed the number living under 16, to comprize about one third of
the community; and also, that those living between 20 and 42, were about
one third of the whole. The preceding analysis of the numbers living at
different ages in one kingdom, may with facility be applied to any
numerical extent. If we wish to calculate the proportion living at similar
uncultivated continents and islands, nor to rank tropical climates for proofs:
we have only to consult Dr. Short’s Registers of several parts in this
kingdom.
The assemblages of the human race are greatly diversified by their Ages.
During nine months only of uterine incubation, and from the most minute
tadpole, an infant at birth has grown to between sixteen inches and two feet;
and from five to ten pounds in weight. After birth, the increase is slower;
and it proceeds to shoot upwards a few inches annually, but not always in
successive progression, and to make additions to its weight and dimensions.
Between puberty and twenty-one years of age, man has generally attained
to the summit of his altitude; females, rather earlier; and those still earlier
who inhabit warm climates. Excluding that fragment of pigmy mortals, the
Laplanders, between five and six feet in height is the most universal and
mean standard of the human race; and their gravity in various gradations,
from eight to twenty stone; in both which respects, females usually fall
short of males. Nature, however, is not limited to one model of altitude or
gravity; she sometimes deviates into extravagancies, producing human
giants, from nine, down to diminutive dwarfs of two feet; together with
shapeless monsters wallowing in fat, and weighing upwards of forty stone.
Let us next endeavour to form arithmetical estimates of the human race, at
different ages. Davenant calculates the inhabitants of England (not
including Scotland) at five million and a half; and their sundry ages as
follows:—Under one year of age, 170,000; under five years of age,
820,000; under ten years of age, 1,500,000; under sixteen years of age,
2,240,000: from sixteen years of age to the extreme of existence, 3,260,000;
of which number he estimates 600,000, or about one ninth part of the whole
community, to have passed sixty years of age; and of which veteran group
the males constitute 270,000; the females, 330,000. Dr. Price supposes
nearly an equal proportion living under 16, and above that age; but that the
latter are the most numerous class: Davenant states the medium at 20. Dr.
Halley supposed the number living under 16, to comprize about one third of
the community; and also, that those living between 20 and 42, were about
one third of the whole. The preceding analysis of the numbers living at
different ages in one kingdom, may with facility be applied to any
numerical extent. If we wish to calculate the proportion living at similar
Page 27
ages amongst one hundred million, we have only to multiply by 18 each of
the preceding groups composing five million and an half of inhabitants.
Two large and important classes are formed in society, by the distinction of
the Sexes into male and female. So soon as the organs of generation are
completely evolved; that is, when the two sexes arrive at puberty, they are
inflamed with a new passion and pleasing sense. In most warm climates,
this generative period is somewhat earlier than in northern latitudes; and in
the former also, women are said to be more prolifick. We shall therefore
devote a few words to the union of the sexes, from whence ensue
procreation and births. Some calculators have computed, that amongst five
million and an half of inhabitants in England, there are annually about
forty-one thousand legal marriages: of which one sixth part are widows and
widowers; about one marriage to every one hundred and four inhabitants;
and the annual marriages to the births, as 1 to 4, or 4½. The mean ages at
which marriages in this island commence, is computed from 32 to 35 on the
side of the man, and 25 on that of the woman; but in this estimate, second
and third marriages are included.
In cities, not only fewer enter into the matrimonial state, but the product
also of city and country-marriages is observed to differ. Marriages in cities,
one with another, seldom produce above four; generally between three and
four, and sometimes not three children: whereas country-marriages seldom
produce less than four, and generally between four and five. Whether this
disparity between the product of city and country-marriages is to be
imputed to dissipation, libertinism, and incontinence, both in the single and
married state; to the cloudy apprehensions and fears of overstocking their
house; to later, fewer, and less frequent unions in the matrimonial bond; or
to all these and other causes combined, I submit to the reader’s
consideration. From authentick registers of a variety of small towns and
country parishes in England, Dr. Short found, that each marriage produced
four and a half children, at a medium; for some married pairs have only one
or two: others six, eight, twelve, or more; and a small remnant are
unprolifick. Natural, or illegitimate children, are enrolled in the public
records of christenings, and swell their proportion to the registered
weddings somewhat greater than they would appear without this extraneous
addition. In some German registers, Dr. Short found, that of 333,655 births,
the illegitimate amounted to one thirty-seventh part; and in an inland town
the preceding groups composing five million and an half of inhabitants.
Two large and important classes are formed in society, by the distinction of
the Sexes into male and female. So soon as the organs of generation are
completely evolved; that is, when the two sexes arrive at puberty, they are
inflamed with a new passion and pleasing sense. In most warm climates,
this generative period is somewhat earlier than in northern latitudes; and in
the former also, women are said to be more prolifick. We shall therefore
devote a few words to the union of the sexes, from whence ensue
procreation and births. Some calculators have computed, that amongst five
million and an half of inhabitants in England, there are annually about
forty-one thousand legal marriages: of which one sixth part are widows and
widowers; about one marriage to every one hundred and four inhabitants;
and the annual marriages to the births, as 1 to 4, or 4½. The mean ages at
which marriages in this island commence, is computed from 32 to 35 on the
side of the man, and 25 on that of the woman; but in this estimate, second
and third marriages are included.
In cities, not only fewer enter into the matrimonial state, but the product
also of city and country-marriages is observed to differ. Marriages in cities,
one with another, seldom produce above four; generally between three and
four, and sometimes not three children: whereas country-marriages seldom
produce less than four, and generally between four and five. Whether this
disparity between the product of city and country-marriages is to be
imputed to dissipation, libertinism, and incontinence, both in the single and
married state; to the cloudy apprehensions and fears of overstocking their
house; to later, fewer, and less frequent unions in the matrimonial bond; or
to all these and other causes combined, I submit to the reader’s
consideration. From authentick registers of a variety of small towns and
country parishes in England, Dr. Short found, that each marriage produced
four and a half children, at a medium; for some married pairs have only one
or two: others six, eight, twelve, or more; and a small remnant are
unprolifick. Natural, or illegitimate children, are enrolled in the public
records of christenings, and swell their proportion to the registered
weddings somewhat greater than they would appear without this extraneous
addition. In some German registers, Dr. Short found, that of 333,655 births,
the illegitimate amounted to one thirty-seventh part; and in an inland town
Page 28
of England, that of 10,337 births, 284, or about one thirtieth part, were
illegitimate.
If the number of inhabitants in any kingdom, city, or village, continues the
same without increase or decrease, and supported by their own procreation
only, it is evident, that there the annual births and burials will be equal, and
the supply proportioned to the waste; and in equal numbers, as many will
die at all ages as are born in the year, on a general average; and the numbers
dying any year at one, two, three years of age, and so on to the extreme of
existence, will be just equal with the numbers who successively attain to
those different ages at which the others die. The total annual births amongst
five million and an half of inhabitants in England, are calculated by
Davenant at 190,000; which is about one birth to every twenty-five
inhabitants; and amongst nine million of inhabitants in Britain and Ireland,
the annual procreation will considerably exceed three hundred thousand;
and the annual mortality should be somewhat inferior. In the kingdom of
Prussia, from the year 1715 to 18, there were christened, at an annual
medium, 78,826; buried, 55,852. In the kingdom of Sweden, the annual
average of births during nine years, ending in 1763, was 90,240; burials,
69,125. In Norway, in 1761, the christenings were 11,024; burials, 6,926. In
France, during three years, ending in 1772, the annual average of births was
920,918; burials, 780,040. In the county district of Vaux, in Switzerland,
during ten years, the births were 3,155; burials, 2,504. The country, says
Graunt, has 6,339 births for 5,280 burials. In that little fertile atlantic island
Madeira, the inhabitants have been computed to double themselves in
eighty-four years; so great is the difference between the births and burials.
In some provinces of North America, if Dr. Franklin’s calculations are
correct, the inhabitants double themselves in the short space of twenty-five,
twenty-two, and even in fifteen years. On the other hand, in all the large
cities of Europe: in Paris, Vienna, Rome, Dresden, Berlin, Amsterdam,
London, Edinburgh, Dublin, and in almost all towns of considerable
magnitude and population, the total annual births are inferior to the burials.
It is calculated, that in London, within the last 150 years, near a million
more of the human species have been wasted, beyond what were reared by
its own original growth and procreation. But in small villages and country
districts, the annual births exceed the burials; and it is from this redundance
that a supply is furnished for the extraordinary consumption of armies,
illegitimate.
If the number of inhabitants in any kingdom, city, or village, continues the
same without increase or decrease, and supported by their own procreation
only, it is evident, that there the annual births and burials will be equal, and
the supply proportioned to the waste; and in equal numbers, as many will
die at all ages as are born in the year, on a general average; and the numbers
dying any year at one, two, three years of age, and so on to the extreme of
existence, will be just equal with the numbers who successively attain to
those different ages at which the others die. The total annual births amongst
five million and an half of inhabitants in England, are calculated by
Davenant at 190,000; which is about one birth to every twenty-five
inhabitants; and amongst nine million of inhabitants in Britain and Ireland,
the annual procreation will considerably exceed three hundred thousand;
and the annual mortality should be somewhat inferior. In the kingdom of
Prussia, from the year 1715 to 18, there were christened, at an annual
medium, 78,826; buried, 55,852. In the kingdom of Sweden, the annual
average of births during nine years, ending in 1763, was 90,240; burials,
69,125. In Norway, in 1761, the christenings were 11,024; burials, 6,926. In
France, during three years, ending in 1772, the annual average of births was
920,918; burials, 780,040. In the county district of Vaux, in Switzerland,
during ten years, the births were 3,155; burials, 2,504. The country, says
Graunt, has 6,339 births for 5,280 burials. In that little fertile atlantic island
Madeira, the inhabitants have been computed to double themselves in
eighty-four years; so great is the difference between the births and burials.
In some provinces of North America, if Dr. Franklin’s calculations are
correct, the inhabitants double themselves in the short space of twenty-five,
twenty-two, and even in fifteen years. On the other hand, in all the large
cities of Europe: in Paris, Vienna, Rome, Dresden, Berlin, Amsterdam,
London, Edinburgh, Dublin, and in almost all towns of considerable
magnitude and population, the total annual births are inferior to the burials.
It is calculated, that in London, within the last 150 years, near a million
more of the human species have been wasted, beyond what were reared by
its own original growth and procreation. But in small villages and country
districts, the annual births exceed the burials; and it is from this redundance
that a supply is furnished for the extraordinary consumption of armies,
Page 29
navies, war, colonization, emigration; exclusive of sickness, and other
morbid casualties: the country and village surplus prevents depopulation.
Providence has also wisely ordained, that throughout those European
kingdoms, of which we have any registers, a few more Males should be
born than Females; and indeed such a surplus is rendered necessary from
the waste by wars, emigration, intemperance, mechanical arts, and trades,
the inclemency and vicissitudes of the weather and seasons, the vices and
misfortunes to which political punishments are annexed; with various other
noxious casualties, to all which the male sex are most exposed. In Dr.
Arbuthnot’s Table, printed in the London Philosophical Transactions, of the
proportion between the births of the sexes; in forty-six years were baptized
of males, 329,742; of females, 308,644: excess of males only, 21,098. By
the London bills, from 1657 to 1776, I find that there have been christened
of males, 1,041,149; of females, 983,061, or as 18 to 17: and therefore, that
in this long interval of 120 years, and comprehending two million of births,
there is only a trifling excess of males, amounting to 58,088: a number
which would scarce recruit the consumption of a few active campaigns. The
excess of male beyond female births, is not so considerable as books of
calculation have represented. In volume the 7th of the Philosophical
Transactions abridged, there is an account of the annual births during
several years at Vienna, Breslaw, Dresden, Leipsic, and Ratisbon: and in
those cities, male and female births were as nineteen to eighteen. Amongst
the abortives and stillborn, we also find the plurality of males. Lastly, if the
registers can be depended upon, it appears that there are more births in
Winter than in Summer, both in town and country. But although the fruit of
the human womb may not have arrived at maturity before winter, it is no
proof against the general law of the spring and summer influence on
animals and vegetables, in contributing to fecundity and generation.
morbid casualties: the country and village surplus prevents depopulation.
Providence has also wisely ordained, that throughout those European
kingdoms, of which we have any registers, a few more Males should be
born than Females; and indeed such a surplus is rendered necessary from
the waste by wars, emigration, intemperance, mechanical arts, and trades,
the inclemency and vicissitudes of the weather and seasons, the vices and
misfortunes to which political punishments are annexed; with various other
noxious casualties, to all which the male sex are most exposed. In Dr.
Arbuthnot’s Table, printed in the London Philosophical Transactions, of the
proportion between the births of the sexes; in forty-six years were baptized
of males, 329,742; of females, 308,644: excess of males only, 21,098. By
the London bills, from 1657 to 1776, I find that there have been christened
of males, 1,041,149; of females, 983,061, or as 18 to 17: and therefore, that
in this long interval of 120 years, and comprehending two million of births,
there is only a trifling excess of males, amounting to 58,088: a number
which would scarce recruit the consumption of a few active campaigns. The
excess of male beyond female births, is not so considerable as books of
calculation have represented. In volume the 7th of the Philosophical
Transactions abridged, there is an account of the annual births during
several years at Vienna, Breslaw, Dresden, Leipsic, and Ratisbon: and in
those cities, male and female births were as nineteen to eighteen. Amongst
the abortives and stillborn, we also find the plurality of males. Lastly, if the
registers can be depended upon, it appears that there are more births in
Winter than in Summer, both in town and country. But although the fruit of
the human womb may not have arrived at maturity before winter, it is no
proof against the general law of the spring and summer influence on
animals and vegetables, in contributing to fecundity and generation.
Page 30
CHAPTER I.
The Comparative Mortality of the Human Species, and of the Sexes at every
Age, in City, Town, and Country; and in different Kingdoms of Europe:
illustrated with a Chart, and with Tables. The Comparative Mortality
of the Human Species, by different Diseases and Casualties: exhibiting
a Chart, and Tables of all the Mortal Diseases and Casualties in
London during Seventy-five Years: illustrated by and contrasted with
the united Observations of Medical Authors, with various Hospital
Registers; and with a Variety of Materials, Observations, and
Comments of the Author.
THAT learned Physician, Dr. Arbuthnot, in his Preface to Huygen’s “de
Ratiociniis in ludo aleæ”, says, There are very few things which we know,
which are not capable of being reduced to a mathematical reasoning; and
when they cannot, it is a sign the knowledge of them is very small and
confused; and, when a mathematical reason can be had, it is as great a folly
to make use of any other, as to grope for a thing in the dark when you have
a candle standing by you. Medical writers, almost universally, have
neglected, or barely skimmed the surface of the following important
subjects. The public registers of births, burials, and diseases, are overlooked
by all the modern systematick authors: they leave us equally ignorant of the
aggregate, or comparative number, or force of those fiends which haunt and
ravage the globe. To speak metaphorically, in medical books, the extensive
desolation of the most rapacious tyrants and conquerors are confounded
with the uninteresting history, and petty depredations of a robber. The
detached observations of physicians, or other literary individuals, confined
perhaps to a small town or parish, a meagre detail of village remarks,
furnish, in innumerable instances, foundations too slight for the erection
and stability of general proportions. In order to form useful tables of the
ratio of mortality at various ages, to determine upon the absolute and
relative havock by different diseases, upon the general effects of climate,
season, local situation, diet, drink, luxuries, new customs, and manners, &c.
we should extend our views far beyond the narrow bounds of a parish, or
The Comparative Mortality of the Human Species, and of the Sexes at every
Age, in City, Town, and Country; and in different Kingdoms of Europe:
illustrated with a Chart, and with Tables. The Comparative Mortality
of the Human Species, by different Diseases and Casualties: exhibiting
a Chart, and Tables of all the Mortal Diseases and Casualties in
London during Seventy-five Years: illustrated by and contrasted with
the united Observations of Medical Authors, with various Hospital
Registers; and with a Variety of Materials, Observations, and
Comments of the Author.
THAT learned Physician, Dr. Arbuthnot, in his Preface to Huygen’s “de
Ratiociniis in ludo aleæ”, says, There are very few things which we know,
which are not capable of being reduced to a mathematical reasoning; and
when they cannot, it is a sign the knowledge of them is very small and
confused; and, when a mathematical reason can be had, it is as great a folly
to make use of any other, as to grope for a thing in the dark when you have
a candle standing by you. Medical writers, almost universally, have
neglected, or barely skimmed the surface of the following important
subjects. The public registers of births, burials, and diseases, are overlooked
by all the modern systematick authors: they leave us equally ignorant of the
aggregate, or comparative number, or force of those fiends which haunt and
ravage the globe. To speak metaphorically, in medical books, the extensive
desolation of the most rapacious tyrants and conquerors are confounded
with the uninteresting history, and petty depredations of a robber. The
detached observations of physicians, or other literary individuals, confined
perhaps to a small town or parish, a meagre detail of village remarks,
furnish, in innumerable instances, foundations too slight for the erection
and stability of general proportions. In order to form useful tables of the
ratio of mortality at various ages, to determine upon the absolute and
relative havock by different diseases, upon the general effects of climate,
season, local situation, diet, drink, luxuries, new customs, and manners, &c.
we should extend our views far beyond the narrow bounds of a parish, or
Page 31
even of a province; we should include an interval of many years, collective
numbers, and large groups of mankind.
It appears to me, that a great number of the fundamental principles, or of
the primary orders of medical architecture, have not yet been established,
neither in Pathology, to which this Dissertation is chiefly related; and much
less in Therapeuticks. The lumber and mountain of ponderous systems,
heaped together from Galen to Stahl, can only be compared to Egyptian
pyramids. Except what has been done by a few authors, hereafter to be
mentioned, the sciences of Medical Arithmetick and Universal
Prognosticks, are new in medicine. In emergencies, the constant appeal has
been, with oracular reverence, to aphorisms and opinions of individuals. In
a word, no medical author has yet attempted to take the gages of life and
death, and of morbid devastation, and, in one general survey, to encircle the
horizon of human existence and distempers. I have made some, at least
laborious efforts, to rescue a momentous part of active medicine from that
conjectural stigma with which the whole profession has been branded in the
lump. And, however it may be slighted as an heretical innovation, I would
strenuously recommend Medical Arithmetick, as a guide and compass
through the labyrinth of Therapeuticks.
We are now to view the human race unexpectedly arrested, and struggling
in the tragical and last stages of their terrestrial pilgrimage. The vision of
human life is soon at an end: we are ushered into the world with lamentable
exclamation; and are too often torn out of it in pain and agony. Bills of
Mortality, however defective and inaccurate, yet sufficiently demonstrate
this awful truth, that very few of the human species die of old age, or
natural decay: by far the greater proportion are prematurely cut off by
diseases. Of all the animal tribe, who usually bring forth one at a birth, none
die in such numbers, in infancy, as the human race. In London, Vienna,
Berlin, and every other overgrown metropolis of Europe, on an average, one
half of the children born, die under three years of age. But in country towns
and villages, the proportion of infant mortality greatly abates. In some
country towns of England, of considerable magnitude and population, as
Manchester, half the children die under five; at Norwich, half under six; at
Northampton, half under ten years of age. London, therefore, will have lost,
out of equal capitals, a number in the intermediate space, between three and
ten, more than Northampton.
numbers, and large groups of mankind.
It appears to me, that a great number of the fundamental principles, or of
the primary orders of medical architecture, have not yet been established,
neither in Pathology, to which this Dissertation is chiefly related; and much
less in Therapeuticks. The lumber and mountain of ponderous systems,
heaped together from Galen to Stahl, can only be compared to Egyptian
pyramids. Except what has been done by a few authors, hereafter to be
mentioned, the sciences of Medical Arithmetick and Universal
Prognosticks, are new in medicine. In emergencies, the constant appeal has
been, with oracular reverence, to aphorisms and opinions of individuals. In
a word, no medical author has yet attempted to take the gages of life and
death, and of morbid devastation, and, in one general survey, to encircle the
horizon of human existence and distempers. I have made some, at least
laborious efforts, to rescue a momentous part of active medicine from that
conjectural stigma with which the whole profession has been branded in the
lump. And, however it may be slighted as an heretical innovation, I would
strenuously recommend Medical Arithmetick, as a guide and compass
through the labyrinth of Therapeuticks.
We are now to view the human race unexpectedly arrested, and struggling
in the tragical and last stages of their terrestrial pilgrimage. The vision of
human life is soon at an end: we are ushered into the world with lamentable
exclamation; and are too often torn out of it in pain and agony. Bills of
Mortality, however defective and inaccurate, yet sufficiently demonstrate
this awful truth, that very few of the human species die of old age, or
natural decay: by far the greater proportion are prematurely cut off by
diseases. Of all the animal tribe, who usually bring forth one at a birth, none
die in such numbers, in infancy, as the human race. In London, Vienna,
Berlin, and every other overgrown metropolis of Europe, on an average, one
half of the children born, die under three years of age. But in country towns
and villages, the proportion of infant mortality greatly abates. In some
country towns of England, of considerable magnitude and population, as
Manchester, half the children die under five; at Norwich, half under six; at
Northampton, half under ten years of age. London, therefore, will have lost,
out of equal capitals, a number in the intermediate space, between three and
ten, more than Northampton.
Page 32
Attend next to the small proportion of Infant Mortality in open country
districts. By Dr. Short’s registers of several small country villages in
England, the major part born live to 25, 27, 33, and 40. In many healthy
country parishes, half the inhabitants born live to mature age; to 40, 46, and
a few even to 50 and 60; and rear large families of children. In some
extensive country districts of Switzerland, similar observations have been
made by Susmilch and Muret. Here, therefore, is an astonishing disparity
between the duration of city and country life: but particularly, let it be
engraved upon the memory, in the early stages of puerile exigence. Infants
in cities resemble tender delicate plants excluded from fresh air; or fish
confined in stagnant putrid water: they perish before acquiring a solidity
and seasoning to endure the adulterated quality of the surrounding element;
and their thread of life is then suspended by a tender cobweb.
Mortality, universally, during the first year after birth, is the most enormous
in the funeral catalogue. A London infant at birth, has but an equal chance
of living to three years old; whereas in the country, as before observed, half
born survive to maturity. Upon reaching the third year, in cities, infants are
somewhat seasoned, and the hurricane of puerile carnage is greatly abated.
There is not afterwards such a prodigious disproportion between city and
country mortality; and, in a few years after, from seven to ten, they
approach nearer to an equality. From the London registers of burials, it
appears that more die in the metropolis under two years of age, than from
two to upwards of forty; and more under five years of age, than from five to
between fifty and sixty: yet under five, there are but an inconsiderable
number alive, compared to the latter class above that age: the deaths are
greatly disproportioned to the living numbers or capitals. A few more die in
the short interval between five and ten years of age, than in the succeeding
double interval from ten to twenty. Between eight and sixteen years of age,
one of every seventy of the Christ School boys is computed to die.
Davenant rates the decrement in these years at only one per cent. After
reaching the tenth year, the torrent of mortality in city, town, and country, is
subsided; and during the next eight or ten years of adolescence, very few
die. From seven to ten, may be termed the highest pinnacle: having
surmounted all the dangers and precipices of the early preceding journey,
there is no stage wherein the future prospects of existence and longevity are
so extensive. From birth to ten, the tide of life continues in annual gradation
to increase; and from ten to the ultimate verge of existence, vitality
districts. By Dr. Short’s registers of several small country villages in
England, the major part born live to 25, 27, 33, and 40. In many healthy
country parishes, half the inhabitants born live to mature age; to 40, 46, and
a few even to 50 and 60; and rear large families of children. In some
extensive country districts of Switzerland, similar observations have been
made by Susmilch and Muret. Here, therefore, is an astonishing disparity
between the duration of city and country life: but particularly, let it be
engraved upon the memory, in the early stages of puerile exigence. Infants
in cities resemble tender delicate plants excluded from fresh air; or fish
confined in stagnant putrid water: they perish before acquiring a solidity
and seasoning to endure the adulterated quality of the surrounding element;
and their thread of life is then suspended by a tender cobweb.
Mortality, universally, during the first year after birth, is the most enormous
in the funeral catalogue. A London infant at birth, has but an equal chance
of living to three years old; whereas in the country, as before observed, half
born survive to maturity. Upon reaching the third year, in cities, infants are
somewhat seasoned, and the hurricane of puerile carnage is greatly abated.
There is not afterwards such a prodigious disproportion between city and
country mortality; and, in a few years after, from seven to ten, they
approach nearer to an equality. From the London registers of burials, it
appears that more die in the metropolis under two years of age, than from
two to upwards of forty; and more under five years of age, than from five to
between fifty and sixty: yet under five, there are but an inconsiderable
number alive, compared to the latter class above that age: the deaths are
greatly disproportioned to the living numbers or capitals. A few more die in
the short interval between five and ten years of age, than in the succeeding
double interval from ten to twenty. Between eight and sixteen years of age,
one of every seventy of the Christ School boys is computed to die.
Davenant rates the decrement in these years at only one per cent. After
reaching the tenth year, the torrent of mortality in city, town, and country, is
subsided; and during the next eight or ten years of adolescence, very few
die. From seven to ten, may be termed the highest pinnacle: having
surmounted all the dangers and precipices of the early preceding journey,
there is no stage wherein the future prospects of existence and longevity are
so extensive. From birth to ten, the tide of life continues in annual gradation
to increase; and from ten to the ultimate verge of existence, vitality
Page 33
continues gradually to ebb. Between twenty and thirty, more die in London
than in the fifteen preceding years; and the burial list continues turgid to
sixty; at which latter stage, the mortality is computed between four and five
per cent.
One reason, but not the only one, as I shall hereafter prove, of the great
surge in the London bills, from twenty up to forty, is, that within this
interval of life, the majority of the new settlers or recruits, arrive; and
consequently augment the burials, from twenty to forty, beyond their
natural proportion. After passing the meridian, and in the evening of life,
the seasoned inhabitants of cities are said by Dr. Price, to have the
advantage of the country, in health and longevity: that is to say, although the
number who have survived in the country to sixty, seventy, and eighty, are
greater proportionally than in cities, yet the latter class arrived at those
years in London, have, comparatively, surer expectations of life. I do not,
however, find this assertion verified in fact; the balance, if any, vibrating
alternately on each side. The proportion of inhabitants who reach eighty
years of age are computed, in London and Vienna, at one of every forty: but
in country parishes, at one of every twenty-two; and in some, even one of
every eleven. In both city and country, the few survivors at ninety, out of
each thousand cœtaneous births, will have lost almost all their fellow-
travellers in the journey, long before reaching that goal; and about three or
four only out of each thousand, on an average, will be then left alive.
There are a few instances of extraordinary Longevity, to 150 and 165; such
are Jenkins and Par, in this island. In Bacon Lord Verulam’s History of
Long Livers, male and female; their climate, diet, mode of life, appetites,
exercises, studies, passions, dispositions, habits, and complexions, were
exceedingly dissimilar. It is however probable, from observation and
analogy, that the indigent and laborious class of mankind do not attain to
longevity in the same proportion with the middling and more opulent ranks.
The wandering Savages of America are notoriously short-lived. Throughout
Europe, Asia, Africa, and America, the rich, the poor, the inhabitants of city
and country, with very different complexion, climate, soil, diet, and
conveniences, all seldom exceed the usual term of life allotted to man:
seventy and eighty is mentioned in holy writ, as the brink of our earthly
duration. Since the days of Moses; that is, between three and four thousand
years, human existence has been circumscribed within the same narrow
than in the fifteen preceding years; and the burial list continues turgid to
sixty; at which latter stage, the mortality is computed between four and five
per cent.
One reason, but not the only one, as I shall hereafter prove, of the great
surge in the London bills, from twenty up to forty, is, that within this
interval of life, the majority of the new settlers or recruits, arrive; and
consequently augment the burials, from twenty to forty, beyond their
natural proportion. After passing the meridian, and in the evening of life,
the seasoned inhabitants of cities are said by Dr. Price, to have the
advantage of the country, in health and longevity: that is to say, although the
number who have survived in the country to sixty, seventy, and eighty, are
greater proportionally than in cities, yet the latter class arrived at those
years in London, have, comparatively, surer expectations of life. I do not,
however, find this assertion verified in fact; the balance, if any, vibrating
alternately on each side. The proportion of inhabitants who reach eighty
years of age are computed, in London and Vienna, at one of every forty: but
in country parishes, at one of every twenty-two; and in some, even one of
every eleven. In both city and country, the few survivors at ninety, out of
each thousand cœtaneous births, will have lost almost all their fellow-
travellers in the journey, long before reaching that goal; and about three or
four only out of each thousand, on an average, will be then left alive.
There are a few instances of extraordinary Longevity, to 150 and 165; such
are Jenkins and Par, in this island. In Bacon Lord Verulam’s History of
Long Livers, male and female; their climate, diet, mode of life, appetites,
exercises, studies, passions, dispositions, habits, and complexions, were
exceedingly dissimilar. It is however probable, from observation and
analogy, that the indigent and laborious class of mankind do not attain to
longevity in the same proportion with the middling and more opulent ranks.
The wandering Savages of America are notoriously short-lived. Throughout
Europe, Asia, Africa, and America, the rich, the poor, the inhabitants of city
and country, with very different complexion, climate, soil, diet, and
conveniences, all seldom exceed the usual term of life allotted to man:
seventy and eighty is mentioned in holy writ, as the brink of our earthly
duration. Since the days of Moses; that is, between three and four thousand
years, human existence has been circumscribed within the same narrow
Page 34
bounds. In the London registers of mortality, during a period of thirty years,
from 1728 to 1758, the total mortality is 750,332; and of all this number,
242 only reached beyond 100 years of age; one of whom arrived at 138. In
some races and families of men, longevity seems to be hereditary; and his
age, though little more than a dream, exceeds that of all other living
creatures, a few only excepted. Amongst the quadruped creation, the
elephant surpasses man in longevity: amongst the birds, the Swan, and a
few others, have survived upwards of a century. The age of fishes is
determined with more ingenuity than certainty: some seem to rival man in
years. Among the numerous vegetable tribes, the Oak, Chestnut, and some
other great trees, survive centuries.
On contrasting the mortality of Males and Females, it appears, that,
notwithstanding the surplus of male births, the perils of childbearing, the
many vexatious diseases peculiar to the fair sex, and that physicians and
apothecaries have many more patients of the latter; yet the total aggregate
number of living females exceeds that of males, in most European
kingdoms. Upon a numerical inquest in Edinburgh, and some other great
cities, it was found, that females were to males as 4 to 3: in London, as 13
to 10; and in some other cities and towns, as 9 to 8. But in country districts,
Graunt and Susmilch agree, that the two sexes approach nearer to an
equality. In the province of Jersey, in North America, the males were found
the majority. From 1702 to 1752; that is, during a period of fifty years, I
find the proportion of male and female mortality in London as follows:
Male deaths, 618,076; Female deaths, 626,692. Whence, therefore, does it
happen, that female deaths preponderate over the male, when more of the
latter are born, and, as calculators assert, the mortality of males, at all ages,
is greater than that of females? As a solution of this difficulty and partial
exception, I should suggest a greater exportation and transportation of
males to the sea and land service, to nautical commerce, and to unhealthy
climates.
Even in the Marriage State, the chance of survivorship seems considerably
in favour of the wife. In Breslaw, during eight years, five married men died
to three married women. Susmilch, on a scrutiny through several kingdoms
and principalities of Germany, found, that three married men died to two
married women. Dr. Price estimates the chance in favour of the wife being
the survivor in marriage, as 3 to 2: and this calculation is confirmed by the
from 1728 to 1758, the total mortality is 750,332; and of all this number,
242 only reached beyond 100 years of age; one of whom arrived at 138. In
some races and families of men, longevity seems to be hereditary; and his
age, though little more than a dream, exceeds that of all other living
creatures, a few only excepted. Amongst the quadruped creation, the
elephant surpasses man in longevity: amongst the birds, the Swan, and a
few others, have survived upwards of a century. The age of fishes is
determined with more ingenuity than certainty: some seem to rival man in
years. Among the numerous vegetable tribes, the Oak, Chestnut, and some
other great trees, survive centuries.
On contrasting the mortality of Males and Females, it appears, that,
notwithstanding the surplus of male births, the perils of childbearing, the
many vexatious diseases peculiar to the fair sex, and that physicians and
apothecaries have many more patients of the latter; yet the total aggregate
number of living females exceeds that of males, in most European
kingdoms. Upon a numerical inquest in Edinburgh, and some other great
cities, it was found, that females were to males as 4 to 3: in London, as 13
to 10; and in some other cities and towns, as 9 to 8. But in country districts,
Graunt and Susmilch agree, that the two sexes approach nearer to an
equality. In the province of Jersey, in North America, the males were found
the majority. From 1702 to 1752; that is, during a period of fifty years, I
find the proportion of male and female mortality in London as follows:
Male deaths, 618,076; Female deaths, 626,692. Whence, therefore, does it
happen, that female deaths preponderate over the male, when more of the
latter are born, and, as calculators assert, the mortality of males, at all ages,
is greater than that of females? As a solution of this difficulty and partial
exception, I should suggest a greater exportation and transportation of
males to the sea and land service, to nautical commerce, and to unhealthy
climates.
Even in the Marriage State, the chance of survivorship seems considerably
in favour of the wife. In Breslaw, during eight years, five married men died
to three married women. Susmilch, on a scrutiny through several kingdoms
and principalities of Germany, found, that three married men died to two
married women. Dr. Price estimates the chance in favour of the wife being
the survivor in marriage, as 3 to 2: and this calculation is confirmed by the
Page 35
experience of the general Clerical Society in Scotland, who have long
established funds to support their widows. From their records, it appears
that twenty married clergymen have died to twelve wives; or, as 5 to 3. By
an accurate survey of several principalities and cities in Germany, and
collected by Susmilch, the widows were to the widowers as 3, and even 4 to
1. At marriage, it should be observed, there is generally a disparity of age;
the bridegroom is from six to twelve years older than the bride; and
therefore should, in the course of nature, die sooner: and perhaps also more
widowers, comparatively with the other sex, enter into a second marriage;
which tends to reduce their numbers. Besides, husbands are more exposed
to the vicissitudes of the weather and seasons, to excessive labour and
noxious trades, and to many other causes of diseases. Dr. Price finds, that
the sexes respectively commence to be widowers and widows about 52 and
44; that is, men and women entering into matrimony, on a general average,
at the age of 33 and 25, will become widowers and widows at 52 and 44:
consequently, that each marriage will be dissolved by the death of one of
them, in nineteen years; which is the ultimate term and probability of the
husband and wife being both alive. For although some marriages may be
protracted forty and fifty years, yet others may be dissolved in one year, or
in a shorter time.
We have not yet sufficient information to determine the comparative
chances of Female Longevity in the married and single state. At Berlin,
indeed, calculators have remarked, that there were more married women
alive at great ages, than of those who remained single. But such result might
naturally be expected from a greater proportion in the decline of life of
widows and wives, compared to antiquated virgins. From the ages of fifteen
to twenty-five, married women likewise are said to have the advantage of
the single, in whom the dictates of nature are frustrated and violated.
Comparing the mortality of the Seasons, Dr. Short found, from a variety of
country-registers, that mortality generally begins its reign in December; that
at March it is in its zenith; and at May in its declension. In twenty-five
country towns and parishes, he found the winter to the summer mortality as
50 to 41. At Manchester, a country town of England, Dr. Percival found the
winter to the summer mortality as 11 to 8. At Vevey, in Switzerland, during
sixty years, Mr. Muret found the burials, during the four winter months, as 5
to 4 to those of the summer. Another proof of this is recorded in the
established funds to support their widows. From their records, it appears
that twenty married clergymen have died to twelve wives; or, as 5 to 3. By
an accurate survey of several principalities and cities in Germany, and
collected by Susmilch, the widows were to the widowers as 3, and even 4 to
1. At marriage, it should be observed, there is generally a disparity of age;
the bridegroom is from six to twelve years older than the bride; and
therefore should, in the course of nature, die sooner: and perhaps also more
widowers, comparatively with the other sex, enter into a second marriage;
which tends to reduce their numbers. Besides, husbands are more exposed
to the vicissitudes of the weather and seasons, to excessive labour and
noxious trades, and to many other causes of diseases. Dr. Price finds, that
the sexes respectively commence to be widowers and widows about 52 and
44; that is, men and women entering into matrimony, on a general average,
at the age of 33 and 25, will become widowers and widows at 52 and 44:
consequently, that each marriage will be dissolved by the death of one of
them, in nineteen years; which is the ultimate term and probability of the
husband and wife being both alive. For although some marriages may be
protracted forty and fifty years, yet others may be dissolved in one year, or
in a shorter time.
We have not yet sufficient information to determine the comparative
chances of Female Longevity in the married and single state. At Berlin,
indeed, calculators have remarked, that there were more married women
alive at great ages, than of those who remained single. But such result might
naturally be expected from a greater proportion in the decline of life of
widows and wives, compared to antiquated virgins. From the ages of fifteen
to twenty-five, married women likewise are said to have the advantage of
the single, in whom the dictates of nature are frustrated and violated.
Comparing the mortality of the Seasons, Dr. Short found, from a variety of
country-registers, that mortality generally begins its reign in December; that
at March it is in its zenith; and at May in its declension. In twenty-five
country towns and parishes, he found the winter to the summer mortality as
50 to 41. At Manchester, a country town of England, Dr. Percival found the
winter to the summer mortality as 11 to 8. At Vevey, in Switzerland, during
sixty years, Mr. Muret found the burials, during the four winter months, as 5
to 4 to those of the summer. Another proof of this is recorded in the
Page 36
Recherches sur la Population, par Messance: The total sick admitted into
the Hotel Dieu hospital in Paris, from 1724 to 1763 (forty years) were, in
the four winter months, December, January, February, and March, 314,824;
and in the four summer months, June, July, August, September, 238,522; or
as 4 to 3. In London too, the undertaker’s, harvest is in winter. There is one
obvious reason why, in every metropolis, the winter mortality should
exceed that of summer, from the greater concourse of inhabitants of all
ranks: but, independent of additional population in winter, the same law
seems to prevail in country places. In a subsequent part I shall attempt to
throw some collateral illustration upon the subject.
Let us close this humiliating scene with a general abstract of human
carnage. If we scan the dolorous mansions of disease, we find, on an
average, 1 death, annually, out of every 5 families in cities: but in country
towns, and open districts, 1 of 7, 8, 9; and in a few healthy places, 1 of
every 10 families. Including the whole assemblage of inhabitants in city,
town, and country, from birth to the extreme of existence, they are
computed to die in the following annual proportion to the living: In London,
1 of 21; Dublin, 1 of 22; Edinburgh, 1 of 21; Vienna, 1 of 20; Amsterdam, 1
of 22; Berlin, 1 of 26. This is nearly Dr. Price’s calculation; but Halley and
Susmilch compute only 1 of 22 to 29 to die annually in cities. In smaller
cities and towns, such as Norwich and Northampton, the general average of
deaths is 1 of 24 to 26; but in several provinces and healthy country
villages, 1 of 32 and 33, up to 45, 50, and even 60, is the annual drain: 1 of
43 to 50 was the average in upwards of a thousand country parishes on the
continent; and recorded in Susmilch. Within the above short intervals of
time, there will have died in the respective cities and country places
enumerated, a number equal to the whole inhabitants. But the annual
decrease of the oppressed Negroes, in the West India islands, is estimated at
1 of 7.
The ancient Egyptians allotted 3 generations to a century, which is
bordering upon the truth; at this day, 1 of 32 and 33 up to 35, is near the
measure of a generation, and to the general decrease of a community
throughout Europe, comprehending all the inhabitants in city, village, and
country: that is, mankind share amongst them from about 32 and 33 to 35
years each of existence: and within this fugitive interval of time, a number
equal to all the present inhabitants of this island, or of the whole earth, will
the Hotel Dieu hospital in Paris, from 1724 to 1763 (forty years) were, in
the four winter months, December, January, February, and March, 314,824;
and in the four summer months, June, July, August, September, 238,522; or
as 4 to 3. In London too, the undertaker’s, harvest is in winter. There is one
obvious reason why, in every metropolis, the winter mortality should
exceed that of summer, from the greater concourse of inhabitants of all
ranks: but, independent of additional population in winter, the same law
seems to prevail in country places. In a subsequent part I shall attempt to
throw some collateral illustration upon the subject.
Let us close this humiliating scene with a general abstract of human
carnage. If we scan the dolorous mansions of disease, we find, on an
average, 1 death, annually, out of every 5 families in cities: but in country
towns, and open districts, 1 of 7, 8, 9; and in a few healthy places, 1 of
every 10 families. Including the whole assemblage of inhabitants in city,
town, and country, from birth to the extreme of existence, they are
computed to die in the following annual proportion to the living: In London,
1 of 21; Dublin, 1 of 22; Edinburgh, 1 of 21; Vienna, 1 of 20; Amsterdam, 1
of 22; Berlin, 1 of 26. This is nearly Dr. Price’s calculation; but Halley and
Susmilch compute only 1 of 22 to 29 to die annually in cities. In smaller
cities and towns, such as Norwich and Northampton, the general average of
deaths is 1 of 24 to 26; but in several provinces and healthy country
villages, 1 of 32 and 33, up to 45, 50, and even 60, is the annual drain: 1 of
43 to 50 was the average in upwards of a thousand country parishes on the
continent; and recorded in Susmilch. Within the above short intervals of
time, there will have died in the respective cities and country places
enumerated, a number equal to the whole inhabitants. But the annual
decrease of the oppressed Negroes, in the West India islands, is estimated at
1 of 7.
The ancient Egyptians allotted 3 generations to a century, which is
bordering upon the truth; at this day, 1 of 32 and 33 up to 35, is near the
measure of a generation, and to the general decrease of a community
throughout Europe, comprehending all the inhabitants in city, village, and
country: that is, mankind share amongst them from about 32 and 33 to 35
years each of existence: and within this fugitive interval of time, a number
equal to all the present inhabitants of this island, or of the whole earth, will
Page 37
be exterminated. If we extend this estimate to the whole human race, eight
hundred million will die in 33 years; about twenty-eight million annually;
seventy or eighty thousand daily; about three thousand hourly; and from
fifty to sixty every minute. It is perhaps superfluous to add, that, in the same
intervals, an equal or superior number will be born.
According to De Moivre and Dr. Price, “the probabilities or expectation of
life, decrease as we advance from childhood to old age, in an arithmetical
progression; that is, in such a manner that the difference is always the same
between the number of persons living at the beginning of any one year, and
the number living at the beginning of the following year.” Or, in other
words, less enveloped in mathematical obscurity, out of any specified
number, an hundred or a thousand, the same proportion will continue to die
every year until near 80 years of age and upwards: consequently, the
probabilities of life are constantly decreasing; because notwithstanding the
progressive annual drain from the capitals, yet the deaths continue
throughout equal. But this proportion is certainly erroneous in the first
stages of life, and until about 10. View the above proposition in another
light.
From any given number there will be an equal drain annually, until what De
Moivre terms the complement or maximum, or utmost probable extreme of
life, which he fixes at 86, all are dead. The probability, therefore, that the
whole of any limited number whatsoever, or age, will all be exterminated is
the number of years between 86 and the year such a number are all alive. Of
56 persons alive at 30, they should all be dead in 56 years, because 56
added to 30 amounts to 86, the maximum: of 46 persons alive at 40 years of
age, they should all be dead in 46 years: and 36 persons alive at 50 years of
age, should be dead in 36 years; for 50 and 36 complete the maximum.
Again, the expectation of any single life is only half the maximum or
complement, or half the space between that age and the ultimate term of
existence: but here we must repeat the former exception, and draw the line
after 10 years of age. The expectation of two equal joint lives, according to
De Moivre, is one third of the complement of life. Example: two lives, aged
40, have an even chance or probable prospect of continuing together in
exigence only 15 years; which is the third of the complement, reckoning
from 40 to 86: the expectation of the survivor is also 15. Or, suppose a lot
of marriages of persons at 40 years of age, they will, on an average,
hundred million will die in 33 years; about twenty-eight million annually;
seventy or eighty thousand daily; about three thousand hourly; and from
fifty to sixty every minute. It is perhaps superfluous to add, that, in the same
intervals, an equal or superior number will be born.
According to De Moivre and Dr. Price, “the probabilities or expectation of
life, decrease as we advance from childhood to old age, in an arithmetical
progression; that is, in such a manner that the difference is always the same
between the number of persons living at the beginning of any one year, and
the number living at the beginning of the following year.” Or, in other
words, less enveloped in mathematical obscurity, out of any specified
number, an hundred or a thousand, the same proportion will continue to die
every year until near 80 years of age and upwards: consequently, the
probabilities of life are constantly decreasing; because notwithstanding the
progressive annual drain from the capitals, yet the deaths continue
throughout equal. But this proportion is certainly erroneous in the first
stages of life, and until about 10. View the above proposition in another
light.
From any given number there will be an equal drain annually, until what De
Moivre terms the complement or maximum, or utmost probable extreme of
life, which he fixes at 86, all are dead. The probability, therefore, that the
whole of any limited number whatsoever, or age, will all be exterminated is
the number of years between 86 and the year such a number are all alive. Of
56 persons alive at 30, they should all be dead in 56 years, because 56
added to 30 amounts to 86, the maximum: of 46 persons alive at 40 years of
age, they should all be dead in 46 years: and 36 persons alive at 50 years of
age, should be dead in 36 years; for 50 and 36 complete the maximum.
Again, the expectation of any single life is only half the maximum or
complement, or half the space between that age and the ultimate term of
existence: but here we must repeat the former exception, and draw the line
after 10 years of age. The expectation of two equal joint lives, according to
De Moivre, is one third of the complement of life. Example: two lives, aged
40, have an even chance or probable prospect of continuing together in
exigence only 15 years; which is the third of the complement, reckoning
from 40 to 86: the expectation of the survivor is also 15. Or, suppose a lot
of marriages of persons at 40 years of age, they will, on an average,
Page 38
continue together 15½ years; and the survivors the same time after. This
expectation, therefore, is the probable duration of each marriage, and the
share of each person’s life. But it may be proper to add, that the duration of
marriages, and the value of single and joint lives, will, on a promiscuous
calculation, be different from the registers of annuitant and insurance
offices; because they are scrupulously vigilant to exclude all diseased and
unhealthy persons from becoming members.
The following Chart and Tables, present a distinct prospect of the fates
clipping the mortal thread, from birth to old age, in city and country. But we
are not to suppose that in every instance there will be annually a regular
arithmetical diminution, as marked in the different tables: some years will
be more fatal than others; and we are to form estimates from an average of
several years. The first column points out the age, the second the number
living at that age, the third the number who die during the year; and so on to
the end of the table. But observe, that the number of infants, at the
beginning of the second column, are supposed to be all born together on the
first day of that year; and this rule applies throughout all the remaining
ages. The two short tables of 15 and 30 years mortality in London,
demonstrate the gradations at longer intervals than a single year. From these
different tables may be estimated the annual waste, out of any specified
number, at all ages, the ultimate prospects of existence, and the odds or
probability of a person in health surviving a stated number of years.
A GENERAL CHART, with different Tables,
Exhibiting the Gradations of Mortality in City and Country.
Shewing the Probability of the Duration of Life in London, deduced by Mr.
Simpson, from Observations on the Bills of Mortality in London for
Ten Years, from 1728 to 1737. The total Number of Inhabitants,
probably, about 650,000 in Winter. One Half born died under Three
Years of Age.
Ages. Persons living. Decr. of life.
0 1000 320
1 680 133
2 547 51
3 496 27
expectation, therefore, is the probable duration of each marriage, and the
share of each person’s life. But it may be proper to add, that the duration of
marriages, and the value of single and joint lives, will, on a promiscuous
calculation, be different from the registers of annuitant and insurance
offices; because they are scrupulously vigilant to exclude all diseased and
unhealthy persons from becoming members.
The following Chart and Tables, present a distinct prospect of the fates
clipping the mortal thread, from birth to old age, in city and country. But we
are not to suppose that in every instance there will be annually a regular
arithmetical diminution, as marked in the different tables: some years will
be more fatal than others; and we are to form estimates from an average of
several years. The first column points out the age, the second the number
living at that age, the third the number who die during the year; and so on to
the end of the table. But observe, that the number of infants, at the
beginning of the second column, are supposed to be all born together on the
first day of that year; and this rule applies throughout all the remaining
ages. The two short tables of 15 and 30 years mortality in London,
demonstrate the gradations at longer intervals than a single year. From these
different tables may be estimated the annual waste, out of any specified
number, at all ages, the ultimate prospects of existence, and the odds or
probability of a person in health surviving a stated number of years.
A GENERAL CHART, with different Tables,
Exhibiting the Gradations of Mortality in City and Country.
Shewing the Probability of the Duration of Life in London, deduced by Mr.
Simpson, from Observations on the Bills of Mortality in London for
Ten Years, from 1728 to 1737. The total Number of Inhabitants,
probably, about 650,000 in Winter. One Half born died under Three
Years of Age.
Ages. Persons living. Decr. of life.
0 1000 320
1 680 133
2 547 51
3 496 27
Page 39
4 469 17
5 452 12
6 440 10
7 430 8
8 422 7
9 415 5
10 410 5
11 405 5
12 400 5
13 395 5
14 390 5
15 385 5
16 380 5
17 375 5
18 370 5
19 365 5
20 360 5
21 355 5
22 350 5
23 345 6
24 339 6
25 333 6
26 327 6
27 321 6
28 315 7
29 308 7
30 301 7
31 294 7
32 287 7
33 280 7
34 273 7
35 266 7
36 259 7
37 252 7
5 452 12
6 440 10
7 430 8
8 422 7
9 415 5
10 410 5
11 405 5
12 400 5
13 395 5
14 390 5
15 385 5
16 380 5
17 375 5
18 370 5
19 365 5
20 360 5
21 355 5
22 350 5
23 345 6
24 339 6
25 333 6
26 327 6
27 321 6
28 315 7
29 308 7
30 301 7
31 294 7
32 287 7
33 280 7
34 273 7
35 266 7
36 259 7
37 252 7
Page 40
38 245 8
39 237 8
40 229 7
41 222 8
42 214 8
43 206 7
44 199 7
45 192 7
46 185 7
47 178 7
48 171 6
49 165 6
50 159 6
51 153 6
52 147 6
53 141 6
54 135 6
55 129 6
56 123 6
57 117 5
58 112 5
59 107 5
60 102 5
61 97 5
62 92 5
63 87 5
64 82 5
65 77 5
66 72 5
67 67 5
68 62 4
69 58 4
70 54 4
71 50 4
39 237 8
40 229 7
41 222 8
42 214 8
43 206 7
44 199 7
45 192 7
46 185 7
47 178 7
48 171 6
49 165 6
50 159 6
51 153 6
52 147 6
53 141 6
54 135 6
55 129 6
56 123 6
57 117 5
58 112 5
59 107 5
60 102 5
61 97 5
62 92 5
63 87 5
64 82 5
65 77 5
66 72 5
67 67 5
68 62 4
69 58 4
70 54 4
71 50 4
Page 41
72 46 4
73 42 3
74 39 3
75 36 3
76 33 3
77 30 3
78 27 2
79 25
Shewing the Probabilities of Life in London for all Ages. Formed from the
Bills for Ten Years, from 1759 to 1768. By Dr. Price.
Ages. Persons living. Decr. of life.
0 1518 486
1 1032 200
2 832 85
3 747 59
4 688 42
5 646 23
6 623 20
7 603 14
8 589 12
9 577 10
10 567 9
11 558 9
12 549 8
13 541 7
14 534 6
15 528 6
16 522 7
17 515 7
18 508 7
19 501 7
20 494 7
73 42 3
74 39 3
75 36 3
76 33 3
77 30 3
78 27 2
79 25
Shewing the Probabilities of Life in London for all Ages. Formed from the
Bills for Ten Years, from 1759 to 1768. By Dr. Price.
Ages. Persons living. Decr. of life.
0 1518 486
1 1032 200
2 832 85
3 747 59
4 688 42
5 646 23
6 623 20
7 603 14
8 589 12
9 577 10
10 567 9
11 558 9
12 549 8
13 541 7
14 534 6
15 528 6
16 522 7
17 515 7
18 508 7
19 501 7
20 494 7
Page 42
21 487 8
22 479 8
23 471 8
24 463 8
25 455 8
26 447 8
27 439 8
28 431 9
29 422 9
30 413 9
31 404 9
32 395 9
33 386 9
34 377 9
35 368 9
36 359 9
37 350 9
38 341 9
39 332 10
40 322 10
41 312 10
42 302 10
43 292 10
44 282 10
45 272 10
46 262 10
47 252 10
48 242 9
49 233 9
50 224 9
51 215 9
52 206 8
53 198 8
54 190 7
22 479 8
23 471 8
24 463 8
25 455 8
26 447 8
27 439 8
28 431 9
29 422 9
30 413 9
31 404 9
32 395 9
33 386 9
34 377 9
35 368 9
36 359 9
37 350 9
38 341 9
39 332 10
40 322 10
41 312 10
42 302 10
43 292 10
44 282 10
45 272 10
46 262 10
47 252 10
48 242 9
49 233 9
50 224 9
51 215 9
52 206 8
53 198 8
54 190 7
Page 43
55 183 7
56 176 7
57 169 7
58 162 7
59 155 8
60 147 8
61 139 7
62 132 7
63 125 7
64 118 7
65 111 7
66 104 7
67 97 7
68 90 7
69 83 7
70 76 6
71 70 6
72 64 6
73 58 5
74 53 5
75 48 5
76 43 5
77 38 5
78 33 4
79 29 4
80 25 3
81 22 3
82 19 3
83 16 3
84 13 2
85 11 2
86 9 2
87 7 2
88 5 1
56 176 7
57 169 7
58 162 7
59 155 8
60 147 8
61 139 7
62 132 7
63 125 7
64 118 7
65 111 7
66 104 7
67 97 7
68 90 7
69 83 7
70 76 6
71 70 6
72 64 6
73 58 5
74 53 5
75 48 5
76 43 5
77 38 5
78 33 4
79 29 4
80 25 3
81 22 3
82 19 3
83 16 3
84 13 2
85 11 2
86 9 2
87 7 2
88 5 1
Page 44
89 4 1
90 3 1
Shewing the Probabilities of Life at Vienna. Formed from the Bills for
Eight Years, as given by Mr. Susmilch, in his Gottliche Ordnung.
Contains upwards of 200,000 Inhabitants. One Half born died under
Three Years of Age.
Ages. Persons living. Decr. of life.
0 1495 682
1 813 107
2 706 61
3 645 46
4 599 33
5 566 30
6 536 20
7 516 11
8 505 9
9 496 7
10 489 6
11 483 5
12 478 5
13 473 6
14 467 6
15 461 6
16 455 7
17 448 6
18 442 6
19 436 6
20 430 5
21 425 5
22 420 5
23 415 6
24 409 6
90 3 1
Shewing the Probabilities of Life at Vienna. Formed from the Bills for
Eight Years, as given by Mr. Susmilch, in his Gottliche Ordnung.
Contains upwards of 200,000 Inhabitants. One Half born died under
Three Years of Age.
Ages. Persons living. Decr. of life.
0 1495 682
1 813 107
2 706 61
3 645 46
4 599 33
5 566 30
6 536 20
7 516 11
8 505 9
9 496 7
10 489 6
11 483 5
12 478 5
13 473 6
14 467 6
15 461 6
16 455 7
17 448 6
18 442 6
19 436 6
20 430 5
21 425 5
22 420 5
23 415 6
24 409 6
Page 45
25 403 6
26 397 6
27 391 7
28 384 7
29 377 7
30 370 6
31 364 6
32 358 5
33 353 6
34 347 7
35 340 8
36 332 8
37 324 8
38 316 9
39 307 9
40 298 8
41 290 7
42 283 6
43 277 6
44 271 7
45 264 8
46 256 9
47 247 9
48 238 9
49 229 9
50 220 8
51 212 7
52 205 7
53 198 7
54 191 7
55 184 8
56 176 8
57 168 9
58 159 8
26 397 6
27 391 7
28 384 7
29 377 7
30 370 6
31 364 6
32 358 5
33 353 6
34 347 7
35 340 8
36 332 8
37 324 8
38 316 9
39 307 9
40 298 8
41 290 7
42 283 6
43 277 6
44 271 7
45 264 8
46 256 9
47 247 9
48 238 9
49 229 9
50 220 8
51 212 7
52 205 7
53 198 7
54 191 7
55 184 8
56 176 8
57 168 9
58 159 8
Page 46
59 151 8
60 143 7
61 136 7
62 129 6
63 123 7
64 116 7
65 109 8
66 101 8
67 93 8
68 85 7
69 78 7
70 71 6
71 65 5
72 60 5
73 55 4
74 51 4
75 47 5
76 42 5
77 37 5
78 32 5
79 27 4
80 23 3
81 20 2
82 18 2
83 16 2
84 14 2
85 12 2
86 10 2
87 8 2
88 6 2
89 4 1
90 3 1
91 2 1
92 1 1
60 143 7
61 136 7
62 129 6
63 123 7
64 116 7
65 109 8
66 101 8
67 93 8
68 85 7
69 78 7
70 71 6
71 65 5
72 60 5
73 55 4
74 51 4
75 47 5
76 42 5
77 37 5
78 32 5
79 27 4
80 23 3
81 20 2
82 18 2
83 16 2
84 14 2
85 12 2
86 10 2
87 8 2
88 6 2
89 4 1
90 3 1
91 2 1
92 1 1
Page 47
Shewing the Probabilities of Life at Berlin. Formed from the Bills from
Four Years, from 1752 to 1755. Given by Mr. Susmilch, in his
Gottliche Ordnung. Contains 134,000 Inhabitants. Half die under
Three Years of Age.
Ages. Persons living. Decr. of life.
0 1427 524
1 903 151
2 752 61
3 691 73
4 618 45
5 573 21
6 552 16
7 536 13
8 523 9
9 514 7
10 507 5
11 502 4
12 498 4
13 494 4
14 490 4
15 486 4
16 482 5
17 477 5
18 472 5
19 467 6
20 461 6
21 455 6
22 449 6
23 443 7
24 436 8
25 428 7
26 421 9
27 412 9
28 403 9
Four Years, from 1752 to 1755. Given by Mr. Susmilch, in his
Gottliche Ordnung. Contains 134,000 Inhabitants. Half die under
Three Years of Age.
Ages. Persons living. Decr. of life.
0 1427 524
1 903 151
2 752 61
3 691 73
4 618 45
5 573 21
6 552 16
7 536 13
8 523 9
9 514 7
10 507 5
11 502 4
12 498 4
13 494 4
14 490 4
15 486 4
16 482 5
17 477 5
18 472 5
19 467 6
20 461 6
21 455 6
22 449 6
23 443 7
24 436 8
25 428 7
26 421 9
27 412 9
28 403 9
Page 48
29 394 9
30 385 9
31 376 8
32 368 7
33 361 7
34 354 7
35 347 8
36 339 9
37 330 10
33 320 10
39 310 10
40 300 10
41 290 9
42 281 8
43 273 7
44 266 7
45 259 7
46 252 7
47 245 7
48 238 7
49 231 7
50 224 7
51 217 7
52 210 7
53 203 8
54 195 8
55 187 8
56 179 8
57 171 8
58 163 9
59 154 9
60 145 8
61 137 7
62 130 6
30 385 9
31 376 8
32 368 7
33 361 7
34 354 7
35 347 8
36 339 9
37 330 10
33 320 10
39 310 10
40 300 10
41 290 9
42 281 8
43 273 7
44 266 7
45 259 7
46 252 7
47 245 7
48 238 7
49 231 7
50 224 7
51 217 7
52 210 7
53 203 8
54 195 8
55 187 8
56 179 8
57 171 8
58 163 9
59 154 9
60 145 8
61 137 7
62 130 6
Page 49
63 124 6
64 118 6
65 112 6
66 106 7
67 99 7
68 92 6
69 86 6
70 80 6
71 74 6
72 68 6
73 62 5
74 57 5
75 52 5
76 47 5
77 42 5
78 37 5
79 32 4
80 28 4
81 24 3
82 21 2
83 19 2
84 17 2
85 15 2
86 13 2
87 11 2
88 9 2
89 7 1
90 6 1
91 5 1
92 4 1
Dr. Short’s Table, from January 1st, 1728, to 1743; a Period of Fifteen
Years. Died by the London Bills, at all Ages, taken at an Annual
64 118 6
65 112 6
66 106 7
67 99 7
68 92 6
69 86 6
70 80 6
71 74 6
72 68 6
73 62 5
74 57 5
75 52 5
76 47 5
77 42 5
78 37 5
79 32 4
80 28 4
81 24 3
82 21 2
83 19 2
84 17 2
85 15 2
86 13 2
87 11 2
88 9 2
89 7 1
90 6 1
91 5 1
92 4 1
Dr. Short’s Table, from January 1st, 1728, to 1743; a Period of Fifteen
Years. Died by the London Bills, at all Ages, taken at an Annual
Page 50
Medium, in the following Proportions.
Years of Age. Died.
Under ——— 2 9910
{2 to 5 2411
{5 ——— 10 980
{10 ——— 20 851
{20 ——— 30 2060
{30 ——— 40 2471
From {40 ——— 50 2510
{50 ——— 60 2231
{60 ——— 70 1675
{70 ——— 80 1200
{80 ——— 90 634
{90 ——— 100 117
———
Total Annual Medium of Deaths in this Period }—27,058
A Table of Thirty Years, taken from the London Bills, beginning with 1728,
and ending with 1757; shewing the Total Number of Deaths and
Decrease in this Period, at every Age.
Years of Age. Died.
Under ——— 2 272903
{2 to 5 64745
{ 5 ——— 10 25912
{ 10 ——— 20 22891
{ 20 ——— 30 58474
{ 30 ——— 40 71502
From { 40 ——— 50 73258
{ 50 ——— 60 59872
{ 60 ——— 70 47269
{ 70 ——— 80 33679
{ 80 ——— 90 16948
Years of Age. Died.
Under ——— 2 9910
{2 to 5 2411
{5 ——— 10 980
{10 ——— 20 851
{20 ——— 30 2060
{30 ——— 40 2471
From {40 ——— 50 2510
{50 ——— 60 2231
{60 ——— 70 1675
{70 ——— 80 1200
{80 ——— 90 634
{90 ——— 100 117
———
Total Annual Medium of Deaths in this Period }—27,058
A Table of Thirty Years, taken from the London Bills, beginning with 1728,
and ending with 1757; shewing the Total Number of Deaths and
Decrease in this Period, at every Age.
Years of Age. Died.
Under ——— 2 272903
{2 to 5 64745
{ 5 ——— 10 25912
{ 10 ——— 20 22891
{ 20 ——— 30 58474
{ 30 ——— 40 71502
From { 40 ——— 50 73258
{ 50 ——— 60 59872
{ 60 ——— 70 47269
{ 70 ——— 80 33679
{ 80 ——— 90 16948
Page 51
{ 90 ——— 100 2496
{100 ——— 138 242
———
Total Deaths in this Period, at all Ages } 750,191
Shewing the Probabilities of Life in a Country Parish in Brandenburg.
Formed from the Bills for Fifty Years, from 1710 to 1759, as given by
Mr. Susmilch, in his Gottliche Ordnung. One Half born lived to 25
Years of Age.
Ages. Persons living. Decr. of life.
0 1000 225
1 775 57
2 718 31
3 687 23
4 664 22
5 642 20
6 622 15
7 607 12
8 595 10
9 585 8
10 577 7
11 570 6
12 564 5
13 559 5
14 554 5
15 549 5
16 544 5
17 539 4
18 535 4
19 531 4
20 527 5
21 522 5
22 517 5
{100 ——— 138 242
———
Total Deaths in this Period, at all Ages } 750,191
Shewing the Probabilities of Life in a Country Parish in Brandenburg.
Formed from the Bills for Fifty Years, from 1710 to 1759, as given by
Mr. Susmilch, in his Gottliche Ordnung. One Half born lived to 25
Years of Age.
Ages. Persons living. Decr. of life.
0 1000 225
1 775 57
2 718 31
3 687 23
4 664 22
5 642 20
6 622 15
7 607 12
8 595 10
9 585 8
10 577 7
11 570 6
12 564 5
13 559 5
14 554 5
15 549 5
16 544 5
17 539 4
18 535 4
19 531 4
20 527 5
21 522 5
22 517 5
Page 52
23 512 5
24 507 5
25 502 4
26 498 3
27 495 3
28 492 3
29 489 3
30 486 4
31 482 5
32 477 5
33 472 5
34 467 5
35 462 6
36 456 6
37 450 6
38 444 6
39 438 6
40 432 5
41 427 5
42 422 5
43 417 5
44 412 6
45 406 6
46 400 6
47 394 6
48 388 7
49 381 7
50 374 7
51 367 8
52 359 8
53 351 8
54 343 9
55 334 10
56 324 10
24 507 5
25 502 4
26 498 3
27 495 3
28 492 3
29 489 3
30 486 4
31 482 5
32 477 5
33 472 5
34 467 5
35 462 6
36 456 6
37 450 6
38 444 6
39 438 6
40 432 5
41 427 5
42 422 5
43 417 5
44 412 6
45 406 6
46 400 6
47 394 6
48 388 7
49 381 7
50 374 7
51 367 8
52 359 8
53 351 8
54 343 9
55 334 10
56 324 10
Page 53
57 314 10
58 304 11
59 293 11
60 282 11
61 271 11
62 260 12
63 248 12
64 236 12
65 224 11
66 213 11
67 202 12
68 190 12
69 178 12
70 166 13
71 153 15
72 138 16
73 122 15
74 107 14
75 93 13
76 80 12
77 68 9
78 59 8
79 51 7
80 44 6
81 38 6
82 32 6
83 26 6
84 20 5
85 15 4
86 11 3
87 8 2
88 6 2
89 4 1
90 3 1
58 304 11
59 293 11
60 282 11
61 271 11
62 260 12
63 248 12
64 236 12
65 224 11
66 213 11
67 202 12
68 190 12
69 178 12
70 166 13
71 153 15
72 138 16
73 122 15
74 107 14
75 93 13
76 80 12
77 68 9
78 59 8
79 51 7
80 44 6
81 38 6
82 32 6
83 26 6
84 20 5
85 15 4
86 11 3
87 8 2
88 6 2
89 4 1
90 3 1
Page 54
91 2 1
92 1 1
Shewing the Probabilities of Life in the Parish of Holy Cross, near
Shrewsbury, in England. Formed from a Register kept by the Rev. Mr.
Gorsuch for Twenty Years, from 1750 to 1770. One Half born lived to
27 Years of Age.
Ages. Persons living. Decr. of life.
0 1000 189
1 811 49
2 762 45
3 717 35
4 682 23
5 659 23
6 636 18
7 618 14
8 604 9
9 595 6
10 589 4
11 585 4
12 581 4
13 577 4
14 573 4
15 569 4
16 565 5
17 560 5
18 555 5
19 550 5
20 545 6
21 539 7
22 532 7
23 525 7
24 518 6
92 1 1
Shewing the Probabilities of Life in the Parish of Holy Cross, near
Shrewsbury, in England. Formed from a Register kept by the Rev. Mr.
Gorsuch for Twenty Years, from 1750 to 1770. One Half born lived to
27 Years of Age.
Ages. Persons living. Decr. of life.
0 1000 189
1 811 49
2 762 45
3 717 35
4 682 23
5 659 23
6 636 18
7 618 14
8 604 9
9 595 6
10 589 4
11 585 4
12 581 4
13 577 4
14 573 4
15 569 4
16 565 5
17 560 5
18 555 5
19 550 5
20 545 6
21 539 7
22 532 7
23 525 7
24 518 6
Page 55
25 512 6
26 506 5
27 501 5
28 496 5
29 491 5
30 486 5
31 481 5
32 476 5
33 471 5
34 466 6
35 460 6
36 454 7
37 447 7
38 440 7
39 433 7
40 426 8
41 418 8
42 410 9
43 401 8
44 393 7
45 386 7
46 379 7
47 372 7
48 365 6
49 359 6
50 353 6
51 347 7
52 340 7
53 333 7
54 326 8
55 318 8
56 310 9
57 301 9
58 292 9
26 506 5
27 501 5
28 496 5
29 491 5
30 486 5
31 481 5
32 476 5
33 471 5
34 466 6
35 460 6
36 454 7
37 447 7
38 440 7
39 433 7
40 426 8
41 418 8
42 410 9
43 401 8
44 393 7
45 386 7
46 379 7
47 372 7
48 365 6
49 359 6
50 353 6
51 347 7
52 340 7
53 333 7
54 326 8
55 318 8
56 310 9
57 301 9
58 292 9
Page 56
59 283 10
60 273 10
61 263 10
62 253 10
63 243 10
64 233 10
65 223 10
66 213 10
67 203 10
68 193 11
69 182 11
70 171 10
71 161 10
72 151 9
73 142 8
74 134 8
75 126 7
76 119 7
77 112 7
78 105 7
79 98 8
80 90 9
81 81 10
82 71 10
83 61 10
84 51 10
85 41 9
86 32 8
87 24 7
88 17 6
89 11 4
90 7 2
91 5 1
92 4 1
60 273 10
61 263 10
62 253 10
63 243 10
64 233 10
65 223 10
66 213 10
67 203 10
68 193 11
69 182 11
70 171 10
71 161 10
72 151 9
73 142 8
74 134 8
75 126 7
76 119 7
77 112 7
78 105 7
79 98 8
80 90 9
81 81 10
82 71 10
83 61 10
84 51 10
85 41 9
86 32 8
87 24 7
88 17 6
89 11 4
90 7 2
91 5 1
92 4 1
Page 57
Shewing the Probabilities of Life in the Country District of Vaud, in
Switzerland, from the Registers of Forty-three Parishes. Given by Mr.
Muret, in the First Part of the Bern Memoirs for the Year 1766. In this
Country Province were 112,951 Inhabitants; and one Half born lived to
the Age of 41.
Switzerland, from the Registers of Forty-three Parishes. Given by Mr.
Muret, in the First Part of the Bern Memoirs for the Year 1766. In this
Country Province were 112,951 Inhabitants; and one Half born lived to
the Age of 41.
Page 58
Ages. Persons living. Decr. of life.
0 1000 189
1 811 46
2 765 30
3 735 20
4 715 14
5 701 13
6 688 11
7 677 10
8 667 8
9 659 6
10 653 5
11 648 5
12 643 4
13 639 4
14 635 4
15 631 5
16 626 4
17 622 4
18 618 4
19 614 4
20 610 4
21 606 4
22 602 5
23 597 5
24 592 5
25 587 5
26 582 5
27 577 5
28 572 5
29 567 4
30 563 5
31 558 5
32 553 5
0 1000 189
1 811 46
2 765 30
3 735 20
4 715 14
5 701 13
6 688 11
7 677 10
8 667 8
9 659 6
10 653 5
11 648 5
12 643 4
13 639 4
14 635 4
15 631 5
16 626 4
17 622 4
18 618 4
19 614 4
20 610 4
21 606 4
22 602 5
23 597 5
24 592 5
25 587 5
26 582 5
27 577 5
28 572 5
29 567 4
30 563 5
31 558 5
32 553 5
Page 59
33 548 4
34 544 5
35 539 6
36 533 6
37 527 7
38 520 7
39 513 7
40 506 6
41 500 6
42 494 6
43 488 6
44 482 6
45 476 7
46 469 8
47 461 10
48 451 10
49 441 10
50 431 9
51 422 8
52 414 8
53 406 9
54 397 9
55 388 11
56 377 13
57 364 16
58 348 17
59 331 17
60 314 15
61 299 13
62 286 12
63 274 12
64 262 12
65 250 14
66 236 16
34 544 5
35 539 6
36 533 6
37 527 7
38 520 7
39 513 7
40 506 6
41 500 6
42 494 6
43 488 6
44 482 6
45 476 7
46 469 8
47 461 10
48 451 10
49 441 10
50 431 9
51 422 8
52 414 8
53 406 9
54 397 9
55 388 11
56 377 13
57 364 16
58 348 17
59 331 17
60 314 15
61 299 13
62 286 12
63 274 12
64 262 12
65 250 14
66 236 16
Page 60
67 220 18
68 202 18
69 184 16
70 168 15
71 153 13
72 140 11
73 129 10
74 119 10
75 109 11
76 98 13
77 85 14
78 71 13
79 58 12
80 46 10
81 36 7
82 29 5
83 24 4
84 20 3
85 17 3
86 14 3
87 11 2
88 9 2
89 7 2
90 5 1
The two following Tables are taken from Dr. Price. I have however omitted
the fractions, for reasons which shall be explained when treating of the
inaccuracy of the public registers. The expectations of life are here rated a
few years inferior to the standard of most other authors.
The probable Expectations or Prospects of Life in
Country Holy Cross, Pais de
Ages. London. Vienna. Berlin. parish of near Vaud, in
Brandenburg. Shrewsbury. Switzerland.
At birth 18 yrs. 17 yrs. 18 yrs. 33 yrs. 33 yrs. 37 yrs.
68 202 18
69 184 16
70 168 15
71 153 13
72 140 11
73 129 10
74 119 10
75 109 11
76 98 13
77 85 14
78 71 13
79 58 12
80 46 10
81 36 7
82 29 5
83 24 4
84 20 3
85 17 3
86 14 3
87 11 2
88 9 2
89 7 2
90 5 1
The two following Tables are taken from Dr. Price. I have however omitted
the fractions, for reasons which shall be explained when treating of the
inaccuracy of the public registers. The expectations of life are here rated a
few years inferior to the standard of most other authors.
The probable Expectations or Prospects of Life in
Country Holy Cross, Pais de
Ages. London. Vienna. Berlin. parish of near Vaud, in
Brandenburg. Shrewsbury. Switzerland.
At birth 18 yrs. 17 yrs. 18 yrs. 33 yrs. 33 yrs. 37 yrs.
Page 61
Age 12 34 36 36 44 44 44
25 26 28 27 36 35 35
30 24 26 25 32 32 31
35 22 23 24 26 28 28
40 20 21 21 25 26 24
45 18 18 19 22 23 21
50 16 16 16 18 20 18
55 14 14 14 15 17 15
60 13 12 13 12 15 12
65 11 10 11 10 12 10
70 9 9 9 8 10 8
75 7 7 7 6 8 6
80 5 6 6 5 5 5
The Odds or Probability of living one Year in
Country Holy Cross, Pais de
Ages. London. Vienna. Berlin. parish of near Vaud, in
Brandenburg. Shrewsbury. Switzerland.
At
2 to 1 2 to 1 2 to 1 4 to 1 5 to 1 5 to 1
birth
Age 12 75 to 1 84 to 1 123 to 1 112 to 1 144 to 1 160 to 1
25 56 to 1 66 to 1 50 to 1 110 to 1 100 to 1 117 to 1
30 45 to 1 56 to 1 44 to 1 107 to 1 96 to 1 111 to 1
40 31 to 1 36 to 1 32 to 1 78 to 1 55 to 1 83 to 1
50 24 to 1 27 to 1 30 to 1 50 to 1 50 to 1 49 to 1
60 18 to 1 19 to 1 18 to 1 25 to 1 26 to 1 23 to 1
70 12 to 1 11 to 1 12 to 1 11 to 1 16 to 1 10 to 1
80 7 to 1 7 to 1 7 to 1 6 to 1 8 to 1 4 to 1
Having in the preceding part endeavoured to establish the mortality of the
human species at different ages, I am now to attempt a more arduous task;
to ascertain the mortality by different diseases. I propose therefore, in
imitation of the geographers, to spread out and to review, in one general
Chart, the enormous host of diseases which disgorge their virulence over
the earth, and, with frightful rapacity, wage incessant hostilities with
25 26 28 27 36 35 35
30 24 26 25 32 32 31
35 22 23 24 26 28 28
40 20 21 21 25 26 24
45 18 18 19 22 23 21
50 16 16 16 18 20 18
55 14 14 14 15 17 15
60 13 12 13 12 15 12
65 11 10 11 10 12 10
70 9 9 9 8 10 8
75 7 7 7 6 8 6
80 5 6 6 5 5 5
The Odds or Probability of living one Year in
Country Holy Cross, Pais de
Ages. London. Vienna. Berlin. parish of near Vaud, in
Brandenburg. Shrewsbury. Switzerland.
At
2 to 1 2 to 1 2 to 1 4 to 1 5 to 1 5 to 1
birth
Age 12 75 to 1 84 to 1 123 to 1 112 to 1 144 to 1 160 to 1
25 56 to 1 66 to 1 50 to 1 110 to 1 100 to 1 117 to 1
30 45 to 1 56 to 1 44 to 1 107 to 1 96 to 1 111 to 1
40 31 to 1 36 to 1 32 to 1 78 to 1 55 to 1 83 to 1
50 24 to 1 27 to 1 30 to 1 50 to 1 50 to 1 49 to 1
60 18 to 1 19 to 1 18 to 1 25 to 1 26 to 1 23 to 1
70 12 to 1 11 to 1 12 to 1 11 to 1 16 to 1 10 to 1
80 7 to 1 7 to 1 7 to 1 6 to 1 8 to 1 4 to 1
Having in the preceding part endeavoured to establish the mortality of the
human species at different ages, I am now to attempt a more arduous task;
to ascertain the mortality by different diseases. I propose therefore, in
imitation of the geographers, to spread out and to review, in one general
Chart, the enormous host of diseases which disgorge their virulence over
the earth, and, with frightful rapacity, wage incessant hostilities with
Page 62
mankind. By this means, we shall, to use a military phrase, reconnoitre
more distinctly our enemies arranged in hostile front; and be warned to
make the best disposition and preparation for defence where the greatest
danger is apprehended, and the most formidable assaults to be sustained.
Armed with diseases, the grim King of Terrors appears in the most hideous
aspect. Under all these predatory disguises and morbifick forms, I shall
track him grappling with mankind, and with his tremendous scythe mowing
down generations. The learned Sauvages thus expresses himself: “Utinam
numerus respectivus diversorum morborum a nostratibus inquirarentur.” It
is, in some measure, from ignorance in this subject, that the streams of
medical inquiries, of academick rudiments, and of charitable donations to
poverty in disease, have not yet been pointedly directed to publick utility.
I could easily have exhibited tables of the Diseases and Casualties in
London during the greater part of the last century. But, compared to its
present magnitude, the British metropolis was then insignificant in size: 23
new parishes have been since gradually added to the London bills: there is
also a chasm of 10 years in which the registers are lost. Again, until 1665
and 6, London was infested with the plague; which disease, previous to that
date, seems to have been one primary object of the registers: and to adopt
Graunt and Short’s sentiments, these records, from various political and
religious obstacles, were then very negligently managed. During the early
part of this interval, the kingdom was distracted with civil war; and after the
great pestilence in 1665, London must have required some years to recruit.
Besides, had I attempted to form tables for even the latter part of the last
century, the reader would have been fruitlesly embarrassed; and such an
attempt must ever prove abortive. For example, under one and the same
title, in the annual bills of mortality, are often confounded flox, small pox,
and measles: consumptions and tissick: cancer, canker, and thrush: wolf,
cancer, gangrene, and fistula: cancer, gangrene, fistula, and mortification:
gout and sciatica: vapours and water in the head: quinsey and thrush: teeth
and worms: sores, ulcers, bruised and broken limbs: cough, cold, and
chincough, &c. These are a few specimens of Nosological absurdity in the
superintendents of the publick registers.
Notwithstanding this rabble of diseases in commenting upon the London
bills and diseases of the present century, I constantly refer back, and
contrast them with the bills of the last thirty years of the preceding century;
more distinctly our enemies arranged in hostile front; and be warned to
make the best disposition and preparation for defence where the greatest
danger is apprehended, and the most formidable assaults to be sustained.
Armed with diseases, the grim King of Terrors appears in the most hideous
aspect. Under all these predatory disguises and morbifick forms, I shall
track him grappling with mankind, and with his tremendous scythe mowing
down generations. The learned Sauvages thus expresses himself: “Utinam
numerus respectivus diversorum morborum a nostratibus inquirarentur.” It
is, in some measure, from ignorance in this subject, that the streams of
medical inquiries, of academick rudiments, and of charitable donations to
poverty in disease, have not yet been pointedly directed to publick utility.
I could easily have exhibited tables of the Diseases and Casualties in
London during the greater part of the last century. But, compared to its
present magnitude, the British metropolis was then insignificant in size: 23
new parishes have been since gradually added to the London bills: there is
also a chasm of 10 years in which the registers are lost. Again, until 1665
and 6, London was infested with the plague; which disease, previous to that
date, seems to have been one primary object of the registers: and to adopt
Graunt and Short’s sentiments, these records, from various political and
religious obstacles, were then very negligently managed. During the early
part of this interval, the kingdom was distracted with civil war; and after the
great pestilence in 1665, London must have required some years to recruit.
Besides, had I attempted to form tables for even the latter part of the last
century, the reader would have been fruitlesly embarrassed; and such an
attempt must ever prove abortive. For example, under one and the same
title, in the annual bills of mortality, are often confounded flox, small pox,
and measles: consumptions and tissick: cancer, canker, and thrush: wolf,
cancer, gangrene, and fistula: cancer, gangrene, fistula, and mortification:
gout and sciatica: vapours and water in the head: quinsey and thrush: teeth
and worms: sores, ulcers, bruised and broken limbs: cough, cold, and
chincough, &c. These are a few specimens of Nosological absurdity in the
superintendents of the publick registers.
Notwithstanding this rabble of diseases in commenting upon the London
bills and diseases of the present century, I constantly refer back, and
contrast them with the bills of the last thirty years of the preceding century;
Page 63
so that, as near as the imperfection of the materials will admit, the mortality
and diseases of 105 years in London is presented at one view; and
comprehends the various acute and chronic diseases, by which about two
million and a half of the human species have been destroyed. The few
authors who have written on bills of mortality, have obscured their works in
a cloud of figures and calculation: the reader must have no small portion of
phlegm and resolution to follow them throughout with attention: they often
tax the memory and patience with a numerical superfluity, even to a
nuisance.
For the above, and many other reasons, I have compressed into one chart,
the London Diseases and Casualties of seventy-five years in the present
century: each disease and casualty arranged in a progressive series of fifteen
years mortality; in a fifth column is added together the mortality of the
preceding five divisions. During this period, London has been more
populous and stationary in numbers: and by this means, the actual and
comparative magnitude, rise, and declension of different diseases, will be
more conspicuous in each period or interval: and by measuring the
mortality with the population, we are enabled, with certain precautions and
exceptions, to make the diseases and casualties of London serve as a morbid
barometer to the whole nation. The important reason which determined me
in forming an arrangement of fifteen years, in preference to any other
number or period, was, that the annual havock by similar diseases and
casualties, throughout this and the neighbouring island, might be computed
with some probability by each fifteen years of the London bills; and thereby
to elicite a new, curious, and comprehensive proportion in medicine. For
instance, if we suppose the standing number, on an average, of the London
inhabitants at six hundred thousand; and the total inhabitants in Britain and
Ireland at nine million; and if the same diseases and casualties were equally
diffused and fatal to this whole community, then, in such case, the London
bills would serve as a scale or index of mortality to both kingdoms: as many
would die annually of every disease and casualty throughout nine million,
as are cut off in fifteen years in London; for six hundred thousand
multiplied by fifteen, amounts to nine million.
But to supply the probable deficiency in the annual mortality of London by
different diseases and casualties, we must make an addition to each of one
third or fourth. To the mortality of Small-Pox, in London, during fifteen
and diseases of 105 years in London is presented at one view; and
comprehends the various acute and chronic diseases, by which about two
million and a half of the human species have been destroyed. The few
authors who have written on bills of mortality, have obscured their works in
a cloud of figures and calculation: the reader must have no small portion of
phlegm and resolution to follow them throughout with attention: they often
tax the memory and patience with a numerical superfluity, even to a
nuisance.
For the above, and many other reasons, I have compressed into one chart,
the London Diseases and Casualties of seventy-five years in the present
century: each disease and casualty arranged in a progressive series of fifteen
years mortality; in a fifth column is added together the mortality of the
preceding five divisions. During this period, London has been more
populous and stationary in numbers: and by this means, the actual and
comparative magnitude, rise, and declension of different diseases, will be
more conspicuous in each period or interval: and by measuring the
mortality with the population, we are enabled, with certain precautions and
exceptions, to make the diseases and casualties of London serve as a morbid
barometer to the whole nation. The important reason which determined me
in forming an arrangement of fifteen years, in preference to any other
number or period, was, that the annual havock by similar diseases and
casualties, throughout this and the neighbouring island, might be computed
with some probability by each fifteen years of the London bills; and thereby
to elicite a new, curious, and comprehensive proportion in medicine. For
instance, if we suppose the standing number, on an average, of the London
inhabitants at six hundred thousand; and the total inhabitants in Britain and
Ireland at nine million; and if the same diseases and casualties were equally
diffused and fatal to this whole community, then, in such case, the London
bills would serve as a scale or index of mortality to both kingdoms: as many
would die annually of every disease and casualty throughout nine million,
as are cut off in fifteen years in London; for six hundred thousand
multiplied by fifteen, amounts to nine million.
But to supply the probable deficiency in the annual mortality of London by
different diseases and casualties, we must make an addition to each of one
third or fourth. To the mortality of Small-Pox, in London, during fifteen
Page 64
years, and rated at thirty thousand, we should add one third or fourth more
to raise it to its just standard; that is, to about thirty-eight thousand; which
would be the annual mortality amongst nine million in Britain and Ireland,
supposing small-pox equally universal, one time or other, and destructive.
By the same hypothesis, amongst two hundred million in Europe Variolous
mortality annually, would amount to four hundred thousand; and, amongst
eight hundred million; that is, the whole human race would exceed three
million annually. On this simple principle, a gross estimate may be formed
of the annual havock by every other disease and casualty; taking the
precaution, however, to attend to the subsequent criticisms on the London
bills.
Another curious corollary may be grounded on the above hypothesis; which
is, to form a probable conjecture of the numbers who are annually Sick, or
afflicted with different diseases. Example: if one of every seven die of the
Small Pox, and the variolous deaths throughout Britain and Ireland are rated
at thirty-eight thousand annually, this number, multiplied by seven, amounts
to two hundred and sixty-six thousand annually, infected with variolous
contagion. Apply the same rule to Childbed mortality; rate the annual
havock by parturition in the two islands at four thousand: it will hereafter be
shewn, that in London one of seventy-four women die in childbed: multiply
therefore 4,000 by 74, the product is 296,000, which, in reality, cannot be
very distant from the total annual procreation in both islands. And in these
two examples, I have suggested what may be termed an inverse proof of
both propositions. From these tables and commentaries, we are likewise
furnished with a key to the comparative mortality of each disease amongst a
community: whether its devastation is in the proportion of a fifth, tenth,
twentieth, or hundredth. Gentlemen who have not particularly attended to
the subject of morbid calculations (and very few of the medical profession
have) will, on better information, be astonished at the flagrant errors daily
committed by authors when treating of these topicks. Out of the many
examples which might be enumerated, I shall merely select one in proof.
Baron Dimsdale, in a Treatise on Inoculation, dedicated to the present
Empress of Russia, calculated that, at least, two million were annually
destroyed by Small Pox alone in the Russian empire; and it was not until
after the publication of my Observations on his different Inoculating
Essays, that this error and others were erased.
to raise it to its just standard; that is, to about thirty-eight thousand; which
would be the annual mortality amongst nine million in Britain and Ireland,
supposing small-pox equally universal, one time or other, and destructive.
By the same hypothesis, amongst two hundred million in Europe Variolous
mortality annually, would amount to four hundred thousand; and, amongst
eight hundred million; that is, the whole human race would exceed three
million annually. On this simple principle, a gross estimate may be formed
of the annual havock by every other disease and casualty; taking the
precaution, however, to attend to the subsequent criticisms on the London
bills.
Another curious corollary may be grounded on the above hypothesis; which
is, to form a probable conjecture of the numbers who are annually Sick, or
afflicted with different diseases. Example: if one of every seven die of the
Small Pox, and the variolous deaths throughout Britain and Ireland are rated
at thirty-eight thousand annually, this number, multiplied by seven, amounts
to two hundred and sixty-six thousand annually, infected with variolous
contagion. Apply the same rule to Childbed mortality; rate the annual
havock by parturition in the two islands at four thousand: it will hereafter be
shewn, that in London one of seventy-four women die in childbed: multiply
therefore 4,000 by 74, the product is 296,000, which, in reality, cannot be
very distant from the total annual procreation in both islands. And in these
two examples, I have suggested what may be termed an inverse proof of
both propositions. From these tables and commentaries, we are likewise
furnished with a key to the comparative mortality of each disease amongst a
community: whether its devastation is in the proportion of a fifth, tenth,
twentieth, or hundredth. Gentlemen who have not particularly attended to
the subject of morbid calculations (and very few of the medical profession
have) will, on better information, be astonished at the flagrant errors daily
committed by authors when treating of these topicks. Out of the many
examples which might be enumerated, I shall merely select one in proof.
Baron Dimsdale, in a Treatise on Inoculation, dedicated to the present
Empress of Russia, calculated that, at least, two million were annually
destroyed by Small Pox alone in the Russian empire; and it was not until
after the publication of my Observations on his different Inoculating
Essays, that this error and others were erased.
Page 65
I would request the reader’s particular attention to another circumstance:
which is, that on comparing the gradations of mortality in the following
chart, we are not to estimate the relative number, frequency, or proportion
of certain diseases, compared to others by the absolute mortality of each.
For instance, Apoplexy kills rather more annually in London than Measles;
but yet the latter disease is infinitely more universal and diffused amongst
the community, and consequently less dangerous to life: Cancerous and
Venereal cases are widely different in the annual number afflicted with
each, although the deaths are not far distant from an equality. The same
observations will apply to Rheumatism, compared to the Dropsy, and to
many other diseases.
There are between eighty and ninety diseases and casualties enumerated in
the London bills, which, in the subsequent comments, I have disentangled
into their separate genera. But, to prevent the possibility of aberration, after
the chart of London diseases, I have added a correct Medical Chart of all
the principal diseases and casualties with which mankind, in every part of
the earth and ocean, are afflicted or harrassed. This will operate as a check
and correction to the public registers; and by this, the defects and errors in
the London bills will be apparent; and it will serve as an index to our future
commentaries. But objections and difficulties occur in our researches for
collateral information and illustration from hospital records. The reasons are
glaring, why, in the latter, diseases should be less fatal; and in this respect,
cities should have the advantage of the country. We cannot therefore apply
hospital registers as a general criterion to a nation. Whenever authentic and
systematic records of diseases, recovery, and mortality, are kept in hospitals,
domestick as well as military, and annually published, whatever may be
alledged respecting the importance and demerits of such institutions, the
community, at all events, will derive much useful information.
A CHART of all the Fatal Diseases and Casualties in London,
during 75 Years;
Beginning from 1701, and ending with 1776.
Collected from the London Bills of Mortality, and arranged into Five
separate progressive Periods of Fifteen Years each.
which is, that on comparing the gradations of mortality in the following
chart, we are not to estimate the relative number, frequency, or proportion
of certain diseases, compared to others by the absolute mortality of each.
For instance, Apoplexy kills rather more annually in London than Measles;
but yet the latter disease is infinitely more universal and diffused amongst
the community, and consequently less dangerous to life: Cancerous and
Venereal cases are widely different in the annual number afflicted with
each, although the deaths are not far distant from an equality. The same
observations will apply to Rheumatism, compared to the Dropsy, and to
many other diseases.
There are between eighty and ninety diseases and casualties enumerated in
the London bills, which, in the subsequent comments, I have disentangled
into their separate genera. But, to prevent the possibility of aberration, after
the chart of London diseases, I have added a correct Medical Chart of all
the principal diseases and casualties with which mankind, in every part of
the earth and ocean, are afflicted or harrassed. This will operate as a check
and correction to the public registers; and by this, the defects and errors in
the London bills will be apparent; and it will serve as an index to our future
commentaries. But objections and difficulties occur in our researches for
collateral information and illustration from hospital records. The reasons are
glaring, why, in the latter, diseases should be less fatal; and in this respect,
cities should have the advantage of the country. We cannot therefore apply
hospital registers as a general criterion to a nation. Whenever authentic and
systematic records of diseases, recovery, and mortality, are kept in hospitals,
domestick as well as military, and annually published, whatever may be
alledged respecting the importance and demerits of such institutions, the
community, at all events, will derive much useful information.
A CHART of all the Fatal Diseases and Casualties in London,
during 75 Years;
Beginning from 1701, and ending with 1776.
Collected from the London Bills of Mortality, and arranged into Five
separate progressive Periods of Fifteen Years each.
Page 66
The Total Amount of the Five Periods, or Seventy-five Years Mortality, is
added together in the Sixth Column.
Total
Amount
Fifteen
of
Years, From From
From From Seventy-
DISEASES AND from 1747 1762
1717 to 1732 to five Years
CASUALTIES. 1701 to to
1732. 1747. Mortality,
to 1762. 1777.
from
1717.
1701 to
1777.
Ague 80 198 82 99 109 574
Fevers. Malignant,
Spotted, Scarlet, and
Purple 50,955 53,330 57,995 45,621 48,594 256,085
Small Pox 22,219 34,448 29,462 29,165 36,276 151,570
Measles 1,972 2,618 2,858 3,099 3,319 13,866
Quincy, Sore Throat 226 169 287 306 309 1,297
Pleurisy 384 602 811 407 321 3,525
Rheumatism 368 447 310 175 128 1,468
Gout 313 645 769 803 1,010 3,236
Consumption 42,541 49,680 66,009 61,749 68,949 288,928
Chin Cough, Hooping
116 632 1,692 2,755 4,252 9,573
Cough, Cough
Asthma and Tissick 5,090 7,938 9,460 5,699 6,154 34,341
Apoplexy and
Suddenly 2,228 3,013 3,287 3,271 3,353 15,152
Palsy 332 550 621 1,021 1,020 3,544
Lethargy 105 126 116 105 74 526
Meagrims 13 10 — — — 23
Headach 21 32 6 18 — 77
added together in the Sixth Column.
Total
Amount
Fifteen
of
Years, From From
From From Seventy-
DISEASES AND from 1747 1762
1717 to 1732 to five Years
CASUALTIES. 1701 to to
1732. 1747. Mortality,
to 1762. 1777.
from
1717.
1701 to
1777.
Ague 80 198 82 99 109 574
Fevers. Malignant,
Spotted, Scarlet, and
Purple 50,955 53,330 57,995 45,621 48,594 256,085
Small Pox 22,219 34,448 29,462 29,165 36,276 151,570
Measles 1,972 2,618 2,858 3,099 3,319 13,866
Quincy, Sore Throat 226 169 287 306 309 1,297
Pleurisy 384 602 811 407 321 3,525
Rheumatism 368 447 310 175 128 1,468
Gout 313 645 769 803 1,010 3,236
Consumption 42,541 49,680 66,009 61,749 68,949 288,928
Chin Cough, Hooping
116 632 1,692 2,755 4,252 9,573
Cough, Cough
Asthma and Tissick 5,090 7,938 9,460 5,699 6,154 34,341
Apoplexy and
Suddenly 2,228 3,013 3,287 3,271 3,353 15,152
Palsy 332 550 621 1,021 1,020 3,544
Lethargy 105 126 116 105 74 526
Meagrims 13 10 — — — 23
Headach 21 32 6 18 — 77
Page 67
Lunatick 412 513 777 1,126 1,048 3,876
Spleen and Vapours 53 52 20 — — 125
Rising of the Lights 1,219 1,239 197 30 10 2,074
Stoppage of the
Stomach 4,139 2,557 2,286 304 179 9,465
Vomiting and
820 682 248 134 120 2,004
Looseness
Cholic, Gripes, and
13,668 11,032 3,739 1,475 796 29,710
Twisting of the Guts
Flux 178 200 — 252 341 971
Bloody Flux 133 248 167 94 93 745
Worms 697 662 161 115 56 1,691
Jaundice 1,261 1,798 2,032 1,729 2,089 8,909
Gravel, Stone, and
789 868 700 421 429 3,205
Strangury
Diabetes 37 48 19 16 5 125
Dropsy and Tympany 11,626 15,430 16,036 13,410 14,038 70,506
Livergrown 76 95 75 23 — 269
French Pox 917 1,372 1,663 997 1,016 5,965
Scurvy 63 28 14 59 42 226
Evil 1,020 519 426 197 198 2,360
Leprosy 19 53 69 39 15 1,915
Rash 77 128 47 59 24 341
Itch — — 42 31 11 84
Childbed 3,560 3,894 3,412 3,005 3,186 17,057
Abortion, and Stillborn 8,746 10,231 8,793 8,820 10,241 46,831
Chrisoms and Infants 850 315 606 — — 1,771
Miscarriage — — 47 56 49 152
Convulsions 91,660 114,718 111,966 85,196 89,221 492,761
Spleen and Vapours 53 52 20 — — 125
Rising of the Lights 1,219 1,239 197 30 10 2,074
Stoppage of the
Stomach 4,139 2,557 2,286 304 179 9,465
Vomiting and
820 682 248 134 120 2,004
Looseness
Cholic, Gripes, and
13,668 11,032 3,739 1,475 796 29,710
Twisting of the Guts
Flux 178 200 — 252 341 971
Bloody Flux 133 248 167 94 93 745
Worms 697 662 161 115 56 1,691
Jaundice 1,261 1,798 2,032 1,729 2,089 8,909
Gravel, Stone, and
789 868 700 421 429 3,205
Strangury
Diabetes 37 48 19 16 5 125
Dropsy and Tympany 11,626 15,430 16,036 13,410 14,038 70,506
Livergrown 76 95 75 23 — 269
French Pox 917 1,372 1,663 997 1,016 5,965
Scurvy 63 28 14 59 42 226
Evil 1,020 519 426 197 198 2,360
Leprosy 19 53 69 39 15 1,915
Rash 77 128 47 59 24 341
Itch — — 42 31 11 84
Childbed 3,560 3,894 3,412 3,005 3,186 17,057
Abortion, and Stillborn 8,746 10,231 8,793 8,820 10,241 46,831
Chrisoms and Infants 850 315 606 — — 1,771
Miscarriage — — 47 56 49 152
Convulsions 91,660 114,718 111,966 85,196 89,221 492,761
Page 68
Headmold-shot, and
609 2,374 2,013 1,022 337 6,355
Water in the Head
Teeth 18,478 25,199 20,274 13,978 11,918 89,847
Thrush 839 1,191 1,512 1,391 1,101 6,034
Scald Head 9 15 29 22 — 75
Rickets 3,916 1,383 954 112 104 6,569
Inflammation 8 67 698 894 1,394 3,061
Imposthume 790 694 387 191 84 2,130
St. Anthony’s Fire — 73 36 63 69 241
Gangrene and
1,071 2,857 3,362 3,083 3,023 13,438
Mortification
Canker 138 181 123 77 61 580
Cancer 1,041 1,059 774 682 719 2,475
Sores and Ulcers 695 485 402 253 236 2,071
Fistula 360 202 210 134 119 1,025
Bursten and Ruptures 310 309 304 163 140 1,226
Swelling and Wen 6 — 47 49 37 139
Killed by Falls,
Bruises, Fractures, and
other Accidents 828 917 926 1,084 1,065 4,820
Self-Murder 445 667 693 555 509 2,869
Murdered 135 109 147 71 77 539
Stabbed, Killed,
15 32 13 — — 60
Wounded, Shot, &c.
Executed — — 495 495 1,020
Drowned 907 1,193 1,444 1,718 1,781 7,043
Burnt 90 54 90 127 132 493
Scalded 19 36 45 51 40 191
Stifled, Suffocated,
13 34 62 90 68 276
and Smothered
Overlaid 817 1,180 1,293 414 95 3,799
Found dead 388 557 668 336 133 2,082
609 2,374 2,013 1,022 337 6,355
Water in the Head
Teeth 18,478 25,199 20,274 13,978 11,918 89,847
Thrush 839 1,191 1,512 1,391 1,101 6,034
Scald Head 9 15 29 22 — 75
Rickets 3,916 1,383 954 112 104 6,569
Inflammation 8 67 698 894 1,394 3,061
Imposthume 790 694 387 191 84 2,130
St. Anthony’s Fire — 73 36 63 69 241
Gangrene and
1,071 2,857 3,362 3,083 3,023 13,438
Mortification
Canker 138 181 123 77 61 580
Cancer 1,041 1,059 774 682 719 2,475
Sores and Ulcers 695 485 402 253 236 2,071
Fistula 360 202 210 134 119 1,025
Bursten and Ruptures 310 309 304 163 140 1,226
Swelling and Wen 6 — 47 49 37 139
Killed by Falls,
Bruises, Fractures, and
other Accidents 828 917 926 1,084 1,065 4,820
Self-Murder 445 667 693 555 509 2,869
Murdered 135 109 147 71 77 539
Stabbed, Killed,
15 32 13 — — 60
Wounded, Shot, &c.
Executed — — 495 495 1,020
Drowned 907 1,193 1,444 1,718 1,781 7,043
Burnt 90 54 90 127 132 493
Scalded 19 36 45 51 40 191
Stifled, Suffocated,
13 34 62 90 68 276
and Smothered
Overlaid 817 1,180 1,293 414 95 3,799
Found dead 388 557 668 336 133 2,082
Page 69
Grief — 267 — 87 77 421
Frightened 8 14 8 13 2 45
Surfeits 685 131 59 31 27 933
Starved — 17 96 53 57 223
Excessive Drinking 19 267 678 189 69 1,222
Bleeding 87 69 57 70 114 397
Poisoned 2 7 7 24 10 40
Bit by Mad Dogs and
— 3 14 15 6 38
Cats
Bedridden — 104 — 56 105 265
Aged 27,341 34,708 30,058 25,109 22,032 139,248
A MEDICAL CATALOGUE of all the principal Diseases and Casualties by
which the Human Species are destroyed or annoyed.
Fevers. Intermittent, quotidian, tertian, quartan, species and varieties.
—— Remittent, Continued, and Eruptive; remittent, and the species,
nervous and putrid, miliary, inflammatory, small pox natural and
inoculated, measles, scarlet fever, some cutaneous eruptions, mixed
and anomalous fevers, plague, sweating sickness.
Fevers with topical inflammation of the brain, of the fauces, including
angina inflammatory and putrid, pleurisy, and peripneumony,
inflammations of the heart, diaphragm, liver, spleen, stomach,
intestines, kidneys and ureters, bladder, peritoneum, erysipelas, acute
and chronic rheumatism, regular and irregular gout. Internal
suppuration and gangrene.
Injured respiration and coughs, catarrh, pulmonary hæmorrhage, pulmonary
consumption, hectick, atrophy and tabes, asthma, hooping cough,
croup.
Natal hemorrhage, headach, nightmare, lethargy, vertigo, apoplexy,
epilepsy, fainting, resemblance of death from drowning, foul air, &c.
palpitation of the heart, internal polypus and aneurism, tetanus and
Frightened 8 14 8 13 2 45
Surfeits 685 131 59 31 27 933
Starved — 17 96 53 57 223
Excessive Drinking 19 267 678 189 69 1,222
Bleeding 87 69 57 70 114 397
Poisoned 2 7 7 24 10 40
Bit by Mad Dogs and
— 3 14 15 6 38
Cats
Bedridden — 104 — 56 105 265
Aged 27,341 34,708 30,058 25,109 22,032 139,248
A MEDICAL CATALOGUE of all the principal Diseases and Casualties by
which the Human Species are destroyed or annoyed.
Fevers. Intermittent, quotidian, tertian, quartan, species and varieties.
—— Remittent, Continued, and Eruptive; remittent, and the species,
nervous and putrid, miliary, inflammatory, small pox natural and
inoculated, measles, scarlet fever, some cutaneous eruptions, mixed
and anomalous fevers, plague, sweating sickness.
Fevers with topical inflammation of the brain, of the fauces, including
angina inflammatory and putrid, pleurisy, and peripneumony,
inflammations of the heart, diaphragm, liver, spleen, stomach,
intestines, kidneys and ureters, bladder, peritoneum, erysipelas, acute
and chronic rheumatism, regular and irregular gout. Internal
suppuration and gangrene.
Injured respiration and coughs, catarrh, pulmonary hæmorrhage, pulmonary
consumption, hectick, atrophy and tabes, asthma, hooping cough,
croup.
Natal hemorrhage, headach, nightmare, lethargy, vertigo, apoplexy,
epilepsy, fainting, resemblance of death from drowning, foul air, &c.
palpitation of the heart, internal polypus and aneurism, tetanus and
Page 70
locked jaw, catalepsy, spasm, cramp, Saint Vitus’s dance, tremor, palsy,
berbiers, insanity furious and melancholy, hypochondriasm.
Diseases of the sight, hearing, smell, taste, voice, and speech, sterility of the
sexes, morbid irritability of the genitals, diseases of the teeth,
deglutition obstructed.
Diseases of the stomach, and of the complex organization, subservient to
appetite and digestion, gall-stones, jaundice, cholera, dysentery,
diarrhœa, cholick, worms, tenesmus, costiveness, hemorrhage from the
stomach and anus.
Morbid symptoms and diseases from various poisons, canine madness,
venomous bites and stings.
Obstruction and suppression of urine, stone in the bladder, diabetes and
incontinence of urine, ulcers of the kidney and bladder, bloody urine.
Watery effusions, or dropsies of the head, spine, chest, pericardium,
external cellular membrane, abdomen, ovarium, fallopian tubes,
womb, scrotum, tympany, corpulency, and excess of fat.
Venereal disease, scurvy, scrophula, leprosy, yaws, itch; several chronic
cutaneous defedations, morb. pedicul.
Female Diseases. Obstruct. mens. chlorosis, excessive menstr. fluor alb.
hystericks, pregnancy, parturition, natural, laborious, preternatural, and
complex, some diseases during pregnancy, abortion and miscarriage,
uterine hemorrhage, fainting, convulsions, lochial excess and
suppression, uterine inflammation, puerperal fever, after-pains, weed,
milk fever, inflammation of the breast, excess and defect of milk.
Infant Diseases. Convulsions internal spasms, dentition, rickets, thrush.
N. B. Vomiting, diarrhœa and watery gripes, hectick and atrophy, small
pox, measles, rash, hooping cough and worms, dropsy of the head
and spine, are before described, under their respective titles.
Internal schirrus affecting various parts, the lungs, stomach, intestines, liver,
spleen, kidneys, ovaria, womb, testicles; also internal cancer, external
scirrhus and cancer.
berbiers, insanity furious and melancholy, hypochondriasm.
Diseases of the sight, hearing, smell, taste, voice, and speech, sterility of the
sexes, morbid irritability of the genitals, diseases of the teeth,
deglutition obstructed.
Diseases of the stomach, and of the complex organization, subservient to
appetite and digestion, gall-stones, jaundice, cholera, dysentery,
diarrhœa, cholick, worms, tenesmus, costiveness, hemorrhage from the
stomach and anus.
Morbid symptoms and diseases from various poisons, canine madness,
venomous bites and stings.
Obstruction and suppression of urine, stone in the bladder, diabetes and
incontinence of urine, ulcers of the kidney and bladder, bloody urine.
Watery effusions, or dropsies of the head, spine, chest, pericardium,
external cellular membrane, abdomen, ovarium, fallopian tubes,
womb, scrotum, tympany, corpulency, and excess of fat.
Venereal disease, scurvy, scrophula, leprosy, yaws, itch; several chronic
cutaneous defedations, morb. pedicul.
Female Diseases. Obstruct. mens. chlorosis, excessive menstr. fluor alb.
hystericks, pregnancy, parturition, natural, laborious, preternatural, and
complex, some diseases during pregnancy, abortion and miscarriage,
uterine hemorrhage, fainting, convulsions, lochial excess and
suppression, uterine inflammation, puerperal fever, after-pains, weed,
milk fever, inflammation of the breast, excess and defect of milk.
Infant Diseases. Convulsions internal spasms, dentition, rickets, thrush.
N. B. Vomiting, diarrhœa and watery gripes, hectick and atrophy, small
pox, measles, rash, hooping cough and worms, dropsy of the head
and spine, are before described, under their respective titles.
Internal schirrus affecting various parts, the lungs, stomach, intestines, liver,
spleen, kidneys, ovaria, womb, testicles; also internal cancer, external
scirrhus and cancer.
Page 71
External inflammation, suppuration, gangrene, burns, wounds, and
contusions, fractures simple and compound, luxations and sprains,
herniæ, or ruptures, abscess and ulcers, white swelling, spina ventosa,
external aneurism and varix, polypus of the nose, fauces, vagina,
womb, wens, bronchocele, corns, warts, chilblains.
An abstract of the general causes of diseases and mortality, of the seasons
and elements, food and drink, excretions and secretions, exercise and
rest, sleep and waking, passions of mind, venery.
An abstract of mortality in various domestic and military hospitals.
The Poet has, in just and emphatical language, stiled health the vital
principle of bliss. In the rude state of science and medicine, and in the ages
of superstition and credulity, it was usual to ascribe diseases to the
immediate resentment of some invisible demon, or to divine displeasure and
chastisement; on which account, in barbarous nations, their physicians have
been a set of stupid conjurors. Two centuries have barely elapsed, since the
people of England could, with difficulty, be persuaded that the jail
distemper, communicated at the Oxford assizes, from the prisoners to the
spectators, was not kindled up by witchcraft and necromancy: but learning
and philosophy have now discarded such supernatural agents. Others again
equally err, in supposing diseases to be unsteady motions of the human
machine, excited by something hurtful. This popular error seems to
originate from confounding diseases themselves with the versatility of
medical remedies and practice. Beyond a doubt, diseases are presented to
us, over and over again, in nearly the same form and shape: the diseases
delineated two thousand years ago by Hippocrates, at this day retain the
same essential marks and prominent features; tho’ in degree and violence,
there are many gradations and shades to vary the picture.
A disease, in the pathological language, is when one or more of the various
corporeal or mental functions, cannot be performed as in usual health. The
symptoms of all diseases are indicated by few or many derangements of the
corporeal functions, of the excretions, and of the sensible qualities: such are
pain, disagreeable sensation, anxiety, irritation internal or external; the
exercise of some of the external or internal senses impeded; of sleep and
waking; of the muscular or moving fibres; of the digestive and intestinal
functions: of the lacteal, lymphatic, or absorbent system; of the respiration,
contusions, fractures simple and compound, luxations and sprains,
herniæ, or ruptures, abscess and ulcers, white swelling, spina ventosa,
external aneurism and varix, polypus of the nose, fauces, vagina,
womb, wens, bronchocele, corns, warts, chilblains.
An abstract of the general causes of diseases and mortality, of the seasons
and elements, food and drink, excretions and secretions, exercise and
rest, sleep and waking, passions of mind, venery.
An abstract of mortality in various domestic and military hospitals.
The Poet has, in just and emphatical language, stiled health the vital
principle of bliss. In the rude state of science and medicine, and in the ages
of superstition and credulity, it was usual to ascribe diseases to the
immediate resentment of some invisible demon, or to divine displeasure and
chastisement; on which account, in barbarous nations, their physicians have
been a set of stupid conjurors. Two centuries have barely elapsed, since the
people of England could, with difficulty, be persuaded that the jail
distemper, communicated at the Oxford assizes, from the prisoners to the
spectators, was not kindled up by witchcraft and necromancy: but learning
and philosophy have now discarded such supernatural agents. Others again
equally err, in supposing diseases to be unsteady motions of the human
machine, excited by something hurtful. This popular error seems to
originate from confounding diseases themselves with the versatility of
medical remedies and practice. Beyond a doubt, diseases are presented to
us, over and over again, in nearly the same form and shape: the diseases
delineated two thousand years ago by Hippocrates, at this day retain the
same essential marks and prominent features; tho’ in degree and violence,
there are many gradations and shades to vary the picture.
A disease, in the pathological language, is when one or more of the various
corporeal or mental functions, cannot be performed as in usual health. The
symptoms of all diseases are indicated by few or many derangements of the
corporeal functions, of the excretions, and of the sensible qualities: such are
pain, disagreeable sensation, anxiety, irritation internal or external; the
exercise of some of the external or internal senses impeded; of sleep and
waking; of the muscular or moving fibres; of the digestive and intestinal
functions: of the lacteal, lymphatic, or absorbent system; of the respiration,
Page 72
sanguiferous circulation, and arterial pulsation; of the different excretions
and secretions, the feces, urine, perspiration, bile, pancreatic fluid, saliva,
milk, menses, semen, mucus, oil, lymph, by extravasated blood: by the
countenance, actions, gestures, debility, strength, heat, colour, smell, taste,
magnitude, hardness, softness, the nature and appearance of the excretions,
&c. I studiously avoid all minute pathological discrimination of symptoms;
as symptoms of the disease, of the cause, of symptoms, of reacting nature;
of primary, pathognomic, accidental, and accessary symptoms. Nor in
briefly enumerating the various causes of diseases, shall I waste time in the
explanation of what may be learned from pathological systems and
vocabularies: such as the technical distinction of causes into external and
internal, predisponent, exciting and occasional, remote and proximate.
There is both fiction and much truth in the warbling melody of the Roman
poet: “Post ignem etherea domo subductum macies, et nova febrium cohors
incubuit terris.” Consumptions and Fevers we see, by arithmetical
demonstration, are amongst the most universal and fatal maladies of our
metropolis and Island. I begin this morbid survey with the latter. The
principal and most general febrile epidemicks which infested England
during two intire centuries, are enumerated in a short abstract, by Dr. Short;
and consist of plagues, agues, remittent fevers, summer and autumnal
dysenteries, spotted putrid fevers, slow fevers, small pox, measles, putrid
and contagious peripneumonies, fatal spring pleurisies, and
peripneumonies, and epidemical catarrhs. Throughout all countries, in
epidemical diseases, there are years when they are more or less prevalent.
Great national calamities, from this source, are rare: none ever inundate a
whole kingdom (catarrh in some instances excepted): they sometimes
indeed spread from one province to another, but all the community are
never attacked at once; nor are large populous kingdoms, or even cities,
totally exempt from them. Fevers of various generic forms, as intermittent,
remittent, nervous and putrid, scarlet, small-pox, measles, &c. may be local
and circumscribed to one city or district, whilst others in the vicinity,
continue at the same time healthy; the disease dissipating its virulence
within a small boundary. From a comparison of 150 different parish
registers, Dr. Short calculates, that within a certain period, some have had 8
to 14 sickly years, and others, in the same interval, only one. He estimates
5, 6, and 8 years interval, as a common rotine of irruption by some
epidemical distemper, even in remote country parishes: and a few of them
and secretions, the feces, urine, perspiration, bile, pancreatic fluid, saliva,
milk, menses, semen, mucus, oil, lymph, by extravasated blood: by the
countenance, actions, gestures, debility, strength, heat, colour, smell, taste,
magnitude, hardness, softness, the nature and appearance of the excretions,
&c. I studiously avoid all minute pathological discrimination of symptoms;
as symptoms of the disease, of the cause, of symptoms, of reacting nature;
of primary, pathognomic, accidental, and accessary symptoms. Nor in
briefly enumerating the various causes of diseases, shall I waste time in the
explanation of what may be learned from pathological systems and
vocabularies: such as the technical distinction of causes into external and
internal, predisponent, exciting and occasional, remote and proximate.
There is both fiction and much truth in the warbling melody of the Roman
poet: “Post ignem etherea domo subductum macies, et nova febrium cohors
incubuit terris.” Consumptions and Fevers we see, by arithmetical
demonstration, are amongst the most universal and fatal maladies of our
metropolis and Island. I begin this morbid survey with the latter. The
principal and most general febrile epidemicks which infested England
during two intire centuries, are enumerated in a short abstract, by Dr. Short;
and consist of plagues, agues, remittent fevers, summer and autumnal
dysenteries, spotted putrid fevers, slow fevers, small pox, measles, putrid
and contagious peripneumonies, fatal spring pleurisies, and
peripneumonies, and epidemical catarrhs. Throughout all countries, in
epidemical diseases, there are years when they are more or less prevalent.
Great national calamities, from this source, are rare: none ever inundate a
whole kingdom (catarrh in some instances excepted): they sometimes
indeed spread from one province to another, but all the community are
never attacked at once; nor are large populous kingdoms, or even cities,
totally exempt from them. Fevers of various generic forms, as intermittent,
remittent, nervous and putrid, scarlet, small-pox, measles, &c. may be local
and circumscribed to one city or district, whilst others in the vicinity,
continue at the same time healthy; the disease dissipating its virulence
within a small boundary. From a comparison of 150 different parish
registers, Dr. Short calculates, that within a certain period, some have had 8
to 14 sickly years, and others, in the same interval, only one. He estimates
5, 6, and 8 years interval, as a common rotine of irruption by some
epidemical distemper, even in remote country parishes: and a few of them
Page 73
have been so fortunate as to escape any uncommon or remarkable mortality
during 11, 12, or even 20 and 30 years. In all the seasons denominated
sickly in the country parishes, the burials exceeded the christenings; and
according to the nature of the epidemick, the morbid state of the seasons,
the medical treatment, and many other circumstances, the gradations of
mortality, even by the same disease, were extremely various.
Collating the annual average of deaths in a sickly year of London, and other
great cities, with sickly years in the country parishes, Dr. Short found, that
cities and towns, in this respect, have the advantage of the country. In
spacious open country districts where fatal epidemicks burst out, according
to this author, more died in one year than during 6, 10, 12, or sometimes 15
healthy years: whereas, says he, in London, and such other cities, not above
one third, fourth, or fifth beyond the ordinary consumption are swept away.
Pestilential mortality is a solitary exception to this proportion. In the
London bills we may frequently observe, that in different months, the
deaths are double or treble above equal periods of the same year: but during
the present century, I find no instance of triple, very rarely of double excess
in the annual London burials. Dr. Short adds, that mortality is more constant
and regular in cities, and not so many destroyed “per saltum” from raging
epidemicks, as in the country. In pure open air, he suggests, that contagion
and infection, or other adulterated effluvia, are more virulent. Or perhaps he
should have said, or at least have added, that in cities where the atmosphere
is charged with a load of smoke, and other heterogeneous vapours,
epidemical poisons may be blunted, decompounded, or annihilated; that
likewise in cities, human bodies are more early seasoned and habituated to
such noxious external impressions, and, like doctors and nurses, are in some
degree fortified by habit: that besides, in every large metropolis, small-pox,
measles, and, some other febrile epidemicks, are almost constant residents;
and consequently the devaluation from these diseases is more regular and
equal than in the country, where several years intervene between their
invasions.
The absolute mortality by fevers in the London bills, without including the
small pox and measles, amounts to nearly one seventh of the whole funeral
catalogue. In the London dispensaries, the Aldersgate and Westminster, and
in the Newcastle hospital, fevers were a fourth and sixth to all other
diseases. De Haen computes, that out of two thousand sick, admitted into
during 11, 12, or even 20 and 30 years. In all the seasons denominated
sickly in the country parishes, the burials exceeded the christenings; and
according to the nature of the epidemick, the morbid state of the seasons,
the medical treatment, and many other circumstances, the gradations of
mortality, even by the same disease, were extremely various.
Collating the annual average of deaths in a sickly year of London, and other
great cities, with sickly years in the country parishes, Dr. Short found, that
cities and towns, in this respect, have the advantage of the country. In
spacious open country districts where fatal epidemicks burst out, according
to this author, more died in one year than during 6, 10, 12, or sometimes 15
healthy years: whereas, says he, in London, and such other cities, not above
one third, fourth, or fifth beyond the ordinary consumption are swept away.
Pestilential mortality is a solitary exception to this proportion. In the
London bills we may frequently observe, that in different months, the
deaths are double or treble above equal periods of the same year: but during
the present century, I find no instance of triple, very rarely of double excess
in the annual London burials. Dr. Short adds, that mortality is more constant
and regular in cities, and not so many destroyed “per saltum” from raging
epidemicks, as in the country. In pure open air, he suggests, that contagion
and infection, or other adulterated effluvia, are more virulent. Or perhaps he
should have said, or at least have added, that in cities where the atmosphere
is charged with a load of smoke, and other heterogeneous vapours,
epidemical poisons may be blunted, decompounded, or annihilated; that
likewise in cities, human bodies are more early seasoned and habituated to
such noxious external impressions, and, like doctors and nurses, are in some
degree fortified by habit: that besides, in every large metropolis, small-pox,
measles, and, some other febrile epidemicks, are almost constant residents;
and consequently the devaluation from these diseases is more regular and
equal than in the country, where several years intervene between their
invasions.
The absolute mortality by fevers in the London bills, without including the
small pox and measles, amounts to nearly one seventh of the whole funeral
catalogue. In the London dispensaries, the Aldersgate and Westminster, and
in the Newcastle hospital, fevers were a fourth and sixth to all other
diseases. De Haen computes, that out of two thousand sick, admitted into
Page 74
the hospitals in Vienna, seven hundred of them laboured under acute and
febrile diseases. Dr. Cleghorn estimates the summer fevers in that warm
Mediterranean island Minorca, as constituting three-fourths of all the
diseases in that island. Dr. Lind calculates, that nineteen out of twenty of all
the numerous Europeans who visit the sultry climates of Africa, America,
and of the East and West Indies, are destroyed by intermittent, remittent
fevers, and fluxes; and probably he also should have added, or by chronic
diseases and broken constitutions, the consequence of those fevers. In the
London bills of mortality, many different genera of fevers are crammed into
one indiscriminate heap, from which it is impossible to extricate the
specific nature or genus of febrile carnage. I was anxious to determine with
some probability, the ratio of desolation in London, by each of the different
febrile genera: because it would be an important guide to the prevention and
cure. I knew that most of our hospital registers were in this particularly
defective; on that account I was favoured by a medical friend, with the
perusal of the books of the Aldersgate dispensary. But although no
gentlemen are better qualified to discriminate diseases, I perceived, on
inspection, that too often the genus of fevers was not marked, only by the
general outlines of the class. However, I converted this scrutiny to some
other use, as will hereafter appear.
We shall first trace the prominent features of the general febrile Class,
descending progressively through the different Orders and Genera. In most
fevers, of whatsoever genus, one or more of the following symptoms occur:
shivering, chilliness, and heat of the skin alternating: the circulation of the
blood, and consequently of the pulse, as felt at the wrist, accelerated more
than in the natural state; in adults, to upwards of 96 strokes every minute;
and in infants, is considerably more increased in velocity: also general
languor, lassitude, and debility of the nerves and muscles; dryness of the
mouth and tongue, thirst; little or no sleep, or disturbed and not refreshing,
and generally headach: in most of the continued and remittent fevers, there
is total suspension of appetite, sickness at the stomach, nausea and
vomiting; increased heat of the skin, at least burning sensation; aversion to
motion; the sick are mostly confined to bed, unable to walk, or frequently
even to sit erect; and this is commonly the case, even in the intermittent
genera during the febrile paroxism: the remittent and continued have
usually an evening or nocturnal febrile exacerbation: the voice and
febrile diseases. Dr. Cleghorn estimates the summer fevers in that warm
Mediterranean island Minorca, as constituting three-fourths of all the
diseases in that island. Dr. Lind calculates, that nineteen out of twenty of all
the numerous Europeans who visit the sultry climates of Africa, America,
and of the East and West Indies, are destroyed by intermittent, remittent
fevers, and fluxes; and probably he also should have added, or by chronic
diseases and broken constitutions, the consequence of those fevers. In the
London bills of mortality, many different genera of fevers are crammed into
one indiscriminate heap, from which it is impossible to extricate the
specific nature or genus of febrile carnage. I was anxious to determine with
some probability, the ratio of desolation in London, by each of the different
febrile genera: because it would be an important guide to the prevention and
cure. I knew that most of our hospital registers were in this particularly
defective; on that account I was favoured by a medical friend, with the
perusal of the books of the Aldersgate dispensary. But although no
gentlemen are better qualified to discriminate diseases, I perceived, on
inspection, that too often the genus of fevers was not marked, only by the
general outlines of the class. However, I converted this scrutiny to some
other use, as will hereafter appear.
We shall first trace the prominent features of the general febrile Class,
descending progressively through the different Orders and Genera. In most
fevers, of whatsoever genus, one or more of the following symptoms occur:
shivering, chilliness, and heat of the skin alternating: the circulation of the
blood, and consequently of the pulse, as felt at the wrist, accelerated more
than in the natural state; in adults, to upwards of 96 strokes every minute;
and in infants, is considerably more increased in velocity: also general
languor, lassitude, and debility of the nerves and muscles; dryness of the
mouth and tongue, thirst; little or no sleep, or disturbed and not refreshing,
and generally headach: in most of the continued and remittent fevers, there
is total suspension of appetite, sickness at the stomach, nausea and
vomiting; increased heat of the skin, at least burning sensation; aversion to
motion; the sick are mostly confined to bed, unable to walk, or frequently
even to sit erect; and this is commonly the case, even in the intermittent
genera during the febrile paroxism: the remittent and continued have
usually an evening or nocturnal febrile exacerbation: the voice and
Page 75
countenance frequently express condolence: and in the genera of topical
inflammations, there is fixed pain in the different parts affected.
Intermittent Fevers, or Agues, notwithstanding their febrile type, fall under
the Chronic class. They are usually distinguished into different genera, or
types; into Quotidian, Tertian, Quartan, with their separate species and
varieties. It would seem, by the London registers, that very few die of
agues, from which no age is exempted, but to which adults are much more
obnoxious. Intermittent havock, if not immediately, yet in its chronic
effects, is far more fatal than the London bills represent. Towns in general,
it is true, are less harrassed with agues than country places. Pringle remarks,
that during the campaigns of the British troops in the marshy countries of
Holland and Flanders, where, in all such climates, and in damp soils and
situations, agues and remittent fevers are epidemick, that the soldiers
quartered in towns were less afflicted than those stationed in country
cantonments: that in the former, the fires, sewers, drains, and paved streets,
prevented an exuberance of moisture: and that, if the men slept in the upper
floors of the house, they were still more secure from damp and intermittent
sickness.
The invasion of Intermittent Paroxisms, is during certain periods only, and
generally consists of a successive series of shivering and cold, burning heat,
and profuse sweats: and exhibits the fundamental outlines of all fevers.
Intermittent paroxisms, and consequently the genera and species, vary in
duration, in recurrence, and in the symptoms. Quotidians, Tertians, and
Quartans, consist of paroxisms, at the respective intervals of 24, 48, and 72
hours. An interval denotes the length of time from the beginning of one
paroxism to the next succeeding: an intermission the vacation between
paroxisms. Other distinctions, perhaps too refined, are made of
intermittents, as Quintanæ, Septiminæ, Decimanæ, Erraticæ, Vagæ. Each of
the three primary intermittent genera, are likewise subdivided into duplex
and triplex. The double tertian is a very universal form, but may be referred
to remittents: it implies that every other or second day the paroxisms are
similar, but different in the intermediate days. Again, the type of
intermittents is often obscured under a cloud of irregular and adventitious
symptoms; and from one predominant symptom, or from similarity to
various other diseases, these three fundamental genera are split by
Nosologists into other species and varieties; the Quotidiana or intermittens,
inflammations, there is fixed pain in the different parts affected.
Intermittent Fevers, or Agues, notwithstanding their febrile type, fall under
the Chronic class. They are usually distinguished into different genera, or
types; into Quotidian, Tertian, Quartan, with their separate species and
varieties. It would seem, by the London registers, that very few die of
agues, from which no age is exempted, but to which adults are much more
obnoxious. Intermittent havock, if not immediately, yet in its chronic
effects, is far more fatal than the London bills represent. Towns in general,
it is true, are less harrassed with agues than country places. Pringle remarks,
that during the campaigns of the British troops in the marshy countries of
Holland and Flanders, where, in all such climates, and in damp soils and
situations, agues and remittent fevers are epidemick, that the soldiers
quartered in towns were less afflicted than those stationed in country
cantonments: that in the former, the fires, sewers, drains, and paved streets,
prevented an exuberance of moisture: and that, if the men slept in the upper
floors of the house, they were still more secure from damp and intermittent
sickness.
The invasion of Intermittent Paroxisms, is during certain periods only, and
generally consists of a successive series of shivering and cold, burning heat,
and profuse sweats: and exhibits the fundamental outlines of all fevers.
Intermittent paroxisms, and consequently the genera and species, vary in
duration, in recurrence, and in the symptoms. Quotidians, Tertians, and
Quartans, consist of paroxisms, at the respective intervals of 24, 48, and 72
hours. An interval denotes the length of time from the beginning of one
paroxism to the next succeeding: an intermission the vacation between
paroxisms. Other distinctions, perhaps too refined, are made of
intermittents, as Quintanæ, Septiminæ, Decimanæ, Erraticæ, Vagæ. Each of
the three primary intermittent genera, are likewise subdivided into duplex
and triplex. The double tertian is a very universal form, but may be referred
to remittents: it implies that every other or second day the paroxisms are
similar, but different in the intermediate days. Again, the type of
intermittents is often obscured under a cloud of irregular and adventitious
symptoms; and from one predominant symptom, or from similarity to
various other diseases, these three fundamental genera are split by
Nosologists into other species and varieties; the Quotidiana or intermittens,
Page 76
into simplex, cephalalgia, ophthalmica, nephralgica, stranguriosa,
ischiadica, sputatoria, catarrhalis, anginosa, epileptica, hysterica, partialis:
the Tertiana into simplex, hemitritæa, duplex, triplex, pleuritica, asthmatica,
arthritica, emetica, hysterica, apoplectica, urticata, and other species of
double tertian enumerated under the remittent type: the Quartana into
cataleptica, epileptica, hysterica, maniaca, comatosa, nephralgica,
splenetica, arthritica.
The three stages of intermittent fevers, during their periodical revolution,
affect, more or less, the brain and nerves, the inherent muscular power, the
heart and arteries, the stomach and intestines, and the sensible qualities of
the body; the symptoms usually succeeding in the following progressive
order: languor, sluggishness, debility, impaired sensibility, sometimes
drowsiness and coma, oscitation, sensation of coldness in the back and
spine, overspreading the body and extremities; accelerated and weak pulse;
laborious respiration with anxiety; impaired appetite, and often sickness,
nausea, and vomiting of bile; thirst; limpid urine; pale face, extremities, and
trunk, and cutaneous collapse; rigor and trembling of the extremities and
trunk, and gnashing of the teeth, as if cold water was poured on the body.
This stage is various in duration in different persons, and in the different
intermittent types. Nature at length rallies its powers with success, and with
the expulsion of the cold, the second or hot stage is kindled up with
undulating flushes of heat, and its preternatural increase over the body; the
cutaneous blood vessels are dilated with suffusion of the countenance,
redness, and burning heat; the pulse becomes strong, full, and more regular;
the respiration continues oppressed, and is accelerated; with headach,
throbbing of the temporal arteries, and sometimes delirium. After some
continuance of this febrile struggle, and tumultuary rage of the re-acting
organs of sensation and motion, the third stage of sweat is introduced by
some moisture oozing throughout all the cutaneous pores, and poured out
often in profuse streams: with this the heat of the body, the pulse,
respiration and appetite become more natural; the urine less transparent
deposits a sediment; the febrile tempest abates to a calm; and the body
recovers the exercise of all its usual functions. Sometimes indeed there are
varieties; such as little or no cold stage, or sweat.
Intermittent paroxisms are always terminated in less than twenty-four
hours. Quotidians have the least cold stage, but the longest paroxism:
ischiadica, sputatoria, catarrhalis, anginosa, epileptica, hysterica, partialis:
the Tertiana into simplex, hemitritæa, duplex, triplex, pleuritica, asthmatica,
arthritica, emetica, hysterica, apoplectica, urticata, and other species of
double tertian enumerated under the remittent type: the Quartana into
cataleptica, epileptica, hysterica, maniaca, comatosa, nephralgica,
splenetica, arthritica.
The three stages of intermittent fevers, during their periodical revolution,
affect, more or less, the brain and nerves, the inherent muscular power, the
heart and arteries, the stomach and intestines, and the sensible qualities of
the body; the symptoms usually succeeding in the following progressive
order: languor, sluggishness, debility, impaired sensibility, sometimes
drowsiness and coma, oscitation, sensation of coldness in the back and
spine, overspreading the body and extremities; accelerated and weak pulse;
laborious respiration with anxiety; impaired appetite, and often sickness,
nausea, and vomiting of bile; thirst; limpid urine; pale face, extremities, and
trunk, and cutaneous collapse; rigor and trembling of the extremities and
trunk, and gnashing of the teeth, as if cold water was poured on the body.
This stage is various in duration in different persons, and in the different
intermittent types. Nature at length rallies its powers with success, and with
the expulsion of the cold, the second or hot stage is kindled up with
undulating flushes of heat, and its preternatural increase over the body; the
cutaneous blood vessels are dilated with suffusion of the countenance,
redness, and burning heat; the pulse becomes strong, full, and more regular;
the respiration continues oppressed, and is accelerated; with headach,
throbbing of the temporal arteries, and sometimes delirium. After some
continuance of this febrile struggle, and tumultuary rage of the re-acting
organs of sensation and motion, the third stage of sweat is introduced by
some moisture oozing throughout all the cutaneous pores, and poured out
often in profuse streams: with this the heat of the body, the pulse,
respiration and appetite become more natural; the urine less transparent
deposits a sediment; the febrile tempest abates to a calm; and the body
recovers the exercise of all its usual functions. Sometimes indeed there are
varieties; such as little or no cold stage, or sweat.
Intermittent paroxisms are always terminated in less than twenty-four
hours. Quotidians have the least cold stage, but the longest paroxism:
Page 77
tertians are in the intermediate degree in both respects; quartans have the
most violent, or at least the longest cold stage, but the shortest paroxism:
their cold stage may be two hours, or longer. The hot and sweating stages
therefore constitute the greatest portion of intermittent conflict. Quotidian
paroxisms rarely exceed eighteen hours: tertians are from six to twelve:
quartans somewhat shorter. Quotidians generally assault in the morning;
tertians and quartans in the noon and afternoon. Vernal are said not to be so
refractory as autumnal intermittents. But in young sound constitutions,
agues, if not inveterate, are frequently cured after a few paroxisms. When
death happens in them, it is generally during the cold stage. More
frequently their fatality is by transition into some other chronic diseases:
such as maladies of the stomach, digestive organs, liver, and intestinal tube;
bilious cachexy, jaundice, consumptions, dropsy. Some inveterate corporeal
infirmities have been relieved by intermittents. During their revolution the
type is frequently changed: quartan and tertian into quotidian: the latter into
remittent; and these into continued fever.
Remittent Fevers: fevers with remissions and exacerbations, or which have
not a temporary and total cessation, are the most universal febrile form in
all parts of the globe. Throughout the equatorial oven, or middle regions of
the earth, from Cancer to Capricorn, intermittents, but, above all, remittents
and dysenteries are the most universal type of fever. They are the locusts
which devour whole crops of mankind. During the periodical rainy seasons
of the tropical zones; particularly where they are choaked up with woods
and morasses, and in uncultivated new settlements, these fevers often
ravage with the desolation of an Egyptian pestilence; and are sometimes so
precipitate as to kill in one or two paroxisms, if not sooner repulsed; the
doctor, lawyer, and priest quickly succeeding each other in their visits. They
destroy not only multitudes immediately, especially of the new European
settlers; but when improperly treated, or when convalescents from
irregularity, fall back into relapses, they often terminate in fatal chronic
diseases, similar to those recently enumerated under the intermittent train.
Not only within the tropicks, but likewise through the northern hemisphere,
to the verge nearly of the polar circles, we can descry this remittent febrile
host. In the sultry summer and autumnal seasons of Europe, in low marshy
countries, soils and situations such as Italy and Hungary, where the
summers are long and intense; and in that northern morass, Holland, these
most violent, or at least the longest cold stage, but the shortest paroxism:
their cold stage may be two hours, or longer. The hot and sweating stages
therefore constitute the greatest portion of intermittent conflict. Quotidian
paroxisms rarely exceed eighteen hours: tertians are from six to twelve:
quartans somewhat shorter. Quotidians generally assault in the morning;
tertians and quartans in the noon and afternoon. Vernal are said not to be so
refractory as autumnal intermittents. But in young sound constitutions,
agues, if not inveterate, are frequently cured after a few paroxisms. When
death happens in them, it is generally during the cold stage. More
frequently their fatality is by transition into some other chronic diseases:
such as maladies of the stomach, digestive organs, liver, and intestinal tube;
bilious cachexy, jaundice, consumptions, dropsy. Some inveterate corporeal
infirmities have been relieved by intermittents. During their revolution the
type is frequently changed: quartan and tertian into quotidian: the latter into
remittent; and these into continued fever.
Remittent Fevers: fevers with remissions and exacerbations, or which have
not a temporary and total cessation, are the most universal febrile form in
all parts of the globe. Throughout the equatorial oven, or middle regions of
the earth, from Cancer to Capricorn, intermittents, but, above all, remittents
and dysenteries are the most universal type of fever. They are the locusts
which devour whole crops of mankind. During the periodical rainy seasons
of the tropical zones; particularly where they are choaked up with woods
and morasses, and in uncultivated new settlements, these fevers often
ravage with the desolation of an Egyptian pestilence; and are sometimes so
precipitate as to kill in one or two paroxisms, if not sooner repulsed; the
doctor, lawyer, and priest quickly succeeding each other in their visits. They
destroy not only multitudes immediately, especially of the new European
settlers; but when improperly treated, or when convalescents from
irregularity, fall back into relapses, they often terminate in fatal chronic
diseases, similar to those recently enumerated under the intermittent train.
Not only within the tropicks, but likewise through the northern hemisphere,
to the verge nearly of the polar circles, we can descry this remittent febrile
host. In the sultry summer and autumnal seasons of Europe, in low marshy
countries, soils and situations such as Italy and Hungary, where the
summers are long and intense; and in that northern morass, Holland, these
Page 78
are the epidemical tyrants. Armies encamped are often at that season
grievously infested with them, and with dysenteric fluxes. In Britain and
Ireland also, they are frequent and fatal epidemicks; and are not confined to
the summer season only. Even in most dry countries and situations without
the tropicks, after an unusual close sultry summer, with long protracted
heats, we often see, or read of, such fevers and fluxes. The humours then,
says Pringle, are corrupted, the solids relaxed; and in such a disposition of
body, irregularities in diet, wet cloaths, and damp air, may give activity to
such latent indisposition. In that small southern Mediterranean island, as
described by Cleghorn, where the soil is rocky, but the summer heats
excessive, such fevers have raged with atrocious severity.
Fevers intermittent and remittent, and those strictly simple inflammatory,
are greatly regulated, not only by the climate, latitude, soil, local elevation
or depression, but also in the same country by the different seasons of the
year. In summer and autumn, fevers tend in various degrees to affect the
stomach and intestines with sickness; they are then, more or less remittent,
and participate less of the inflammatory. “In Holland,” continues Pringle,
“towards June, a healthy month, the inflammatory fevers begin to recede;
and the remittent, bilious, and putrid often succeed throughout the summer
and autumn, until the return of winter, when the inflammatory again
recommence; the seasons and diseases insensibly interchanging and running
into each other.” We may also add, that in all warm climates there is a
copious and superabundant secretion of bile; and that none of the animal
fluids so soon turn putrid. They are more obnoxious to remittent fevers who
are constantly exercised in labour and fatigue, and exposed to the external
air, than other ranks who are comfortably accommodated, cloathed, and fed.
Pringle remarks, that the peasants of Holland were always greater sufferers
by the summer, autumnal, and remittent fevers, than those of the more
opulent class; and also, that during summer and winter, in the field and in
garrison, the private soldiers were more sickly than the officers, and liable
to fevers.
Remittent fevers seem to consist of a repetition of protracted diurnal
paroxisms, or periodical aggravated exacerbations, nearly similar to the
intermittent or primitive type; but without the latter’s complete
intermission. Authors have described them under a variety of apellations;
but they may be all comprehended as ramifications of one great trunk, or
grievously infested with them, and with dysenteric fluxes. In Britain and
Ireland also, they are frequent and fatal epidemicks; and are not confined to
the summer season only. Even in most dry countries and situations without
the tropicks, after an unusual close sultry summer, with long protracted
heats, we often see, or read of, such fevers and fluxes. The humours then,
says Pringle, are corrupted, the solids relaxed; and in such a disposition of
body, irregularities in diet, wet cloaths, and damp air, may give activity to
such latent indisposition. In that small southern Mediterranean island, as
described by Cleghorn, where the soil is rocky, but the summer heats
excessive, such fevers have raged with atrocious severity.
Fevers intermittent and remittent, and those strictly simple inflammatory,
are greatly regulated, not only by the climate, latitude, soil, local elevation
or depression, but also in the same country by the different seasons of the
year. In summer and autumn, fevers tend in various degrees to affect the
stomach and intestines with sickness; they are then, more or less remittent,
and participate less of the inflammatory. “In Holland,” continues Pringle,
“towards June, a healthy month, the inflammatory fevers begin to recede;
and the remittent, bilious, and putrid often succeed throughout the summer
and autumn, until the return of winter, when the inflammatory again
recommence; the seasons and diseases insensibly interchanging and running
into each other.” We may also add, that in all warm climates there is a
copious and superabundant secretion of bile; and that none of the animal
fluids so soon turn putrid. They are more obnoxious to remittent fevers who
are constantly exercised in labour and fatigue, and exposed to the external
air, than other ranks who are comfortably accommodated, cloathed, and fed.
Pringle remarks, that the peasants of Holland were always greater sufferers
by the summer, autumnal, and remittent fevers, than those of the more
opulent class; and also, that during summer and winter, in the field and in
garrison, the private soldiers were more sickly than the officers, and liable
to fevers.
Remittent fevers seem to consist of a repetition of protracted diurnal
paroxisms, or periodical aggravated exacerbations, nearly similar to the
intermittent or primitive type; but without the latter’s complete
intermission. Authors have described them under a variety of apellations;
but they may be all comprehended as ramifications of one great trunk, or
Page 79
integral genus: they appear in essence the same disease, and are cured by
similar remedies. In the medical nomenclature, they are denominated
remittent, semitertian, hemitritea, tritophyea, double and triple tertian,
putrid remittent, marsh, camp, ardent, bilious fevers, gall sickness: tertian
fever obscured under a mist of one or more dangerous and prominent
symptoms; hence named tertiana lethargica, vertiginosa, soporosa,
apoplectica, paralytica, cataleptica, epileptica, convulsiva, phrenitica,
hysterica, syncopalis, asthmatica, arthritica, cardialgica, singultuosa,
rheumatica, pleuritica, dysenterica, atrabilaria, cholerica, emetica,
diaphoretica, pituitosa, miliaris, scorbutica.
Exclusive of the symptoms common to such fevers, and partly delineated
under the intermittent paroxism, remittent fevers are variously diversified
by a rotine and medley of nervous, putrid, and inflammatory symptoms; but
infinitely more of the two former. The climate, season of the year,
remissions, and the notorious epidemick or endemick of that region or
place, all contribute to their unerring detection. Sometimes they attack very
suddenly and violently with delirium and inflammatory simulation; but
soon afterwards, and at the interval of a few days, remissions are evident.
Sometimes their approach is in appearance mild, but not less alarming. In
general there are great lassitude, debility, anxiety, restlessness, severe
headach, frequently delirium, especially at the exacerbations; disturbed
sleep, and not refreshing; sickness at the stomach, nausea, bilious vomiting,
or efforts to evacuate the ventricular contents; fecal excretion bilious with
gripes; inextinguishable thirst; tongue dry and parched; quick hot
respiration; skin sometimes dry. When bile is redundant, the intestinal
excretion is often putrid and offensive, with bilious diarrhœa or dysentery,
in repetition and quantity profuse, exciting tenesmus, and sometimes
excoriation of the anus; to these may be added pain in the stomach and
intestines, tension and elevation of the belly. According to Lind, the tropical
remittents are the most virulent, yet are not contagious, unless accompanied
with dysentery, or the sick crowded together; which, if an irrefragable fact,
distinguishes this fever from the nervous and putrid: and besides, in those
febrile epidemicks and endemicks, from marshy effluvia, the remissions are
more perceptible and synchronous than in these from animal contagion.
From the air, season, and medical treatment, the remittent may be converted
into the intermittent or continued type; in the intermittent there is more
security. In warm climates putrescency and death may ensue in a few
similar remedies. In the medical nomenclature, they are denominated
remittent, semitertian, hemitritea, tritophyea, double and triple tertian,
putrid remittent, marsh, camp, ardent, bilious fevers, gall sickness: tertian
fever obscured under a mist of one or more dangerous and prominent
symptoms; hence named tertiana lethargica, vertiginosa, soporosa,
apoplectica, paralytica, cataleptica, epileptica, convulsiva, phrenitica,
hysterica, syncopalis, asthmatica, arthritica, cardialgica, singultuosa,
rheumatica, pleuritica, dysenterica, atrabilaria, cholerica, emetica,
diaphoretica, pituitosa, miliaris, scorbutica.
Exclusive of the symptoms common to such fevers, and partly delineated
under the intermittent paroxism, remittent fevers are variously diversified
by a rotine and medley of nervous, putrid, and inflammatory symptoms; but
infinitely more of the two former. The climate, season of the year,
remissions, and the notorious epidemick or endemick of that region or
place, all contribute to their unerring detection. Sometimes they attack very
suddenly and violently with delirium and inflammatory simulation; but
soon afterwards, and at the interval of a few days, remissions are evident.
Sometimes their approach is in appearance mild, but not less alarming. In
general there are great lassitude, debility, anxiety, restlessness, severe
headach, frequently delirium, especially at the exacerbations; disturbed
sleep, and not refreshing; sickness at the stomach, nausea, bilious vomiting,
or efforts to evacuate the ventricular contents; fecal excretion bilious with
gripes; inextinguishable thirst; tongue dry and parched; quick hot
respiration; skin sometimes dry. When bile is redundant, the intestinal
excretion is often putrid and offensive, with bilious diarrhœa or dysentery,
in repetition and quantity profuse, exciting tenesmus, and sometimes
excoriation of the anus; to these may be added pain in the stomach and
intestines, tension and elevation of the belly. According to Lind, the tropical
remittents are the most virulent, yet are not contagious, unless accompanied
with dysentery, or the sick crowded together; which, if an irrefragable fact,
distinguishes this fever from the nervous and putrid: and besides, in those
febrile epidemicks and endemicks, from marshy effluvia, the remissions are
more perceptible and synchronous than in these from animal contagion.
From the air, season, and medical treatment, the remittent may be converted
into the intermittent or continued type; in the intermittent there is more
security. In warm climates putrescency and death may ensue in a few
Page 80
paroxisms; in others, in all the intervals during three weeks: and usually the
crisis is by some of the larger excretories.
Nervous and Putrid Fevers. This febrile host are also widely dispersed over
the earth; and probably are not so much governed or influenced as the
preceding remittents by the climate, season, and sensible qualities of the
atmosphere; but may originate in all countries, climates, seasons, and
situations; and when extremely virulent, may, like the plague or small pox,
be communicated by imperceptible emanation or contagion from one
infected person to another; by personal intercourse, by the medium of
polluted goods, furniture, apparel, cloaths, and houses; in all which the
noxious miasma may be concentrated and lodged. Sometimes they harrass a
nation or city in detachment only; and sometimes in formidable phalanx.
Such fevers are frequently engendered in jails, crowded with filth and
animal steams, and excluded from free ventilation: also in military
hospitals, crammed with sick, with dysenteries, putrid sores, and
mortifications: also in ships and large fleets, when hastened out in the hurry
and spur of approaching hostilities: also in wet and stormy weather at sea,
when the hatches are closed.
In cities, contagious fevers may be traced to prisons, perhaps sometimes to
hospitals; certainly often to narrow courts and alleys, and small crowded
apartments; to the houses of the indigent; to filth, rags, and squalid poverty,
co-operating with foul unventilated air: and in the open perflated streets, are
much less frequent. Cities, therefore, should be more infested with them
than the country; and the poor more than the affluent. Children with adults
are subject to them, but more of the latter. In London, perhaps, nine-tenths
of the fevers, are of the remittent, nervous, and putrid type, and not of the
simple inflammatory. But I exclude from this calculation the exanthematous
order, and the topical inflammations. Some, not without argument, alledge,
that slow nervous fevers are in general derived from the same origin; and
that they differ from the putrid in degree only. Petechial spots are by no
means constant symptoms of the putrid type; but when they occur, they
point out the disease more unerringly, and its greater malignity. In many
instances, their differences may be rationally imputed to climate, season,
constitution, miasma, and medical treatment.
I meet with inextricable embarrassment, in endeavouring to draw the exact
limits, not only between nervous and putrid fevers, but also between them
crisis is by some of the larger excretories.
Nervous and Putrid Fevers. This febrile host are also widely dispersed over
the earth; and probably are not so much governed or influenced as the
preceding remittents by the climate, season, and sensible qualities of the
atmosphere; but may originate in all countries, climates, seasons, and
situations; and when extremely virulent, may, like the plague or small pox,
be communicated by imperceptible emanation or contagion from one
infected person to another; by personal intercourse, by the medium of
polluted goods, furniture, apparel, cloaths, and houses; in all which the
noxious miasma may be concentrated and lodged. Sometimes they harrass a
nation or city in detachment only; and sometimes in formidable phalanx.
Such fevers are frequently engendered in jails, crowded with filth and
animal steams, and excluded from free ventilation: also in military
hospitals, crammed with sick, with dysenteries, putrid sores, and
mortifications: also in ships and large fleets, when hastened out in the hurry
and spur of approaching hostilities: also in wet and stormy weather at sea,
when the hatches are closed.
In cities, contagious fevers may be traced to prisons, perhaps sometimes to
hospitals; certainly often to narrow courts and alleys, and small crowded
apartments; to the houses of the indigent; to filth, rags, and squalid poverty,
co-operating with foul unventilated air: and in the open perflated streets, are
much less frequent. Cities, therefore, should be more infested with them
than the country; and the poor more than the affluent. Children with adults
are subject to them, but more of the latter. In London, perhaps, nine-tenths
of the fevers, are of the remittent, nervous, and putrid type, and not of the
simple inflammatory. But I exclude from this calculation the exanthematous
order, and the topical inflammations. Some, not without argument, alledge,
that slow nervous fevers are in general derived from the same origin; and
that they differ from the putrid in degree only. Petechial spots are by no
means constant symptoms of the putrid type; but when they occur, they
point out the disease more unerringly, and its greater malignity. In many
instances, their differences may be rationally imputed to climate, season,
constitution, miasma, and medical treatment.
I meet with inextricable embarrassment, in endeavouring to draw the exact
limits, not only between nervous and putrid fevers, but also between them
Page 81
and what some authors have termed the universal remittent of this island;
and which is not limited to any season of the year. I take this opportunity,
therefore, to avow, that in what proportion these very general fevers with
remissions originate from marshy effluvia, from climate, and constitutional
indisposition, from animal contagion, or from other occult causes, I am
unable to decide: Their precise relation as to lineage and consanguinity, is
beyond my penetration. Nervous and putrid fevers have been described
under the following different names: slow nervous fevers, febricula,
maligna lenta insidiose mitis, nervous and putrid fevers, putrid remittents,
typhus castrensis, jail, hospital, infectious, putrid, malignant, continued,
putrid, spotted, purple, petechial fevers; yellow fever of the West Indies, or
typhus Icterodes.
Slow nervous fever frequently steals on with treacherous mildness; the sick
are rendered unfit for business, but yet not confined to bed, and except to
sagacious judges, the fever is not apparently alarming; and too often the
sick and their friends are lulled into fatal security. The symptoms slight
alternate chills and fugacious heats, especially in the evenings; heaviness,
giddiness, and headach, particularly in the posterior and superior part, and
the pain often descending down the spine; great debility and prostration of
strength; and in both nervous and putrid, the functions of the brain, and of
muscular motion, considerably weakened, and interrupted; also depression
of spirits, sighing, restlessness, very little sleep and not refreshing;
accelerated, weak, and small pulse; nausea, total inappetency;
inconsiderable heat of the skin or thirst; dry tongue, a little yellow at the
sides; pale urine, and without sediment; irregular sweats; sometimes pains
resembling rheumatick. After a few days, the fever, stupor, delirium, and
headach increase, with low muttering delirium, chiefly during the nocturnal
exacerbation, and with noise in the ears, and universal debility of the
corporeal and mental organs. The remissions are generally more distinct in
the beginning, and, by degrees, more obscure.
Putrid fever sometimes creeps on with deceitful approach under the nervous
cloak; and sometimes, with furious onset, counterfeits the inflammatory.
The symptoms when radicated and inveterate are, unremitting headach, pain
in the back and loins, and course of the spine; vertigo, throbbing of the
temporal and carotid arteries, noise in the ears; delirium, extreme
diminution of strength and despondency of mind, trembling of the hands
and which is not limited to any season of the year. I take this opportunity,
therefore, to avow, that in what proportion these very general fevers with
remissions originate from marshy effluvia, from climate, and constitutional
indisposition, from animal contagion, or from other occult causes, I am
unable to decide: Their precise relation as to lineage and consanguinity, is
beyond my penetration. Nervous and putrid fevers have been described
under the following different names: slow nervous fevers, febricula,
maligna lenta insidiose mitis, nervous and putrid fevers, putrid remittents,
typhus castrensis, jail, hospital, infectious, putrid, malignant, continued,
putrid, spotted, purple, petechial fevers; yellow fever of the West Indies, or
typhus Icterodes.
Slow nervous fever frequently steals on with treacherous mildness; the sick
are rendered unfit for business, but yet not confined to bed, and except to
sagacious judges, the fever is not apparently alarming; and too often the
sick and their friends are lulled into fatal security. The symptoms slight
alternate chills and fugacious heats, especially in the evenings; heaviness,
giddiness, and headach, particularly in the posterior and superior part, and
the pain often descending down the spine; great debility and prostration of
strength; and in both nervous and putrid, the functions of the brain, and of
muscular motion, considerably weakened, and interrupted; also depression
of spirits, sighing, restlessness, very little sleep and not refreshing;
accelerated, weak, and small pulse; nausea, total inappetency;
inconsiderable heat of the skin or thirst; dry tongue, a little yellow at the
sides; pale urine, and without sediment; irregular sweats; sometimes pains
resembling rheumatick. After a few days, the fever, stupor, delirium, and
headach increase, with low muttering delirium, chiefly during the nocturnal
exacerbation, and with noise in the ears, and universal debility of the
corporeal and mental organs. The remissions are generally more distinct in
the beginning, and, by degrees, more obscure.
Putrid fever sometimes creeps on with deceitful approach under the nervous
cloak; and sometimes, with furious onset, counterfeits the inflammatory.
The symptoms when radicated and inveterate are, unremitting headach, pain
in the back and loins, and course of the spine; vertigo, throbbing of the
temporal and carotid arteries, noise in the ears; delirium, extreme
diminution of strength and despondency of mind, trembling of the hands
Page 82
and tongue when thrust out; anxiety, restlessness, or no refreshing sleep;
intense burning heat of the skin, especially in the evenings; nausea, bitter
taste in the mouth, vomiting of green or black bile: sometimes insatiable
thirst; at other times the sick are insensible to thirst and heat, and only
complain of universal languor and weariness; the tongue, teeth, and lips
covered with a brown or black tenacious crust, with thrush and ulcers; the
fecal excretion black, and fetid; the breath and perspiration offensive to the
smell; the pulse progressively small, irregular, and quick, often 130 to 140
pulsations, even in adults, every minute; the eyes glazy, the vessels of the
tunica albugina turgid with blood, and what is called blood-shot: in stages
of still more virulency, petechial eruption sprinkled on the skin, with
hemorrhages from the gums and nose, and hemorrhagick subcutaneous
extravasations. In the yellow fever of the West Indies, there is a jaundice-
colour of the eyes.
In the duration, crisis, and termination of nervous and putrid fevers, there is
considerable diversity. Some may be suddenly stifled before they burst into
a flame: some of inveterate malignity may prove fatal in a few days; others
may terminate in all the intervals within three weeks, or even later. Some
terminate auspiciously without any sensible crisis or evacuation: in others,
there is more or less sensible defecation by some of the excretories, by
perspiration and sweat; diarrhœa and fetid stools; turbid urine; exspuition
and salivation; vomiting; tumor of the parotid glands; eruption about the
mouth.
Miliary fever, febris purpurata, rubra and alba, is never epidemick, and is
denied to be a primary disease; but is spurious, symptomatick, accessary, or
fortuitous; it is very rare, and may be complicated with the nervous and
putrid, and with small pox and measles. The miliaris alba is more frequent
amongst the female sex, especially during the puerperal state, and in other
females debilitated by fluor albus, and hemorrhages, of weak constitutions,
delicate, prolifick. It sometimes exhibits previous symptoms of angina,
pleurisy, catarrh, rheumatism, erysipelas. Its peculiar diagnosticks are
extreme languor, anxiety, despondency, terror, sighing, prostration of
strength, headach, delirium, restlessness, quick weak pulse, oppression of
the breast and stomach, dry cough without expectoration; sometimes
profuse sweats towards the third day or later, and the sooner the worse;
inextinguishable thirst; urine and stools various. In different stages of the
intense burning heat of the skin, especially in the evenings; nausea, bitter
taste in the mouth, vomiting of green or black bile: sometimes insatiable
thirst; at other times the sick are insensible to thirst and heat, and only
complain of universal languor and weariness; the tongue, teeth, and lips
covered with a brown or black tenacious crust, with thrush and ulcers; the
fecal excretion black, and fetid; the breath and perspiration offensive to the
smell; the pulse progressively small, irregular, and quick, often 130 to 140
pulsations, even in adults, every minute; the eyes glazy, the vessels of the
tunica albugina turgid with blood, and what is called blood-shot: in stages
of still more virulency, petechial eruption sprinkled on the skin, with
hemorrhages from the gums and nose, and hemorrhagick subcutaneous
extravasations. In the yellow fever of the West Indies, there is a jaundice-
colour of the eyes.
In the duration, crisis, and termination of nervous and putrid fevers, there is
considerable diversity. Some may be suddenly stifled before they burst into
a flame: some of inveterate malignity may prove fatal in a few days; others
may terminate in all the intervals within three weeks, or even later. Some
terminate auspiciously without any sensible crisis or evacuation: in others,
there is more or less sensible defecation by some of the excretories, by
perspiration and sweat; diarrhœa and fetid stools; turbid urine; exspuition
and salivation; vomiting; tumor of the parotid glands; eruption about the
mouth.
Miliary fever, febris purpurata, rubra and alba, is never epidemick, and is
denied to be a primary disease; but is spurious, symptomatick, accessary, or
fortuitous; it is very rare, and may be complicated with the nervous and
putrid, and with small pox and measles. The miliaris alba is more frequent
amongst the female sex, especially during the puerperal state, and in other
females debilitated by fluor albus, and hemorrhages, of weak constitutions,
delicate, prolifick. It sometimes exhibits previous symptoms of angina,
pleurisy, catarrh, rheumatism, erysipelas. Its peculiar diagnosticks are
extreme languor, anxiety, despondency, terror, sighing, prostration of
strength, headach, delirium, restlessness, quick weak pulse, oppression of
the breast and stomach, dry cough without expectoration; sometimes
profuse sweats towards the third day or later, and the sooner the worse;
inextinguishable thirst; urine and stools various. In different stages of the
Page 83
fever, after a few days, a cutaneous efflorescence is perceivable, from
which the disease takes its name, preceded by and accompanied with
itching and pricking heat of the skin, and eruption of diminutive pustules,
the size of millet seed, and, by the fingers, may be felt prominent: they are
rarely seen on the face; commonly on the neck, back, breast, and
extremities; some of them change into small serous vesications, distinct or
clustered, and emitting a peculiar sour odour: of these there is often a
retrocession and new eruption, variously protracting the fever to a few days,
or even weeks. It is distinguishable from measles by the pruriency and sour
smell, and the absence of morbillous sternutation.
Inflammatory Fevers, synochus continua non putris of Boerhaave. To this
we may add the febris diaria. A different genus of fever, both in its nature
and cure, from the remittent, nervous, and putrid, is the simple
inflammatory. The frequency and the fatality of this fever, is infinitely
inferior to the preceding groups; and in comparison, is as a wasp to a tyger;
or a babe to Hercules. The false lights hung out successively by multitudes
of authors, and transmitted, in some degree, through the Boerhaavean
school, to steer with the antiphlogistick compass and lancet in each hand, in
the generality of fevers, have been the cause of numerous shipwrecks.
Inflammatory fever is frequently complicated with some local
inflammation, and then is distinguished under a different name, and
hereafter described. Pringle observes, that in military camps, pleurisies, and
peripneumonies are the most frequent form of fever with inflammation; and
next to these acute rheumatisms.
The predominancy and reign of inflammatory fever in northern latitudes, is
in winter and spring, in cold climates and rigorous seasons, and where cold
and moisture are combined. It commonly attacks the robust, strong,
athletick, and those in the vigour of life: it is not contagious; and neither its
remission nor exacerbation are conspicuous. Its assault is sudden and
violent, with severe headach, quick laborious respiration, interrupted sleep
and restlessness, or sometimes somnolency; sometimes delirium; but in
general the mental functions are not greatly disordered, nor the muscular
debility so great as in the nervous and putrid fevers: pulse accelerated,
strong, full, and tense; commotion and throbbing of the temporal and
carotid arteries; intense heat of the skin, dryness of the mouth, fauces,
tongue, and nose; ingurgitation of drink with avidity; the urine somewhat
which the disease takes its name, preceded by and accompanied with
itching and pricking heat of the skin, and eruption of diminutive pustules,
the size of millet seed, and, by the fingers, may be felt prominent: they are
rarely seen on the face; commonly on the neck, back, breast, and
extremities; some of them change into small serous vesications, distinct or
clustered, and emitting a peculiar sour odour: of these there is often a
retrocession and new eruption, variously protracting the fever to a few days,
or even weeks. It is distinguishable from measles by the pruriency and sour
smell, and the absence of morbillous sternutation.
Inflammatory Fevers, synochus continua non putris of Boerhaave. To this
we may add the febris diaria. A different genus of fever, both in its nature
and cure, from the remittent, nervous, and putrid, is the simple
inflammatory. The frequency and the fatality of this fever, is infinitely
inferior to the preceding groups; and in comparison, is as a wasp to a tyger;
or a babe to Hercules. The false lights hung out successively by multitudes
of authors, and transmitted, in some degree, through the Boerhaavean
school, to steer with the antiphlogistick compass and lancet in each hand, in
the generality of fevers, have been the cause of numerous shipwrecks.
Inflammatory fever is frequently complicated with some local
inflammation, and then is distinguished under a different name, and
hereafter described. Pringle observes, that in military camps, pleurisies, and
peripneumonies are the most frequent form of fever with inflammation; and
next to these acute rheumatisms.
The predominancy and reign of inflammatory fever in northern latitudes, is
in winter and spring, in cold climates and rigorous seasons, and where cold
and moisture are combined. It commonly attacks the robust, strong,
athletick, and those in the vigour of life: it is not contagious; and neither its
remission nor exacerbation are conspicuous. Its assault is sudden and
violent, with severe headach, quick laborious respiration, interrupted sleep
and restlessness, or sometimes somnolency; sometimes delirium; but in
general the mental functions are not greatly disordered, nor the muscular
debility so great as in the nervous and putrid fevers: pulse accelerated,
strong, full, and tense; commotion and throbbing of the temporal and
carotid arteries; intense heat of the skin, dryness of the mouth, fauces,
tongue, and nose; ingurgitation of drink with avidity; the urine somewhat
Page 84
crimson in tincture, and in small quantity; the belly generally costive; the
blood drawn, forming a buffy incrustation on the contracted coagulum,
complete its portrait. The natural crisis is various by nasal hemorrhage, by
sweats, turbid urine, diarrhœa; and the duration of the fever from four to
eleven days. The Febris Diaria of a few days continuance, is a sort of minor
or infant species, an appendix of the inflammatory: it begins suddenly with
nausea, vomiting, shivering, cold, headach, lassitude, heat of the skin,
flushed face, restlessness, or disturbed sleep, strong quick pulse: and is
rarely dangerous.
With respect to all the preceding confederate genera of fevers, we shall
make the following general observation. In the preceding century, during
the last thirty years, febrile mortality, by the London bills, is rated at
87,645: and the mortality of the present century is seen in the Chart.
Formerly, in this metropolis and island, and probably throughout Europe,
fevers seem to have been much more prevalent and fatal than at present:
their essential nature and cure is now much better understood by physicians;
and we are provided with far more powerful auxiliary remedies, and are
more expert in their application. In this particular instance, modern
medicine, especially of the century in which we live, is signalized, and may,
without arrogance, claim triumphal honours. The supposed innumerable
varieties of fevers, and from which perplexity Sydenham could not
altogether extricate himself, is now disproved by repeated experience, and
by the infallible efficacy of general remedies. It is, however, as yet
impossible to fix any definite medium or average of mortality in the above
genera of fevers, whether remittent, nervous, putrid, or inflammatory. We
have modern authentick records, wherein, under judicious and skilful
treatment, of 200 sick in remittent fevers only one died; and even in the
nervous and putrid, the blanks were trifling compared to the prizes;
whereas, under different and erroneous management, one half, and often the
greatest part of the sick perished. The corroboration of these assertions may
be seen in those learned authors, Lind, Millar, Robinson, Clarke, Lettsom,
Sims, and others.
Throughout the intire morbid host of human foes, there is probably no such
flagrant variation in the therapeutick barometer, or scale of mortality, as in
that of the fevers hitherto described. Different curatory processes and
remedies soon change the natural genus, symptoms, crisis, prognosticks,
blood drawn, forming a buffy incrustation on the contracted coagulum,
complete its portrait. The natural crisis is various by nasal hemorrhage, by
sweats, turbid urine, diarrhœa; and the duration of the fever from four to
eleven days. The Febris Diaria of a few days continuance, is a sort of minor
or infant species, an appendix of the inflammatory: it begins suddenly with
nausea, vomiting, shivering, cold, headach, lassitude, heat of the skin,
flushed face, restlessness, or disturbed sleep, strong quick pulse: and is
rarely dangerous.
With respect to all the preceding confederate genera of fevers, we shall
make the following general observation. In the preceding century, during
the last thirty years, febrile mortality, by the London bills, is rated at
87,645: and the mortality of the present century is seen in the Chart.
Formerly, in this metropolis and island, and probably throughout Europe,
fevers seem to have been much more prevalent and fatal than at present:
their essential nature and cure is now much better understood by physicians;
and we are provided with far more powerful auxiliary remedies, and are
more expert in their application. In this particular instance, modern
medicine, especially of the century in which we live, is signalized, and may,
without arrogance, claim triumphal honours. The supposed innumerable
varieties of fevers, and from which perplexity Sydenham could not
altogether extricate himself, is now disproved by repeated experience, and
by the infallible efficacy of general remedies. It is, however, as yet
impossible to fix any definite medium or average of mortality in the above
genera of fevers, whether remittent, nervous, putrid, or inflammatory. We
have modern authentick records, wherein, under judicious and skilful
treatment, of 200 sick in remittent fevers only one died; and even in the
nervous and putrid, the blanks were trifling compared to the prizes;
whereas, under different and erroneous management, one half, and often the
greatest part of the sick perished. The corroboration of these assertions may
be seen in those learned authors, Lind, Millar, Robinson, Clarke, Lettsom,
Sims, and others.
Throughout the intire morbid host of human foes, there is probably no such
flagrant variation in the therapeutick barometer, or scale of mortality, as in
that of the fevers hitherto described. Different curatory processes and
remedies soon change the natural genus, symptoms, crisis, prognosticks,
Page 85
and event. No dangerous diseases almost whatsoever, are more successfully
oppugnable under discreet medical regimen; and when entrusted to nature,
from the days of Hippocrates to the present time, they have ever been
extremely fatal. Sorry I am to add, that, perhaps in many instances, the
errors and fatality of nature, have been less destructive than those of
artificial and therapeutick mismanagement. Since the discovery of
antimonials and Peruvian bark, few now, under skilful medical pilots, die,
compared to the multitudes of sick: but still in the aggregate list of funerals,
except perhaps pulmonary Consumptions, it may be doubted whether any
other of the belligerent morbid foes commit such ravages amongst mankind.
Small Pox, natural and inoculated. We have no vestiges, neither in history
nor tradition, of this loathsome disease, nor of the measles, before the
irruption of Mahomet and his followers from the Arabian deserts, about
1,300 years ago; and from whom this extraneous contagion was first
transplanted into Europe. It is little more than 200 years since the
exportation of this exotic poison to the American continent, where it had
never before been seen nor heard of. The havock by this scourge of the
human race, amounts, in London, to nearly a decimation of the inhabitants;
or to about one tenth, or one twelfth. It is equally or oftener much more
fatal throughout the torrid and frigid zones; and in the adult age is more
violent than in childhood. It attacks the same person but once in life: had
this not been the case, the human race must long since have been extinct.
On a promiscuous average, one of every seven infected die of the natural
disease; but under inoculation only 1 of 500. Besides, to the former deadly
catalogue may be superadded a frightful train of mangled constitutions and
countenances, of consumptions, abscesses, ulcers, opthalmias, blindness.
In every large metropolis, small pox is an annual epidemick. In country
towns and open districts, its invasions are more distant; at uncertain
intervals of some years, when numbers contiguous are attacked at the same
time. In our climate, it is alledged to be most prevalent in spring and
autumn. Very few of the human species escape the small pox, especially in
populous cities and towns, wherein there is always lasting variolous fuel, or,
lurking embers: a wooden horse with ferocious foes in ambuscade, tolerated
within their walls, rioting in human slaughter, and infantile immolation. It
might easily be demonstrated, that in London, and probably in all other
large cities, variolous ravages are principally amongst children under five
oppugnable under discreet medical regimen; and when entrusted to nature,
from the days of Hippocrates to the present time, they have ever been
extremely fatal. Sorry I am to add, that, perhaps in many instances, the
errors and fatality of nature, have been less destructive than those of
artificial and therapeutick mismanagement. Since the discovery of
antimonials and Peruvian bark, few now, under skilful medical pilots, die,
compared to the multitudes of sick: but still in the aggregate list of funerals,
except perhaps pulmonary Consumptions, it may be doubted whether any
other of the belligerent morbid foes commit such ravages amongst mankind.
Small Pox, natural and inoculated. We have no vestiges, neither in history
nor tradition, of this loathsome disease, nor of the measles, before the
irruption of Mahomet and his followers from the Arabian deserts, about
1,300 years ago; and from whom this extraneous contagion was first
transplanted into Europe. It is little more than 200 years since the
exportation of this exotic poison to the American continent, where it had
never before been seen nor heard of. The havock by this scourge of the
human race, amounts, in London, to nearly a decimation of the inhabitants;
or to about one tenth, or one twelfth. It is equally or oftener much more
fatal throughout the torrid and frigid zones; and in the adult age is more
violent than in childhood. It attacks the same person but once in life: had
this not been the case, the human race must long since have been extinct.
On a promiscuous average, one of every seven infected die of the natural
disease; but under inoculation only 1 of 500. Besides, to the former deadly
catalogue may be superadded a frightful train of mangled constitutions and
countenances, of consumptions, abscesses, ulcers, opthalmias, blindness.
In every large metropolis, small pox is an annual epidemick. In country
towns and open districts, its invasions are more distant; at uncertain
intervals of some years, when numbers contiguous are attacked at the same
time. In our climate, it is alledged to be most prevalent in spring and
autumn. Very few of the human species escape the small pox, especially in
populous cities and towns, wherein there is always lasting variolous fuel, or,
lurking embers: a wooden horse with ferocious foes in ambuscade, tolerated
within their walls, rioting in human slaughter, and infantile immolation. It
might easily be demonstrated, that in London, and probably in all other
large cities, variolous ravages are principally amongst children under five
Page 86
years of age. Without entering into any elaborate argumentation, or proofs
of this assertion, the reader may, in some degree, be convinced, by only
turning his eye to the first Chart, and to a small table of London mortality
during ten years; wherein he will observe the trifling annual mortality in the
interval between 5 and 20 years; before which last period, a mere handful of
the native progeny of the metropolis can be supposed to have escaped an
infection with which they are constantly enveloped. It is obvious that the
total annual mortality by all diseases, inclusively, in London during this
adolescent period of life of 15 years, is not equal to variolous carnage
singly. As to inoculation, or artificial engrafting of the contagion, it is
throughout the greatest part of Europe a modern practice of the present
century, and is yet in its cradle. Even in the London small pox hospital,
since its first institution, forty years ago, there have not been inoculated
altogether 25,000.
The cruel carnage perpetrated by small pox throughout the earth; the rooted
prejudices, and the insinuations urged to shackle the universal benefits of
inoculation, and which pervade not only the ignorant mass of the
community, but also the generality of the medical profession throughout
Europe, would abundantly excuse and urge me to be more diffuse on this
interesting and litigated topick. But having, some years ago, published a
small Essay on Inoculation, and having now nearly finished a general
treatise on the natural and inoculated small pox, I shall postpone the result
of much reading and reflection to that republication. An acquiescence in
neutrality or indifference, where it can be proved to mathematical
demonstration that myriads of lives might be preserved, which are now
sacrificed, would, at least in a moral sense, constitute an accessary in
criminality.
Small pox, or variolæ, have been properly discriminated into several
species: the distinct and confluent, or benign and malign; the crystalline,
lymphatick, warty, petechial, and hemorrhagick; the inoculated; the
spurious. The principal differences between small pox consist in the period
of eruption, the number and form of the pustules, the quantity and state of
the fluid contained in them, and the contumacious perseverance of the fever.
The progress of variolous fever has been divided into four stages, that
preceding the eruption; the eruption; the suppuration; and the exsiccation of
the pustules. The first visible effects of the contagion and fever are nausea,
of this assertion, the reader may, in some degree, be convinced, by only
turning his eye to the first Chart, and to a small table of London mortality
during ten years; wherein he will observe the trifling annual mortality in the
interval between 5 and 20 years; before which last period, a mere handful of
the native progeny of the metropolis can be supposed to have escaped an
infection with which they are constantly enveloped. It is obvious that the
total annual mortality by all diseases, inclusively, in London during this
adolescent period of life of 15 years, is not equal to variolous carnage
singly. As to inoculation, or artificial engrafting of the contagion, it is
throughout the greatest part of Europe a modern practice of the present
century, and is yet in its cradle. Even in the London small pox hospital,
since its first institution, forty years ago, there have not been inoculated
altogether 25,000.
The cruel carnage perpetrated by small pox throughout the earth; the rooted
prejudices, and the insinuations urged to shackle the universal benefits of
inoculation, and which pervade not only the ignorant mass of the
community, but also the generality of the medical profession throughout
Europe, would abundantly excuse and urge me to be more diffuse on this
interesting and litigated topick. But having, some years ago, published a
small Essay on Inoculation, and having now nearly finished a general
treatise on the natural and inoculated small pox, I shall postpone the result
of much reading and reflection to that republication. An acquiescence in
neutrality or indifference, where it can be proved to mathematical
demonstration that myriads of lives might be preserved, which are now
sacrificed, would, at least in a moral sense, constitute an accessary in
criminality.
Small pox, or variolæ, have been properly discriminated into several
species: the distinct and confluent, or benign and malign; the crystalline,
lymphatick, warty, petechial, and hemorrhagick; the inoculated; the
spurious. The principal differences between small pox consist in the period
of eruption, the number and form of the pustules, the quantity and state of
the fluid contained in them, and the contumacious perseverance of the fever.
The progress of variolous fever has been divided into four stages, that
preceding the eruption; the eruption; the suppuration; and the exsiccation of
the pustules. The first visible effects of the contagion and fever are nausea,
Page 87
vomiting, soreness at the stomach, drowsiness: before the eruption infants
are prone to startings, and some even to epileptic fits; adults to sweats. The
second stage of eruption is, from three to four days, from the first attack, of
small red spots or pimples on the skin, resembling flea-bites, in number and
quantity extremely various; from one or more, multiplied to many
hundreds. The eruption is commonly first on the face, spreading gradually
over the body and extremities, and is compleated about the fifth or sixth day
from the febrile commencement: and on this eruption, the fever abates or
subsides. In the third stage of maturation the pimples increase daily in size;
are elevated into prominences inflamed at the base; and the suppuration is
compleated between the eighth and eleventh day from the first attack: the
pustules then detached from each other, have risen into small boils, the size
of peas or larger, turgid with pus, gradually becoming opake, yellowish, and
tenacious. In the fourth stage the pustules shrivel or burst, oozing out part of
their contents, and a superficial incrustation is formed, which, after some
days, together with the shrivelled pustules, scales off, leaving the subjacent
skin of a brown red colour. This is the mild form of the disease; but we are
next to describe it under more dangerous and fatal forms.
In the Confluent small pox, the revolutions are the same, but the symptoms
more exasperated; the vomiting and the eruptive fever violent, frequently
with coma, or delirium. The eruption protrudes earlier; on the second or
third day, in congregated clusters, like measles, and more numerous on the
face; the fever does not then subside, but increases towards the fifth or sixth
day, and continues throughout the disease. The swelling of the face is
commonly earlier and more severe: and both in confluent and distinct, when
the pustules are numerous on the face and fauces, there is soreness and
inflammation of the throat, hoarseness, and difficulty of swallowing; and
about the eighth day, the eye-lids are closed up with temporary blindness.
On the face, especially, the pustules are small, less elevated, coalescent; and
it is often covered with a universal flat vesicle: the fluid is whitish or
brownish, not yellow and tenacious, or of due maturation and concocted
purulency. The pustular interstices, if any, are pale and flaccid. The facial
intumescence subsides about the tenth or eleventh day: and during these
stages of fermentation and depuration, a salivation commonly ensues,
especially in adults; and in infants a diarrhœa. About the fourth stage the
fever, called secondary, is often renewed with considerable vehemence, and
with various duration and event. In the latter stages the pustules excite
are prone to startings, and some even to epileptic fits; adults to sweats. The
second stage of eruption is, from three to four days, from the first attack, of
small red spots or pimples on the skin, resembling flea-bites, in number and
quantity extremely various; from one or more, multiplied to many
hundreds. The eruption is commonly first on the face, spreading gradually
over the body and extremities, and is compleated about the fifth or sixth day
from the febrile commencement: and on this eruption, the fever abates or
subsides. In the third stage of maturation the pimples increase daily in size;
are elevated into prominences inflamed at the base; and the suppuration is
compleated between the eighth and eleventh day from the first attack: the
pustules then detached from each other, have risen into small boils, the size
of peas or larger, turgid with pus, gradually becoming opake, yellowish, and
tenacious. In the fourth stage the pustules shrivel or burst, oozing out part of
their contents, and a superficial incrustation is formed, which, after some
days, together with the shrivelled pustules, scales off, leaving the subjacent
skin of a brown red colour. This is the mild form of the disease; but we are
next to describe it under more dangerous and fatal forms.
In the Confluent small pox, the revolutions are the same, but the symptoms
more exasperated; the vomiting and the eruptive fever violent, frequently
with coma, or delirium. The eruption protrudes earlier; on the second or
third day, in congregated clusters, like measles, and more numerous on the
face; the fever does not then subside, but increases towards the fifth or sixth
day, and continues throughout the disease. The swelling of the face is
commonly earlier and more severe: and both in confluent and distinct, when
the pustules are numerous on the face and fauces, there is soreness and
inflammation of the throat, hoarseness, and difficulty of swallowing; and
about the eighth day, the eye-lids are closed up with temporary blindness.
On the face, especially, the pustules are small, less elevated, coalescent; and
it is often covered with a universal flat vesicle: the fluid is whitish or
brownish, not yellow and tenacious, or of due maturation and concocted
purulency. The pustular interstices, if any, are pale and flaccid. The facial
intumescence subsides about the tenth or eleventh day: and during these
stages of fermentation and depuration, a salivation commonly ensues,
especially in adults; and in infants a diarrhœa. About the fourth stage the
fever, called secondary, is often renewed with considerable vehemence, and
with various duration and event. In the latter stages the pustules excite
Page 88
intolerable itching of the skin, and, if not prevented, incessant scratching
and cutaneous denudation: the breath, exhalations and excretions are then
offensive to the smell. In the mild distinct, the pustules commonly begin to
dry on the ninth day, and continue to the fourteenth in a process of
exsiccation; but in the confluent, this stage begins about the eleventh day.
The following are all unfavourable omens in small pox: Sudden and
premature eruption of pustules. In this first stage, infants, especially before
dentition, are sometimes snatched off in epileptick fits. The more small pox
appear in the confluent, or in the distinct form, they are more or less
perilous. It is only where the distinct are crowded with pustules on the face;
or accompanied with fever and putrescency; or with pustules warty and
lymphatick, that they are dangerous. Or, a natural mild small pox may be
rendered malignant from confined air, heated room, and regimen. In the
catalogue of unfavourable symptoms, are the fever continuing pertinaceous;
and with putrescency it is still more dangerous: the pustules not sufficiently
filled and distended, hard, or warty, or not filled with maturated pus; the top
of the pustules depressed; pale interstices at their base; sudden retrocession
or subsidence of the pustules during the stage of maturation: severe
inflammation of the fauces; difficult deglutition; severe pain at the stomach.
The secondary fever arising commonly about the recession and exsiccation
of the pustules, or ebb of maturation, is the most dangerous period of small
pox. The variolous crisis then is generally by diarrhœa, or turbid urine, or
both conjointly, or by salivation. It is evident that, as the cutaneous pores
are blocked up, the absorbed, and other floating pus, must be defecated by
some grosser excretory. Additional symptoms of alarm, especially in the
confluent, are, if the suppurating stage of the fever continues severe, the
salivation ceases, and the hands do not then swell. When the putrescency is
virulent, the disease sometimes proves fatal in a few days; but in most cases
on the eleventh, and sometimes not until the fourteenth or seventeenth.
Fatal symptoms of putrescency are petechiæ, and bloody pustules; putrid
urine and stools; tumid emphysematous abdomen.
Inoculated Small Pox. Between seven and nine days, some slight fever
succeeded by an eruption of pustules; in general not numerous, and the
patients are very seldom confined to bed, or indisposed. In ninety-nine
cases out of an hundred, inoculation produces a distinct small pox, void of
danger. After inoculation from the maturated pustules of real small pox, and
and cutaneous denudation: the breath, exhalations and excretions are then
offensive to the smell. In the mild distinct, the pustules commonly begin to
dry on the ninth day, and continue to the fourteenth in a process of
exsiccation; but in the confluent, this stage begins about the eleventh day.
The following are all unfavourable omens in small pox: Sudden and
premature eruption of pustules. In this first stage, infants, especially before
dentition, are sometimes snatched off in epileptick fits. The more small pox
appear in the confluent, or in the distinct form, they are more or less
perilous. It is only where the distinct are crowded with pustules on the face;
or accompanied with fever and putrescency; or with pustules warty and
lymphatick, that they are dangerous. Or, a natural mild small pox may be
rendered malignant from confined air, heated room, and regimen. In the
catalogue of unfavourable symptoms, are the fever continuing pertinaceous;
and with putrescency it is still more dangerous: the pustules not sufficiently
filled and distended, hard, or warty, or not filled with maturated pus; the top
of the pustules depressed; pale interstices at their base; sudden retrocession
or subsidence of the pustules during the stage of maturation: severe
inflammation of the fauces; difficult deglutition; severe pain at the stomach.
The secondary fever arising commonly about the recession and exsiccation
of the pustules, or ebb of maturation, is the most dangerous period of small
pox. The variolous crisis then is generally by diarrhœa, or turbid urine, or
both conjointly, or by salivation. It is evident that, as the cutaneous pores
are blocked up, the absorbed, and other floating pus, must be defecated by
some grosser excretory. Additional symptoms of alarm, especially in the
confluent, are, if the suppurating stage of the fever continues severe, the
salivation ceases, and the hands do not then swell. When the putrescency is
virulent, the disease sometimes proves fatal in a few days; but in most cases
on the eleventh, and sometimes not until the fourteenth or seventeenth.
Fatal symptoms of putrescency are petechiæ, and bloody pustules; putrid
urine and stools; tumid emphysematous abdomen.
Inoculated Small Pox. Between seven and nine days, some slight fever
succeeded by an eruption of pustules; in general not numerous, and the
patients are very seldom confined to bed, or indisposed. In ninety-nine
cases out of an hundred, inoculation produces a distinct small pox, void of
danger. After inoculation from the maturated pustules of real small pox, and
Page 89
the usual symptoms of impregnation, mankind are ever after invulnerable
by this contagion.
Chicken Pox. Bastard or spurious; and distinguished under the apellation of
petite verole volante, stein pox, and swain pox. They are sometimes
epidemick, but inoffensive; and have given rise to the supposition of a
person’s undergoing the natural small pox a second time. The eruption
forms very quickly into pustules, of which the pus is not concocted, nor
tenacious; and after three or four days, incrustations.
Measles. Morbilli rubeola. From 100 to 120th part of the community seem
to be destroyed by measles. Morbillous mortality is to that of small pox in
the ratio of one to ten or twelve; and consequently may be estimated at one
of seventy-seven whom it attacks. Sydenham, long ago observed, that
measles, if judiciously treated, are attended with very little danger; but he
should at least have qualified the expression, by adding immediate and
considerable danger; for both immediately, and in their future
consequences, they are by no means so innocuous. Few escape this exotick
contagion, especially in childhood and in cities. It attacks the same persons
but once in life; and, with us, is said to be most epidemick in winter.
Morbillous symptoms are fever, impaired appetite, heaviness of the head
and eyes, somnolency, catarrh, acrid defluxion from the fauces, nose, and
eyes, with hoarseness, sneezing, and lachrymation; short dry cough, and
some difficulty in respiration. Prior to the eruption, there is generally
anxiety about the breast, palpitation of the heart, itching of the face,
peevishness, and considerable fever. On the third or fourth day there is an
eruption of small red spots first on the face, resembling the bites of ants or
fleas, generally confluent and entangled, and broad on the trunk and
extremities; but not elevated above the skin, nor rising into pustules, nor
suppurating: the size and shape various and irregular. About the sixth day
the eruption on the face begins to dry, and on the ninth, is totally obliterated
with desquamation of the cuticle. With the eruption the fever frequently
does not cease; and the cough and difficulty in respiration often continue
beyond the eruptive limits and cuticular desquamation. The usual crisis is
by scaling of the cuticle, turbid urine, or diarrhœa. Unfavourable symptoms
are, too sudden or too tardy eruption; pale or yellow eruption; great debility;
and above all, pulmonick inflammation. The last in the train of morbillous
evils and consequences are, consumption, anasarca, ophthalmy. Sometimes,
by this contagion.
Chicken Pox. Bastard or spurious; and distinguished under the apellation of
petite verole volante, stein pox, and swain pox. They are sometimes
epidemick, but inoffensive; and have given rise to the supposition of a
person’s undergoing the natural small pox a second time. The eruption
forms very quickly into pustules, of which the pus is not concocted, nor
tenacious; and after three or four days, incrustations.
Measles. Morbilli rubeola. From 100 to 120th part of the community seem
to be destroyed by measles. Morbillous mortality is to that of small pox in
the ratio of one to ten or twelve; and consequently may be estimated at one
of seventy-seven whom it attacks. Sydenham, long ago observed, that
measles, if judiciously treated, are attended with very little danger; but he
should at least have qualified the expression, by adding immediate and
considerable danger; for both immediately, and in their future
consequences, they are by no means so innocuous. Few escape this exotick
contagion, especially in childhood and in cities. It attacks the same persons
but once in life; and, with us, is said to be most epidemick in winter.
Morbillous symptoms are fever, impaired appetite, heaviness of the head
and eyes, somnolency, catarrh, acrid defluxion from the fauces, nose, and
eyes, with hoarseness, sneezing, and lachrymation; short dry cough, and
some difficulty in respiration. Prior to the eruption, there is generally
anxiety about the breast, palpitation of the heart, itching of the face,
peevishness, and considerable fever. On the third or fourth day there is an
eruption of small red spots first on the face, resembling the bites of ants or
fleas, generally confluent and entangled, and broad on the trunk and
extremities; but not elevated above the skin, nor rising into pustules, nor
suppurating: the size and shape various and irregular. About the sixth day
the eruption on the face begins to dry, and on the ninth, is totally obliterated
with desquamation of the cuticle. With the eruption the fever frequently
does not cease; and the cough and difficulty in respiration often continue
beyond the eruptive limits and cuticular desquamation. The usual crisis is
by scaling of the cuticle, turbid urine, or diarrhœa. Unfavourable symptoms
are, too sudden or too tardy eruption; pale or yellow eruption; great debility;
and above all, pulmonick inflammation. The last in the train of morbillous
evils and consequences are, consumption, anasarca, ophthalmy. Sometimes,
Page 90
though rarely, measles have been seen in accompanyment with other
eruptive fevers, as small pox, and gangrenous angina.
Scarlet fever. Febris scarlatina, ignis facer, scarlatina anginosa. Its mortality
in the London bills is added to the general febrile heap. This contagious
epidemick is most frequent in the infant and adolescent age; it attacks
families and schools about one time; and the same person but once in life;
and is said to be most frequent in winter. It is generally accompanied with
an anginous or ulcerous sore throat, but not putrid. That genus or species of
scarlet fever which usually accompanies angina gangrenosa, and is
extremely dangerous, is hereafter described. The symptoms of simple
scarlet are the usual febrile precursors; on the second, third, or fourth day,
an eruption of broad irregular redness and spots; general or partial only over
the face, trunk, and extremities, and not elevated above the surface:
sometimes overspreading the face with a crimson colour. Concomitant
symptoms are, difficulty of swallowing, and uneasiness in the throat,
redness, tension, and sloughs: commonly also nausea, sickness at the
stomach, vomiting, vertigo, drowsiness, headach, difficulty of breathing,
anxiety. After three or four days more; that is, between the sixth and ninth,
the cutaneous eruption and redness disappears, with desquamation of the
cuticle, and harrassing pruriency. The usual crisis is by sweats, urine, fetid
stools, and exscreation of sloughs. Sometimes, a few days after the cuticular
desquamation, an anasarcous swelling suddenly appears; and during the
convalescent state, from exposure to cold air, or neglect of cutaneous and
other expurgation, anasarca, hydrothorax or ascites have ensued.
There are two or three other febrile eruptions to which authors have
appropriated distinct names, but by which very few of the human race are
destroyed. These are febris urticata, bullosa, and pemphigodes. In general,
they consist of red spots and serous vesicles on different parts of the skin,
exciting heat and itching; the urticata resembling blisters from the burning
of nettles. Some of these are mobile, receding and re-appearing, and prone
to relapse. After a few days, however, or at the utmost a few weeks, they
vanish: and are not contagious nor epidemick.
Plague. Pestis. This febrile demon cannot now be called one of the mortal
epidemicks of Europe, except in the south-east extremity, inhabited by the
Turks. The two greatest pestilences on record, happened in the sixth and
fourteenth centuries of our era; which, with more barbarous havock than
eruptive fevers, as small pox, and gangrenous angina.
Scarlet fever. Febris scarlatina, ignis facer, scarlatina anginosa. Its mortality
in the London bills is added to the general febrile heap. This contagious
epidemick is most frequent in the infant and adolescent age; it attacks
families and schools about one time; and the same person but once in life;
and is said to be most frequent in winter. It is generally accompanied with
an anginous or ulcerous sore throat, but not putrid. That genus or species of
scarlet fever which usually accompanies angina gangrenosa, and is
extremely dangerous, is hereafter described. The symptoms of simple
scarlet are the usual febrile precursors; on the second, third, or fourth day,
an eruption of broad irregular redness and spots; general or partial only over
the face, trunk, and extremities, and not elevated above the surface:
sometimes overspreading the face with a crimson colour. Concomitant
symptoms are, difficulty of swallowing, and uneasiness in the throat,
redness, tension, and sloughs: commonly also nausea, sickness at the
stomach, vomiting, vertigo, drowsiness, headach, difficulty of breathing,
anxiety. After three or four days more; that is, between the sixth and ninth,
the cutaneous eruption and redness disappears, with desquamation of the
cuticle, and harrassing pruriency. The usual crisis is by sweats, urine, fetid
stools, and exscreation of sloughs. Sometimes, a few days after the cuticular
desquamation, an anasarcous swelling suddenly appears; and during the
convalescent state, from exposure to cold air, or neglect of cutaneous and
other expurgation, anasarca, hydrothorax or ascites have ensued.
There are two or three other febrile eruptions to which authors have
appropriated distinct names, but by which very few of the human race are
destroyed. These are febris urticata, bullosa, and pemphigodes. In general,
they consist of red spots and serous vesicles on different parts of the skin,
exciting heat and itching; the urticata resembling blisters from the burning
of nettles. Some of these are mobile, receding and re-appearing, and prone
to relapse. After a few days, however, or at the utmost a few weeks, they
vanish: and are not contagious nor epidemick.
Plague. Pestis. This febrile demon cannot now be called one of the mortal
epidemicks of Europe, except in the south-east extremity, inhabited by the
Turks. The two greatest pestilences on record, happened in the sixth and
fourteenth centuries of our era; which, with more barbarous havock than
Page 91
that of Goths or Saracens, overwhelmed millions in three quarters of the
globe in one indiscriminate massacre. In London, before the general
conflagration in 1666, of one half nearly of the old city, the plague was very
frequent: but since that event, or at the most two or three years after, it has
been exterminated and banished from us. That fortunate disaster which
consumed a magazine of putrefaction; together with widened streets,
ventilation, cleanliness, and many other causes, have all contributed to the
extinction of this exotick incendiary. For it is well known, that pestilential
miasma has been preserved dormant many years in porous materials. From
1592 to 1665, the plague appears to have had annually more or less share in
the mortality of the British metropolis; and adding together the different
periods of its duration, amounts to twenty-five years. In 1665, which is the
most furious pestilence in the London annals, the deaths amounted to
100,000; but in the eight preceding years, to only 113. Registers, in other
parts of Europe, prove, that this disease has committed direful carnage since
our emancipation. At Marseilles they can enumerate twenty general
plagues, which have successively laid waste that populous city. Many other
European cities and towns, during the last and present century, and
especially those bordering on the Mediterranean, have, in a very short space
of time, severely smarted by pestilence, and have been nearly depopulated.
At present, in all the Mediterranean ports they are, from fatal experience,
scrupulously vigilant to guard, by a circumvallation of alarm posts, against
the pestilential infection, and the clandestine entry of infected goods or
merchandize. It rarely now gains admittance, by stealth into any of the
European ports; (Constantinople excepted) or even if imported to our
shores, the wise precautions and regulations, enacted by Quarantines, soon
check its irruption and progress. This is a most interesting epoch and
improvement in the police of modern states; for the original institution and
rough draft of which, about 300 years ago, we are indebted to the Venetians.
The political ordinances, however, enacted for the exclusion and
suppression of pestilential contagion, were, until the present century,
extremely erroneous and impolitick. Formerly, the plague in London, and in
most other European cities, where it was permitted to sojourn, was rendered
infinitely more terrifick and destructive by injudicious legislative
regulations; especially by the barbarous sacrifice, and absurd policy of sick
and sound immured together, with a forlorn motto on their doors, until all
were dead or recovered. This was an effectual discouragement against an
globe in one indiscriminate massacre. In London, before the general
conflagration in 1666, of one half nearly of the old city, the plague was very
frequent: but since that event, or at the most two or three years after, it has
been exterminated and banished from us. That fortunate disaster which
consumed a magazine of putrefaction; together with widened streets,
ventilation, cleanliness, and many other causes, have all contributed to the
extinction of this exotick incendiary. For it is well known, that pestilential
miasma has been preserved dormant many years in porous materials. From
1592 to 1665, the plague appears to have had annually more or less share in
the mortality of the British metropolis; and adding together the different
periods of its duration, amounts to twenty-five years. In 1665, which is the
most furious pestilence in the London annals, the deaths amounted to
100,000; but in the eight preceding years, to only 113. Registers, in other
parts of Europe, prove, that this disease has committed direful carnage since
our emancipation. At Marseilles they can enumerate twenty general
plagues, which have successively laid waste that populous city. Many other
European cities and towns, during the last and present century, and
especially those bordering on the Mediterranean, have, in a very short space
of time, severely smarted by pestilence, and have been nearly depopulated.
At present, in all the Mediterranean ports they are, from fatal experience,
scrupulously vigilant to guard, by a circumvallation of alarm posts, against
the pestilential infection, and the clandestine entry of infected goods or
merchandize. It rarely now gains admittance, by stealth into any of the
European ports; (Constantinople excepted) or even if imported to our
shores, the wise precautions and regulations, enacted by Quarantines, soon
check its irruption and progress. This is a most interesting epoch and
improvement in the police of modern states; for the original institution and
rough draft of which, about 300 years ago, we are indebted to the Venetians.
The political ordinances, however, enacted for the exclusion and
suppression of pestilential contagion, were, until the present century,
extremely erroneous and impolitick. Formerly, the plague in London, and in
most other European cities, where it was permitted to sojourn, was rendered
infinitely more terrifick and destructive by injudicious legislative
regulations; especially by the barbarous sacrifice, and absurd policy of sick
and sound immured together, with a forlorn motto on their doors, until all
were dead or recovered. This was an effectual discouragement against an
Page 92
early alarm which, as in cases of fire, is of the utmost importance. It is
evident, by the London bills, that a mere handful, at any time, died in the
publick pest-house; consequently, every corner of the city was polluted with
infection.
True plague is now chiefly chained down to Constantinople, and to Grand
Cairo in Egypt, the two original, or at least one of the hotbeds and volcanos
of pestilence; to several of the maritime towns of Asia and Africa situated
on the Archipelago and Mediterranean; as Smyrna, Aleppo, Tripoli, Tunis,
Algiers, &c. In many of these cities the pestilential miasma is hatched and
accumulated into venomous malignity: it is in some nearly an annual, or
triennial epidemick. At this day, plague almost solely wreaks its venom on
the Mahometan nations, whose prejudices and ignorance, rivetted by
religious and predestinarian absurdities, give licence and activity to its
imperious domination. From such implicit and enthusiastick submission to
the tenets of the Alcoran, joined to gross stupidity in science and
philosophy, the Mahometans are encouraged, defenceless and rash, to brave
this most malignant and terrible of the febrile host.
Fortunately for mankind, the pestilential contagion spreads to a very small
distance through the air, without some contact or adhesion to infected goods
and porous materials; or by personal communication and intercourse of the
sound with the diseased. The atmosphere is not tainted to any considerable
distance. A neighbour barricading himself within his house, at a few yards
distance from infection, may escape unhurt. If pestilential contagion could
be so suddenly and widely scattered over a kingdom as epidemical
influenza, the earth, in a few months, would be converted into an enormous
church-yard. It is not like some other exotick poisons of the exanthematous
order, after enduring which once, mankind are rendered invulnerable: the
plague, as well as putrid fever, may attack the same person repeatedly. What
proportion die or recover, I cannot ascertain; and indeed the prophylactic or
preventitive, is infinitely the most important indication. Its invariable
characteristic features are buboes, carbuncles, and petechiæ. The general
progress of the symptoms are, great abasement of strength and of spirits,
apprehension of death, dejected countenance, and wildness of the eyes;
nausea, vomiting of bile; headach, giddiness, delirium; weak irregular
pulse; petechiæ, hæmorrhages; fetid breath and excretions; buboes or boils
in the inguinal, axillary, or jugular lymphatick glands; and appearing early,
evident, by the London bills, that a mere handful, at any time, died in the
publick pest-house; consequently, every corner of the city was polluted with
infection.
True plague is now chiefly chained down to Constantinople, and to Grand
Cairo in Egypt, the two original, or at least one of the hotbeds and volcanos
of pestilence; to several of the maritime towns of Asia and Africa situated
on the Archipelago and Mediterranean; as Smyrna, Aleppo, Tripoli, Tunis,
Algiers, &c. In many of these cities the pestilential miasma is hatched and
accumulated into venomous malignity: it is in some nearly an annual, or
triennial epidemick. At this day, plague almost solely wreaks its venom on
the Mahometan nations, whose prejudices and ignorance, rivetted by
religious and predestinarian absurdities, give licence and activity to its
imperious domination. From such implicit and enthusiastick submission to
the tenets of the Alcoran, joined to gross stupidity in science and
philosophy, the Mahometans are encouraged, defenceless and rash, to brave
this most malignant and terrible of the febrile host.
Fortunately for mankind, the pestilential contagion spreads to a very small
distance through the air, without some contact or adhesion to infected goods
and porous materials; or by personal communication and intercourse of the
sound with the diseased. The atmosphere is not tainted to any considerable
distance. A neighbour barricading himself within his house, at a few yards
distance from infection, may escape unhurt. If pestilential contagion could
be so suddenly and widely scattered over a kingdom as epidemical
influenza, the earth, in a few months, would be converted into an enormous
church-yard. It is not like some other exotick poisons of the exanthematous
order, after enduring which once, mankind are rendered invulnerable: the
plague, as well as putrid fever, may attack the same person repeatedly. What
proportion die or recover, I cannot ascertain; and indeed the prophylactic or
preventitive, is infinitely the most important indication. Its invariable
characteristic features are buboes, carbuncles, and petechiæ. The general
progress of the symptoms are, great abasement of strength and of spirits,
apprehension of death, dejected countenance, and wildness of the eyes;
nausea, vomiting of bile; headach, giddiness, delirium; weak irregular
pulse; petechiæ, hæmorrhages; fetid breath and excretions; buboes or boils
in the inguinal, axillary, or jugular lymphatick glands; and appearing early,
Page 93
or in the progress of the disease; besides gangrenous carbuncles in different
parts. According to the virulence of the contagion, and other co-operating
causes, the disease may be fatal in a few hours, a few days, or in one, two,
or three weeks. The poison arrested in the lymphatic glands and
suppurating, is a favourable presage. Domestick animals, as quadrupeds and
fowls, are liable to the infection, and to be changed into carrion.
Sweating Sickness, ephemera sudatoria et elodes, cannot now be considered
as an epidemick cause of mortality. Somewhat more than 300 years ago,
this singular contagious and vagrant disease burst out, for the first time, in
the army of Henry VII. in his return to England from an expedition against
France; and in four hours sickness, numbers were exterminated: but by
keeping warm in bed, under profuse sweats, the dangerous whirlpool
generally was escaped. The same infection was imported into England at
several subsequent intervals; but happily, its greatest devastation was
always of short duration; and this morbid meteor has long since disappeared
from our island, and from Europe. Its symptoms were continued profuse
sweats, extreme debility, fainting, anxiety, restlessness, pain in the stomach,
thirst, vertigo, quick irregular pulse. Sometimes it was fatal in one day; and,
if the sick survived to the seventh, they generally recovered. Of the
predisposing and occasional Causes of fevers, intermittent and remittent,
nervous and putrid, inflammatory, small-pox, measles, scarlet, plague,
sweating sickness. The principal causes of the preceding genera of fevers
may conveniently be presented at one view, in abbreviation. We throw to
one side all that specious romance and sapient pomposity, strutting in the
tinsel robes of proximate causes, and merely attend to the predisponent and
occasional. Because, after diving and climbing as assiduously as many of
our fellow-labourers in search of those arcana, we experienced reiterated
retrogradation; and, as in metaphysicks, error supplanted by error. Neither
do we attempt to pry into those latent predispositions in the human
organization, which renders them susceptible to many various febrile
impressions.
The predisposing and occasional causes of intermittent and remittent fevers
are, cloudy winter and autumn: northern morasses: noxious miasma or
emanation from morasses, from countries and soils low, damp, woody,
uncultivated, especially in warm climates, weather, and seasons:
atmosphere moist and hot: foggy atmosphere: unusual irregularity of the
parts. According to the virulence of the contagion, and other co-operating
causes, the disease may be fatal in a few hours, a few days, or in one, two,
or three weeks. The poison arrested in the lymphatic glands and
suppurating, is a favourable presage. Domestick animals, as quadrupeds and
fowls, are liable to the infection, and to be changed into carrion.
Sweating Sickness, ephemera sudatoria et elodes, cannot now be considered
as an epidemick cause of mortality. Somewhat more than 300 years ago,
this singular contagious and vagrant disease burst out, for the first time, in
the army of Henry VII. in his return to England from an expedition against
France; and in four hours sickness, numbers were exterminated: but by
keeping warm in bed, under profuse sweats, the dangerous whirlpool
generally was escaped. The same infection was imported into England at
several subsequent intervals; but happily, its greatest devastation was
always of short duration; and this morbid meteor has long since disappeared
from our island, and from Europe. Its symptoms were continued profuse
sweats, extreme debility, fainting, anxiety, restlessness, pain in the stomach,
thirst, vertigo, quick irregular pulse. Sometimes it was fatal in one day; and,
if the sick survived to the seventh, they generally recovered. Of the
predisposing and occasional Causes of fevers, intermittent and remittent,
nervous and putrid, inflammatory, small-pox, measles, scarlet, plague,
sweating sickness. The principal causes of the preceding genera of fevers
may conveniently be presented at one view, in abbreviation. We throw to
one side all that specious romance and sapient pomposity, strutting in the
tinsel robes of proximate causes, and merely attend to the predisponent and
occasional. Because, after diving and climbing as assiduously as many of
our fellow-labourers in search of those arcana, we experienced reiterated
retrogradation; and, as in metaphysicks, error supplanted by error. Neither
do we attempt to pry into those latent predispositions in the human
organization, which renders them susceptible to many various febrile
impressions.
The predisposing and occasional causes of intermittent and remittent fevers
are, cloudy winter and autumn: northern morasses: noxious miasma or
emanation from morasses, from countries and soils low, damp, woody,
uncultivated, especially in warm climates, weather, and seasons:
atmosphere moist and hot: foggy atmosphere: unusual irregularity of the
Page 94
seasons and atmosphere: unusual continuance of cold rainy weather: damp
night-air, especially in warm unhealthy climates: excessive heats: burning
zones and regions: sudden vicissitudes from heat to cold of the seasons and
weather: unusually excessive and long continued heats: also damp weather,
particularly when unusually warm for the season and climate: damp
ground-floors and habitations: damp sheets and beds: sleeping in the open
air, and on damp ground: sudden stoppage of perspiration: bile depraved,
redundant; septick miasma introduced from without, or generated within the
body: efforts of nature to disencumber its functions and organs of some
clogs or impurities. Perhaps rather contributing as exciting causes are
passions of mind, fatigue, hardships, long watching, hunger, thirst,
intoxication, venery, interruption of the excretions, &c.
The predisposing and occasional causes of nervous and putrid fevers are,
many or perhaps all of the preceding causes: noxious miasma or contagion,
engendered from human effluvia in cities, jails, hospitals, dirty, small,
crowded houses and apartments, especially in unventilated alleys and lanes;
accumulation of corporeal filth from want of cloathing, change of raiment,
slothfulness; contagion concentrated in porous materials, furniture, raiment,
and houses: cadaverous exhalations, effluvia from putrid carcasses of
animals, and from both animal and vegetable heaps in a state of
fermentative putrefaction: damp rainy seasons: bad harvest, and putrid
grain; putrid diet animal or farinaceous: improper medical treatment of
remittent fevers; corrupted bile, or other secerned and excreted fluids,
noxious in quantity or quality: profuse evacuation, immoderate venery,
desponding passions of mind, intemperance in food or drink, stoppage of
perspiration, &c. Of miliary fever the causes are, estuation, hot regimen,
and rooms, during fever or parturition, excessive evacuations, weak
constitutions, debility, depressing passions, moist air, wet summer.
The predisposing and occasional causes of inflammatory fevers and diary
are, cold climate and winter: cold winds: change of seasons: heat of the
atmosphere: insolation: excessive labour, exercise, and fatigue: violent
passions of mind: long watching: cold drink when the body is heated:
intoxication with spirituous liquors: crude chyle: heating stimulating diet:
disordered stomach, plethora: excess of coagulable lymph and its tenacity:
menstrual, lacteal, hæmorrhoidal, arthritick: warm baths; excruciating pain.
night-air, especially in warm unhealthy climates: excessive heats: burning
zones and regions: sudden vicissitudes from heat to cold of the seasons and
weather: unusually excessive and long continued heats: also damp weather,
particularly when unusually warm for the season and climate: damp
ground-floors and habitations: damp sheets and beds: sleeping in the open
air, and on damp ground: sudden stoppage of perspiration: bile depraved,
redundant; septick miasma introduced from without, or generated within the
body: efforts of nature to disencumber its functions and organs of some
clogs or impurities. Perhaps rather contributing as exciting causes are
passions of mind, fatigue, hardships, long watching, hunger, thirst,
intoxication, venery, interruption of the excretions, &c.
The predisposing and occasional causes of nervous and putrid fevers are,
many or perhaps all of the preceding causes: noxious miasma or contagion,
engendered from human effluvia in cities, jails, hospitals, dirty, small,
crowded houses and apartments, especially in unventilated alleys and lanes;
accumulation of corporeal filth from want of cloathing, change of raiment,
slothfulness; contagion concentrated in porous materials, furniture, raiment,
and houses: cadaverous exhalations, effluvia from putrid carcasses of
animals, and from both animal and vegetable heaps in a state of
fermentative putrefaction: damp rainy seasons: bad harvest, and putrid
grain; putrid diet animal or farinaceous: improper medical treatment of
remittent fevers; corrupted bile, or other secerned and excreted fluids,
noxious in quantity or quality: profuse evacuation, immoderate venery,
desponding passions of mind, intemperance in food or drink, stoppage of
perspiration, &c. Of miliary fever the causes are, estuation, hot regimen,
and rooms, during fever or parturition, excessive evacuations, weak
constitutions, debility, depressing passions, moist air, wet summer.
The predisposing and occasional causes of inflammatory fevers and diary
are, cold climate and winter: cold winds: change of seasons: heat of the
atmosphere: insolation: excessive labour, exercise, and fatigue: violent
passions of mind: long watching: cold drink when the body is heated:
intoxication with spirituous liquors: crude chyle: heating stimulating diet:
disordered stomach, plethora: excess of coagulable lymph and its tenacity:
menstrual, lacteal, hæmorrhoidal, arthritick: warm baths; excruciating pain.
Page 95
The predisposing and occasional causes of small pox, measles, scarlet fever,
and sweating sickness, are unknown, both as to their source and nature: the
two first are exotick leavens. Of plague: venomous effluvia in certain hot
climates, from putrid animal exhalations and filth, such as the stagnant
canals and reservoirs of putridity in the city of Grand Cairo: putrid
emanations from swarms of dead locusts. Predisposing causes to pestilential
infection are, long watching, hunger, poor diet, intemperance, excess of
venery, fatigue, terror, fear, debility, low spirits, &c.
With respect to the great sources of fevers, noxious miasma from morasses,
contagion from human effluvia, and animal bodies, and that from specifick
unknown origin, I shall make a few observations. Of what elementary
nature miasma and contagion consist; the analysis of their minute atoms;
whether animalculæ, or to us invisible emanations, I pretend not to decide.
Of small pox, measles, scarlet fever, and sweating sickness, we are totally
ignorant of their origin and essence. We, however, know to a certainty, and
it is of infinitely more importance to the publick safety, that neither marshy
miasma, nor those from human effluvia, spread to any considerable distance
through the air. Even by the plague the atmosphere is tainted to a very
inconsiderable distance; and mankind find an asylum and sanctuary within
a few yards. Nor do marshy miasma emitted from the earth, mount or
diffuse themselves to any considerable distance in the air: the inhabitants at
the top of a hill have continued healthy, whilst those situated in a swamp at
the bottom, have been infested with intermittents, and remittents. To what
distance the contagion of small pox, measles, and scarlet fever extend
through the air, I am ignorant: like the plague, the two former have been
transplanted to distant regions, in animal bodies, or in polluted porous
materials. Another important discovery of modern times is, that by fire and
smoke, the heat of a baker’s oven, the most virulent contagion may be
annihilated, when concentrated in apparel, spungy materials, ships, houses,
&c.
Of Febrile Prognosticks. The event of all the preceding fevers (intermittent
excepted) is terminated with precipitancy in a few days, or, at the utmost, a
few weeks in recovery, in death, or in some other disease. The predictions
in fevers, and indeed in all diseases, should be deduced from the
comparative mortality at different ages; the comparative mortality by
different fevers; the symptoms peculiar to each genus, whether ominous or
and sweating sickness, are unknown, both as to their source and nature: the
two first are exotick leavens. Of plague: venomous effluvia in certain hot
climates, from putrid animal exhalations and filth, such as the stagnant
canals and reservoirs of putridity in the city of Grand Cairo: putrid
emanations from swarms of dead locusts. Predisposing causes to pestilential
infection are, long watching, hunger, poor diet, intemperance, excess of
venery, fatigue, terror, fear, debility, low spirits, &c.
With respect to the great sources of fevers, noxious miasma from morasses,
contagion from human effluvia, and animal bodies, and that from specifick
unknown origin, I shall make a few observations. Of what elementary
nature miasma and contagion consist; the analysis of their minute atoms;
whether animalculæ, or to us invisible emanations, I pretend not to decide.
Of small pox, measles, scarlet fever, and sweating sickness, we are totally
ignorant of their origin and essence. We, however, know to a certainty, and
it is of infinitely more importance to the publick safety, that neither marshy
miasma, nor those from human effluvia, spread to any considerable distance
through the air. Even by the plague the atmosphere is tainted to a very
inconsiderable distance; and mankind find an asylum and sanctuary within
a few yards. Nor do marshy miasma emitted from the earth, mount or
diffuse themselves to any considerable distance in the air: the inhabitants at
the top of a hill have continued healthy, whilst those situated in a swamp at
the bottom, have been infested with intermittents, and remittents. To what
distance the contagion of small pox, measles, and scarlet fever extend
through the air, I am ignorant: like the plague, the two former have been
transplanted to distant regions, in animal bodies, or in polluted porous
materials. Another important discovery of modern times is, that by fire and
smoke, the heat of a baker’s oven, the most virulent contagion may be
annihilated, when concentrated in apparel, spungy materials, ships, houses,
&c.
Of Febrile Prognosticks. The event of all the preceding fevers (intermittent
excepted) is terminated with precipitancy in a few days, or, at the utmost, a
few weeks in recovery, in death, or in some other disease. The predictions
in fevers, and indeed in all diseases, should be deduced from the
comparative mortality at different ages; the comparative mortality by
different fevers; the symptoms peculiar to each genus, whether ominous or
Page 96
propitious; and the general symptoms applicable to an intire group or class.
These enrich medicine with a rudder, compass and quadrant: in them
consist the tactick and the sublime of medical divination. We have already
treated of the three former, and have now only to add the general febrile
predictions.
It is foreign to my plan, to squander time or words, in eulogy or censure of
those elaborate treatises on the pulse and urine, and their presumed
extensive application to the diagnostick and prognostick of diseases. Of
strength and weakness, hardness and softness, fulness and inanition,
slowness, celerity, velocity, saliency, intermission, irregularity, and a few
other distinctions of the circulation and arterial pulsation, we are competent
judges; and of the measurement of velocity to a still greater nicety with the
stop-watch. But, with all due reverence to Galen and his copyists, down to
De Bordeu, in discriminating the multitude and variety, if I may be
permitted the expression, of complicated tones, combinations, divisions,
subdivisions, chromaticks and chords in the arterial vibrations, we confess
the bluntness and incapacity of our tangible organs. We have still fewer
scruples to disclaim that affected sagacity and alchymistical intuition, of
forming auguries from the urine; from its innumerable shades,
intermixtures, pellicles, precipitation, and sediment. This is, even in our
time, one of the decoys in vaticination to inveigle the ignorant and
credulous; the stale manœuvres and chiromancy of vagabond empiricism
and imposture.
A few words will finish our general remarks on the pulse. From physiology,
we know that the whole mass of blood is circulated round the body from the
heart, its lever and center, to the circumference, and back again, in the space
of a few minutes. But in the velocity of the crimson torrent and arterial
pulsation, prodigious variations ensue from age, sex, constitution, peculiar
temperament, climate, season, food, drink, mental passions, exercise, rest,
sleep, waking, health, different diseases, and different periods of the day. It
is therefore, singly, a precarious sign; and did time permit, there would be
no difficulty in demonstrating the urine to be infinitely more fallible. From
infancy to old age, the velocity of the blood decreases, and is one half
slower: in the adult and middle age, between sixty and eighty pulsations
every minute is the usual natural pace: the febrile pulse is marked at 96, and
These enrich medicine with a rudder, compass and quadrant: in them
consist the tactick and the sublime of medical divination. We have already
treated of the three former, and have now only to add the general febrile
predictions.
It is foreign to my plan, to squander time or words, in eulogy or censure of
those elaborate treatises on the pulse and urine, and their presumed
extensive application to the diagnostick and prognostick of diseases. Of
strength and weakness, hardness and softness, fulness and inanition,
slowness, celerity, velocity, saliency, intermission, irregularity, and a few
other distinctions of the circulation and arterial pulsation, we are competent
judges; and of the measurement of velocity to a still greater nicety with the
stop-watch. But, with all due reverence to Galen and his copyists, down to
De Bordeu, in discriminating the multitude and variety, if I may be
permitted the expression, of complicated tones, combinations, divisions,
subdivisions, chromaticks and chords in the arterial vibrations, we confess
the bluntness and incapacity of our tangible organs. We have still fewer
scruples to disclaim that affected sagacity and alchymistical intuition, of
forming auguries from the urine; from its innumerable shades,
intermixtures, pellicles, precipitation, and sediment. This is, even in our
time, one of the decoys in vaticination to inveigle the ignorant and
credulous; the stale manœuvres and chiromancy of vagabond empiricism
and imposture.
A few words will finish our general remarks on the pulse. From physiology,
we know that the whole mass of blood is circulated round the body from the
heart, its lever and center, to the circumference, and back again, in the space
of a few minutes. But in the velocity of the crimson torrent and arterial
pulsation, prodigious variations ensue from age, sex, constitution, peculiar
temperament, climate, season, food, drink, mental passions, exercise, rest,
sleep, waking, health, different diseases, and different periods of the day. It
is therefore, singly, a precarious sign; and did time permit, there would be
no difficulty in demonstrating the urine to be infinitely more fallible. From
infancy to old age, the velocity of the blood decreases, and is one half
slower: in the adult and middle age, between sixty and eighty pulsations
every minute is the usual natural pace: the febrile pulse is marked at 96, and
Page 97
is sometimes spurred to 130 or 140; and in infants sometimes outstrips the
divisions of time or accurate mensuration.
All fevers with dangerous symptoms may be termed malignant; but in
general, this term is appropriated to fevers, intermittent, remittent, nervous,
putrid, exanthematous, and also to some of those complicated with topical
inflammation. General prognosticks of danger are indicated by a
concatenation of few or many of the following symptoms, which may, in
some degree, be transposed to the intire febrile class; and to the phlogistick
order not yet surveyed: as the brain, lungs, abdominal viscera, and organs
indispensible to life, much deranged: debility in the executive and
legislative functions; or vital, natural, and animal: signs of putrefactions.
We shall enumerate the principal of those in detail. The pulse weak, quick,
fluttering, salient, irregular, intermittent, its systole duplicated, its velocity
130 or 140; tendency to faint or fainting in an erect posture; cold
extremities: the respiration slow, laborious, quick, cold; all the subsidiary
muscles of respiration labouring to distend the thorax; deep interrupted
sighs, hiccup; particular noise in respiration, as if mucus plugged up the
throat and lungs: the stomach very weak, with nausea, sickness, vomiting,
desire of acids; deglutition difficult, struggling, and with noise; involuntary
excretion of feces and urine; thirst; the tongue, teeth, and lips foul, and
furred with a black gelatinous incrustation; the urine pale, red, black, fetid;
intense burning heat in the abdomen; the belly tumid and puffed; fetid
cadaverous smell and exhalations; clammy sweats, especially in the breast:
the blood if drawn not coagulating: cutaneous petechiæ, like small bruises
in different parts; subcutaneous effusions; hemorrhages: weakness,
confusion, irregularity in the intellectual functions; the manners different
from natural; in the speech or actions something unusual; loquacity; no
sleep; coma or delirium furious, or low and muttering; in the countenance
and eyes perturbation, agitation, amazement, despondency, despair, anxiety;
attempts to rise out of bed; throwing off the bed-cloaths, incessant tossing
about the bed; forgetfulness, loss of memory, so as not to know the nearest
friend; refusing or exspuating food, drink, or medicines; moats floating
before the eyes, and objects seen as through a cloud; total inattention to
every object; twitching and spasms of the tendons at the wrist: catching and
picking with the hands and fingers at the bed-cloaths, as if feeling for some
object; starting of the muscles, convulsions; trembling of the hands and
divisions of time or accurate mensuration.
All fevers with dangerous symptoms may be termed malignant; but in
general, this term is appropriated to fevers, intermittent, remittent, nervous,
putrid, exanthematous, and also to some of those complicated with topical
inflammation. General prognosticks of danger are indicated by a
concatenation of few or many of the following symptoms, which may, in
some degree, be transposed to the intire febrile class; and to the phlogistick
order not yet surveyed: as the brain, lungs, abdominal viscera, and organs
indispensible to life, much deranged: debility in the executive and
legislative functions; or vital, natural, and animal: signs of putrefactions.
We shall enumerate the principal of those in detail. The pulse weak, quick,
fluttering, salient, irregular, intermittent, its systole duplicated, its velocity
130 or 140; tendency to faint or fainting in an erect posture; cold
extremities: the respiration slow, laborious, quick, cold; all the subsidiary
muscles of respiration labouring to distend the thorax; deep interrupted
sighs, hiccup; particular noise in respiration, as if mucus plugged up the
throat and lungs: the stomach very weak, with nausea, sickness, vomiting,
desire of acids; deglutition difficult, struggling, and with noise; involuntary
excretion of feces and urine; thirst; the tongue, teeth, and lips foul, and
furred with a black gelatinous incrustation; the urine pale, red, black, fetid;
intense burning heat in the abdomen; the belly tumid and puffed; fetid
cadaverous smell and exhalations; clammy sweats, especially in the breast:
the blood if drawn not coagulating: cutaneous petechiæ, like small bruises
in different parts; subcutaneous effusions; hemorrhages: weakness,
confusion, irregularity in the intellectual functions; the manners different
from natural; in the speech or actions something unusual; loquacity; no
sleep; coma or delirium furious, or low and muttering; in the countenance
and eyes perturbation, agitation, amazement, despondency, despair, anxiety;
attempts to rise out of bed; throwing off the bed-cloaths, incessant tossing
about the bed; forgetfulness, loss of memory, so as not to know the nearest
friend; refusing or exspuating food, drink, or medicines; moats floating
before the eyes, and objects seen as through a cloud; total inattention to
every object; twitching and spasms of the tendons at the wrist: catching and
picking with the hands and fingers at the bed-cloaths, as if feeling for some
object; starting of the muscles, convulsions; trembling of the hands and
Page 98
tongue when thrust out; supine posture; inability to support themselves
erect or sitting; sliding down to the foot of the bed: livid nose; collapsed
cheeks and temples; sunk and glazy eyes; dead, ghastly countenance, cold
extremities.
It has been asserted by authors, that no certain febrile presages can be
formed before the periodical crisis; but this is antiquated and erroneous. In
tropical climates, the critical days are much more certain and evident than
in northern regions: and as transmitted from the prognostical Alcoran of
Hippocrates, are the 3d or 4th, 5, 7, 9, 11, 14, 17, 20; which amounts to
rather more than one half critical, and the remainder non-critical. On such
critical days the event is generally most decisive, whether salutary or fatal;
in the non-critical it is a temporary respite. Besides, in tropical climates, the
moon is observed to have considerable influence on febrile paroxisms, and
crisis. As to the effect of febrile crisis on the human excretories, we have
been sufficiently explicit. The favourable termination of fevers is chiefly
discovered by cessation of delirium, abatement of the frequency of the
pulse; mild sweats equally diffused; the urine depositing a sediment freely
and copiously; coolness of the skin; return of natural sleep and appetite; and
food recruiting the lost strength. The storm is then subsided, and the ship
arrived at anchor.
erect or sitting; sliding down to the foot of the bed: livid nose; collapsed
cheeks and temples; sunk and glazy eyes; dead, ghastly countenance, cold
extremities.
It has been asserted by authors, that no certain febrile presages can be
formed before the periodical crisis; but this is antiquated and erroneous. In
tropical climates, the critical days are much more certain and evident than
in northern regions: and as transmitted from the prognostical Alcoran of
Hippocrates, are the 3d or 4th, 5, 7, 9, 11, 14, 17, 20; which amounts to
rather more than one half critical, and the remainder non-critical. On such
critical days the event is generally most decisive, whether salutary or fatal;
in the non-critical it is a temporary respite. Besides, in tropical climates, the
moon is observed to have considerable influence on febrile paroxisms, and
crisis. As to the effect of febrile crisis on the human excretories, we have
been sufficiently explicit. The favourable termination of fevers is chiefly
discovered by cessation of delirium, abatement of the frequency of the
pulse; mild sweats equally diffused; the urine depositing a sediment freely
and copiously; coolness of the skin; return of natural sleep and appetite; and
food recruiting the lost strength. The storm is then subsided, and the ship
arrived at anchor.
Page 99
THE phlogistick group of febrile diseases are now to be reviewed. The
majority of these in their immediate causes and mode of cure, intimately
anastomose; and the principal differences in the symptoms are to be
ascribed to the different organs and parts enraged by inflammation. These
are not like the generality of the preceding fevers, in which most of the
corporeal functions participate: here, in many cases, one single portion of
the human organization is originally transfixed with pain and commotion;
and doomed to bear the brunt of the hydraulick torrent and inundation. After
mature consideration, we imagined it would occasion less confusion and
burthen to the memory, to detach a few diseases from the phlogistick
legion. Inflammation of the ears, eyes, intestines, kidneys, and bladder, are
incorporated amongst the other diseases by which those various organs are
liable to be invested. I am aware that this does not quadrate with the stiff
etiquette of nosological parade: but, without digressing into a critical
disquisition on this subject, I shall content myself with simply
acknowledging that I am no convert to any of those modern pedagogues in
morbid arrangement and nomenclature. With similar and intentional
omission, I avoid the technical subtilities of parenchymatous and
membranaceous inflammation.
Inflammation of the Brain. Phrenitis vera. As a primary disease, it is very
rare in this kingdom. It is much more frequent in tropical and hot climates:
and is the febrile calenture of those scorching regions. With us it is mostly
symptomatick in different fevers: and may either affect the brain and
medullary substance, or its investing membranes: and in the former case the
delirium is said to be mild. Morbid dissections have proved, that when
inflammation was believed to be present, none could be discovered; and in
other cases, that the brain was inflamed, without expressing the usual
symptoms. Of idiopathick phrenzy, the symptoms are, fever, excruciating
and deep seated headach, restlessness, and want of sleep; intolerance of
light and noise, with acute sensibility and irritability; red, prominent,
ferocious eyes; audacious, and flushed countenance; contracted and languid
pulse; throbbing of the temporal arteries; noise in the ears; change in the
voice; impetuous delirium, and the patient, with difficulty, restrained in bed;
dry parched tongue, but sometimes no complaint of thirst; costiveness;
limpid urine. It is extremely dangerous and precipitate, terminating in a few
days in recovery, death, or some other disease; and is rarely protracted
majority of these in their immediate causes and mode of cure, intimately
anastomose; and the principal differences in the symptoms are to be
ascribed to the different organs and parts enraged by inflammation. These
are not like the generality of the preceding fevers, in which most of the
corporeal functions participate: here, in many cases, one single portion of
the human organization is originally transfixed with pain and commotion;
and doomed to bear the brunt of the hydraulick torrent and inundation. After
mature consideration, we imagined it would occasion less confusion and
burthen to the memory, to detach a few diseases from the phlogistick
legion. Inflammation of the ears, eyes, intestines, kidneys, and bladder, are
incorporated amongst the other diseases by which those various organs are
liable to be invested. I am aware that this does not quadrate with the stiff
etiquette of nosological parade: but, without digressing into a critical
disquisition on this subject, I shall content myself with simply
acknowledging that I am no convert to any of those modern pedagogues in
morbid arrangement and nomenclature. With similar and intentional
omission, I avoid the technical subtilities of parenchymatous and
membranaceous inflammation.
Inflammation of the Brain. Phrenitis vera. As a primary disease, it is very
rare in this kingdom. It is much more frequent in tropical and hot climates:
and is the febrile calenture of those scorching regions. With us it is mostly
symptomatick in different fevers: and may either affect the brain and
medullary substance, or its investing membranes: and in the former case the
delirium is said to be mild. Morbid dissections have proved, that when
inflammation was believed to be present, none could be discovered; and in
other cases, that the brain was inflamed, without expressing the usual
symptoms. Of idiopathick phrenzy, the symptoms are, fever, excruciating
and deep seated headach, restlessness, and want of sleep; intolerance of
light and noise, with acute sensibility and irritability; red, prominent,
ferocious eyes; audacious, and flushed countenance; contracted and languid
pulse; throbbing of the temporal arteries; noise in the ears; change in the
voice; impetuous delirium, and the patient, with difficulty, restrained in bed;
dry parched tongue, but sometimes no complaint of thirst; costiveness;
limpid urine. It is extremely dangerous and precipitate, terminating in a few
days in recovery, death, or some other disease; and is rarely protracted
Page 100
beyond a week. The favourable crisis is various: by nasal hemorrhage,
sweats, diarrhœa, turbid urine: but on any irregularity or intemperance,
convalescents are prone to relapse. The predisposing and occasional causes
are, warm climate; insolation, especially with the head uncovered; sudden
suppression of the puerperal lochia; intoxication; violent passions of mind;
ambition, anger, grief, profound contemplation, unremitting study; long
deprivation of sleep; external injuries; erysipelas, or scald head prematurely
repelled; violent exercise; symptomatick.
Angina: cynanche, quinsey; and distinguished into the inflammatory; and
into the putrid, gangrenous, or malignant. The mortality by quinsey and sore
throat, appears in the London bills inconsiderable; and without
discrimination of the inflammatory and putrid. Inflammatory angina is a
general and frequent affliction in both sexes, and especially in ours and
some northern regions. Adults more than infants; and some individuals
more than others, are obnoxious to it: its reign is in spring and autumn, on
the change and vicissitudes of the seasons, or of heat and cold. In that very
different species, the Gangrenous Angina, the ancient authors are nearly
barren of information: some years this is epidemick and contagious in
different parts of our island; and is much more inimical to childhood and
adolescence than to adults; discharging its venom on schools, and the
younger branches of families.
The principal differences in inflammatory angina are in the parts affected,
and the degrees of inflammation; which may be in one or in both sides; and
variously extended over the mucous membrane of the fauces, tonsils,
velum, uvula, pharynx, and larynx. The usual symptoms are difficulty and
pain in deglutition, and sometimes in respiration; internal intumescence and
redness of the fauces, stiffness of the neck, and the lower jaw moved with
pain; frequent and difficult in excreation of viscid mucus and saliva, and
clamminess of the mouth and throat; impediment in the distinct articulation
of words and speech; noise and darting pain in the ears; flushed face,
prominent eyes; quick, strong, and hard pulse; anxiety, restlessness;
sometimes considerable contiguous tumor externally; and in violent
inflammation, necessity of an erect posture of the head, to prevent
suffocation: the more the pharynx is affected, deglutition is proportionally
interrupted; and some cannot swallow food or liquids during several days.
The crisis is in a few days, at the utmost in a week or two, by resolution, or
sweats, diarrhœa, turbid urine: but on any irregularity or intemperance,
convalescents are prone to relapse. The predisposing and occasional causes
are, warm climate; insolation, especially with the head uncovered; sudden
suppression of the puerperal lochia; intoxication; violent passions of mind;
ambition, anger, grief, profound contemplation, unremitting study; long
deprivation of sleep; external injuries; erysipelas, or scald head prematurely
repelled; violent exercise; symptomatick.
Angina: cynanche, quinsey; and distinguished into the inflammatory; and
into the putrid, gangrenous, or malignant. The mortality by quinsey and sore
throat, appears in the London bills inconsiderable; and without
discrimination of the inflammatory and putrid. Inflammatory angina is a
general and frequent affliction in both sexes, and especially in ours and
some northern regions. Adults more than infants; and some individuals
more than others, are obnoxious to it: its reign is in spring and autumn, on
the change and vicissitudes of the seasons, or of heat and cold. In that very
different species, the Gangrenous Angina, the ancient authors are nearly
barren of information: some years this is epidemick and contagious in
different parts of our island; and is much more inimical to childhood and
adolescence than to adults; discharging its venom on schools, and the
younger branches of families.
The principal differences in inflammatory angina are in the parts affected,
and the degrees of inflammation; which may be in one or in both sides; and
variously extended over the mucous membrane of the fauces, tonsils,
velum, uvula, pharynx, and larynx. The usual symptoms are difficulty and
pain in deglutition, and sometimes in respiration; internal intumescence and
redness of the fauces, stiffness of the neck, and the lower jaw moved with
pain; frequent and difficult in excreation of viscid mucus and saliva, and
clamminess of the mouth and throat; impediment in the distinct articulation
of words and speech; noise and darting pain in the ears; flushed face,
prominent eyes; quick, strong, and hard pulse; anxiety, restlessness;
sometimes considerable contiguous tumor externally; and in violent
inflammation, necessity of an erect posture of the head, to prevent
suffocation: the more the pharynx is affected, deglutition is proportionally
interrupted; and some cannot swallow food or liquids during several days.
The crisis is in a few days, at the utmost in a week or two, by resolution, or
Page 101
by suppuration; seldom or ever by gangrene. Resolution or discussion is
accompanied with copious excreation and salivation; and frequently with
critical perspiration, sweats, urine. Suppuration may be artificially
discharged, or may spontaneously burst internally or externally. With
judicious and opportune assistance, there is trifling danger. When fatal, it is
by suffocation. The predisposing and occasional causes are cold air inspired
cold and moist air: perspiration suddenly checked, especially on the neck;
cold water drank when the body is heated: epidemical influence of the air
and seasons.
Inflammation principally attached to the muscles of the os hyoides, glottis,
larynx, and trachea, is fortunately far less frequent than the former. In this,
the current of air being intercepted, there is necessarily difficulty and pain
in respiration, quick short breathing, sense of strangulation, great anxiety
and restlessness; acute squeaking or ringing sound of the voice; quick and
irregular pulse. Of that disease, which at least in symptoms has considerable
analogy with the present, and called with us the Croup, we are hereafter to
treat. We may here, however, with propriety, subjoin two other
inflammations, the Angina Parotidea, and the Glossitis. The Angina
Parotidea is often epidemick, but not dangerous. It commences as a
glandular tumor externally, at the articulation of the lower jaw, becoming
gradually more enlarged and unequally diffused, increasing to the fourth
day, and from thence declining: and often is succeeded by swelling of the
male testicles, or of the female breasts. The Glossitis is rarely a primary
disease; but mostly complicated with angina, or venereal salivation. Its
symptoms are obvious; pain and swelling of the tongue; speech and
deglutition exercised with difficulty, headach, restlessness, flow of saliva. If
violent in the extreme, there is danger of suffocation or starving.
The strong cardinal outlines in the features of Angina Gangrenosa are,
symptoms of nervous and putrid fever, with ulcerations in the tonsils. Upon
these we shall enlarge in their rotine and detail: soreness or uneasiness in
the fauces and throat; stiffness of the neck; headach, nausea, and vomiting;
the fauces and tonsils inflamed, but seldom in any considerable degree, of a
shining crimson colour, with ash-coloured spots on the tonsils, and sloughs,
forming soon into corroding ulcers; some pain is felt in deglutition; there is
sudden prostration of strength; depression of spirits; anxiety and oppression
at the breast; small, quick, and fluttering pulse; dizziness in the head; slight
accompanied with copious excreation and salivation; and frequently with
critical perspiration, sweats, urine. Suppuration may be artificially
discharged, or may spontaneously burst internally or externally. With
judicious and opportune assistance, there is trifling danger. When fatal, it is
by suffocation. The predisposing and occasional causes are cold air inspired
cold and moist air: perspiration suddenly checked, especially on the neck;
cold water drank when the body is heated: epidemical influence of the air
and seasons.
Inflammation principally attached to the muscles of the os hyoides, glottis,
larynx, and trachea, is fortunately far less frequent than the former. In this,
the current of air being intercepted, there is necessarily difficulty and pain
in respiration, quick short breathing, sense of strangulation, great anxiety
and restlessness; acute squeaking or ringing sound of the voice; quick and
irregular pulse. Of that disease, which at least in symptoms has considerable
analogy with the present, and called with us the Croup, we are hereafter to
treat. We may here, however, with propriety, subjoin two other
inflammations, the Angina Parotidea, and the Glossitis. The Angina
Parotidea is often epidemick, but not dangerous. It commences as a
glandular tumor externally, at the articulation of the lower jaw, becoming
gradually more enlarged and unequally diffused, increasing to the fourth
day, and from thence declining: and often is succeeded by swelling of the
male testicles, or of the female breasts. The Glossitis is rarely a primary
disease; but mostly complicated with angina, or venereal salivation. Its
symptoms are obvious; pain and swelling of the tongue; speech and
deglutition exercised with difficulty, headach, restlessness, flow of saliva. If
violent in the extreme, there is danger of suffocation or starving.
The strong cardinal outlines in the features of Angina Gangrenosa are,
symptoms of nervous and putrid fever, with ulcerations in the tonsils. Upon
these we shall enlarge in their rotine and detail: soreness or uneasiness in
the fauces and throat; stiffness of the neck; headach, nausea, and vomiting;
the fauces and tonsils inflamed, but seldom in any considerable degree, of a
shining crimson colour, with ash-coloured spots on the tonsils, and sloughs,
forming soon into corroding ulcers; some pain is felt in deglutition; there is
sudden prostration of strength; depression of spirits; anxiety and oppression
at the breast; small, quick, and fluttering pulse; dizziness in the head; slight
Page 102
delirium, especially at the nocturnal exacerbation; heavy, red, and watery
eyes; the tongue foul at the root; in some the voice hoarse; and in most the
nostrils excoriated by a sharp defluxion; the breath unusually fetid, and
generally the fecal discharge: the external tumor of the fauces, when visible,
which, so far as my experience reaches, was rarely the case, is edematous,
indenting by pressure. In most cases there is a cutaneous efflorescence
overspreading the face, neck, and other parts of the body, in small points,
scarcely eminent, or in confused and confluent blotches: the period of this
eruption and of its duration varies; and with its recedence there is
desquamation of the cuticle.
This is infinitely more dangerous than the inflammatory angina, terminating
salutary or fatal from the third to the seventh day, according to the degrees
of virulence and medical aid. Alarming symptoms are, great debility;
cutaneous petechiæ; the internal functions of the brain much deranged;
weak, quick, fluttering, and irregular pulse; livid colour of the ulcers;
refusal of drink and medicine; together with the other inauspicious
symptoms enumerated under febrile prognosticks in general. I have seen not
only petechiæ, but also putrescent hemorrhages from the nose and gums in
this disease. At the crisis there are often fetid stools; but whether critical, or
from the acrid matter swallowed, may be disputed. General sweats and
excreation of the ulcerous sloughs are favourable omens. By the speedy and
judicious assistance of remedies and regimen, very few, compared to the
sick and infected, sink. It is epidemick and contagious: but of the source or
nature of the contagion, we are unacquainted.
Inflammation of the Lungs and Organs of Respiration, is a frequent
inflammation in northern climates; and most so in spring, autumn, and
winter; when the body, hydraulick canals, and blood are in a state of
inflammatory diathesis: it generally encounters the robust vigorous
constitution, those of strong muscular fibre, and dense rich blood; the
athletick rustick, manufacturer, and artizan; those in the prime, and in all the
intervals between twenty and the decline of life: it is very rare in infancy, as
in idiopathick disease, and seldom under puberty, or in old age. It is most
universal amongst the male sex; and in all probability, both more universal
and destructive amongst the necessitous laborious mass of the community.
We also read in authors, of spring pleurisies as no unusual affliction in some
climates considerably nearer to the equator than ours. I apprehend, that in
eyes; the tongue foul at the root; in some the voice hoarse; and in most the
nostrils excoriated by a sharp defluxion; the breath unusually fetid, and
generally the fecal discharge: the external tumor of the fauces, when visible,
which, so far as my experience reaches, was rarely the case, is edematous,
indenting by pressure. In most cases there is a cutaneous efflorescence
overspreading the face, neck, and other parts of the body, in small points,
scarcely eminent, or in confused and confluent blotches: the period of this
eruption and of its duration varies; and with its recedence there is
desquamation of the cuticle.
This is infinitely more dangerous than the inflammatory angina, terminating
salutary or fatal from the third to the seventh day, according to the degrees
of virulence and medical aid. Alarming symptoms are, great debility;
cutaneous petechiæ; the internal functions of the brain much deranged;
weak, quick, fluttering, and irregular pulse; livid colour of the ulcers;
refusal of drink and medicine; together with the other inauspicious
symptoms enumerated under febrile prognosticks in general. I have seen not
only petechiæ, but also putrescent hemorrhages from the nose and gums in
this disease. At the crisis there are often fetid stools; but whether critical, or
from the acrid matter swallowed, may be disputed. General sweats and
excreation of the ulcerous sloughs are favourable omens. By the speedy and
judicious assistance of remedies and regimen, very few, compared to the
sick and infected, sink. It is epidemick and contagious: but of the source or
nature of the contagion, we are unacquainted.
Inflammation of the Lungs and Organs of Respiration, is a frequent
inflammation in northern climates; and most so in spring, autumn, and
winter; when the body, hydraulick canals, and blood are in a state of
inflammatory diathesis: it generally encounters the robust vigorous
constitution, those of strong muscular fibre, and dense rich blood; the
athletick rustick, manufacturer, and artizan; those in the prime, and in all the
intervals between twenty and the decline of life: it is very rare in infancy, as
in idiopathick disease, and seldom under puberty, or in old age. It is most
universal amongst the male sex; and in all probability, both more universal
and destructive amongst the necessitous laborious mass of the community.
We also read in authors, of spring pleurisies as no unusual affliction in some
climates considerably nearer to the equator than ours. I apprehend, that in
Page 103
the London registers the mortality by pulmonick inflammation is under-
rated, and perhaps delegated to imposthume and consumption.
Nosologists have enumerated several extraneous symptoms as complicated
species of pleurisy and peripneumony; such as bilious, erysipelatous,
catarrhal, rheumatick, intercostal, arthritick, verminous, flatulent,
scorbutick, putrid, and malignant: most of which are merely symptomatick:
for neither rheumatick pains in the intercostal muscles, nor flatulence pent
up in the intestines, can impose on medical discernment as genuine pleurisy.
The primary seat of pulmonick inflammation, whether in the parenchyma or
internal viscus, or in its investing membranes, is not clearly established in
medical diagnosticks; and therefore we comprehend pleurisy and
peripneumony under one genus: in most cases they are complicated; and it
is now doubted whether any pure peripneumony occurs without the pleura
also participating in the affliction. The inflammation confined to the pleura
alone, was described as unaccompanied with expectoration; hence the
distinction of dry and humid species; and in genuine pleurisy the pain was
represented as more acute than in peripneumony.
The symptoms of pulmonick inflammation are fever, darting pungent pain
fixed like a dagger in some part of the chest, the side, breast, or back; and
sometimes shooting to the scapula and clavicle: sometimes the pain is more
dull and obtuse; and its situation oftenest in the side, about the middle of the
ribs, between the sternum and spine; and commonly confined to one lobe.
At the invasion there is shivering, restlessness, anxiety, succeeded by heat:
hot accelerated laborious respiration; load and oppression at the breast;
urgent, short, and painful cough; and very early in the disease more or less
expectoration, streaked with blood; the pain is exasperated by inspiration
and coughing, and mostly fixed, but sometimes veering or shifting: the
pulse quick, full, hard, and tense, like a stretched chord; the blood drawn
forms a buffy tenacious crust on the coagulum; the urine is of a florid
colour: from the violence of pain, patients are often unable to lay on either
side, but compelled to recline half-erect on their backs: when the
inflammation is violent, or both pulmonick lobes assailed, there is
inexpressible anxiety and struggle in respiration, florid countenance,
prominent eyes; with other symptoms of obstructed circulation, and return
of blood from the head, and menacing suffocation. In the advanced or
rated, and perhaps delegated to imposthume and consumption.
Nosologists have enumerated several extraneous symptoms as complicated
species of pleurisy and peripneumony; such as bilious, erysipelatous,
catarrhal, rheumatick, intercostal, arthritick, verminous, flatulent,
scorbutick, putrid, and malignant: most of which are merely symptomatick:
for neither rheumatick pains in the intercostal muscles, nor flatulence pent
up in the intestines, can impose on medical discernment as genuine pleurisy.
The primary seat of pulmonick inflammation, whether in the parenchyma or
internal viscus, or in its investing membranes, is not clearly established in
medical diagnosticks; and therefore we comprehend pleurisy and
peripneumony under one genus: in most cases they are complicated; and it
is now doubted whether any pure peripneumony occurs without the pleura
also participating in the affliction. The inflammation confined to the pleura
alone, was described as unaccompanied with expectoration; hence the
distinction of dry and humid species; and in genuine pleurisy the pain was
represented as more acute than in peripneumony.
The symptoms of pulmonick inflammation are fever, darting pungent pain
fixed like a dagger in some part of the chest, the side, breast, or back; and
sometimes shooting to the scapula and clavicle: sometimes the pain is more
dull and obtuse; and its situation oftenest in the side, about the middle of the
ribs, between the sternum and spine; and commonly confined to one lobe.
At the invasion there is shivering, restlessness, anxiety, succeeded by heat:
hot accelerated laborious respiration; load and oppression at the breast;
urgent, short, and painful cough; and very early in the disease more or less
expectoration, streaked with blood; the pain is exasperated by inspiration
and coughing, and mostly fixed, but sometimes veering or shifting: the
pulse quick, full, hard, and tense, like a stretched chord; the blood drawn
forms a buffy tenacious crust on the coagulum; the urine is of a florid
colour: from the violence of pain, patients are often unable to lay on either
side, but compelled to recline half-erect on their backs: when the
inflammation is violent, or both pulmonick lobes assailed, there is
inexpressible anxiety and struggle in respiration, florid countenance,
prominent eyes; with other symptoms of obstructed circulation, and return
of blood from the head, and menacing suffocation. In the advanced or
Page 104
dangerous stage of the disease, the pulse is weak, soft, and irregular.
Sometimes there is nausea of the stomach; and sometimes delirium.
The termination of pulmonick inflammation is by resolution, by
suppuration, by gangrene, by fatal effusion of blood, or exudation of
coagulable lymph into the cellular texture. Favourable symptoms are, as in
anginous excreation, facility in expectoration, without much exertion or
coughing, copious, of due consistence, a little yellow, white, thick, slightly
streaked with blood; the sooner this is concocted and excreted, the sooner is
the crisis; less urgent and painful cough; freer breathing; abatement in the
heat of the body and velocity of the pulse; general perspiration; deposition
of sediment in the urine; nasal hemorrhage; dispersion of the pain, hitherto
fixed in the thorax, about the shoulders, back, or arms; erysipelas in some
external part; pustular eruption about the breast, neck, and scapulæ;
abscesses in different parts. A crisis, when favourable, always ensues within
seven, or at the utmost fourteen days; and after such crisis, expectoration
may continue copious several days.
Inauspicious symptoms are, the respiration struggling and laborious in the
extreme; dry pertinacious cough; no expectoration, or with difficulty;
suppressed expectoration; obtuse pain, with difficult respiration; frequent
violent cough exasperating the pain; the pain changing from one side into
the other; the pulmonick lobes in both sides inflamed; the breathing
intolerable and suffocating, except in an erect posture, and even then with
laborious anxiety; the face turgid and florid, or pale, with features of
consternation; violent headach; delirium; remission succeeded by relapse;
excessive sweats; dry skin; weak, soft, and irregular pulse; sudden cessation
of pain; grumous livid expectoration; rattling noise in the thorax, as if
plugged up by phlegm; dejected countenance, squalid sunk eyes; great
prostration of strength; cold clammy partial sweats; limpid urine; florid
blood coughed up, or white and glutinous matter resembling the branches of
blood-vessels. Effusion of blood, and exudation of coagulable lymph into
the pulmonary cellular texture, bronchial vesicles and air-pipes, is more
frequently than gangrene, the cause of suffocation and death. The
occurrence of either is seldom later than fourteen days. There is also great
danger of pulmonick inflammation, persevering beyond seven or, at the
utmost, fourteen days, and without any considerable remission or signs of
resolution, terminating in suppuration; of which the diagnosticks are
Sometimes there is nausea of the stomach; and sometimes delirium.
The termination of pulmonick inflammation is by resolution, by
suppuration, by gangrene, by fatal effusion of blood, or exudation of
coagulable lymph into the cellular texture. Favourable symptoms are, as in
anginous excreation, facility in expectoration, without much exertion or
coughing, copious, of due consistence, a little yellow, white, thick, slightly
streaked with blood; the sooner this is concocted and excreted, the sooner is
the crisis; less urgent and painful cough; freer breathing; abatement in the
heat of the body and velocity of the pulse; general perspiration; deposition
of sediment in the urine; nasal hemorrhage; dispersion of the pain, hitherto
fixed in the thorax, about the shoulders, back, or arms; erysipelas in some
external part; pustular eruption about the breast, neck, and scapulæ;
abscesses in different parts. A crisis, when favourable, always ensues within
seven, or at the utmost fourteen days; and after such crisis, expectoration
may continue copious several days.
Inauspicious symptoms are, the respiration struggling and laborious in the
extreme; dry pertinacious cough; no expectoration, or with difficulty;
suppressed expectoration; obtuse pain, with difficult respiration; frequent
violent cough exasperating the pain; the pain changing from one side into
the other; the pulmonick lobes in both sides inflamed; the breathing
intolerable and suffocating, except in an erect posture, and even then with
laborious anxiety; the face turgid and florid, or pale, with features of
consternation; violent headach; delirium; remission succeeded by relapse;
excessive sweats; dry skin; weak, soft, and irregular pulse; sudden cessation
of pain; grumous livid expectoration; rattling noise in the thorax, as if
plugged up by phlegm; dejected countenance, squalid sunk eyes; great
prostration of strength; cold clammy partial sweats; limpid urine; florid
blood coughed up, or white and glutinous matter resembling the branches of
blood-vessels. Effusion of blood, and exudation of coagulable lymph into
the pulmonary cellular texture, bronchial vesicles and air-pipes, is more
frequently than gangrene, the cause of suffocation and death. The
occurrence of either is seldom later than fourteen days. There is also great
danger of pulmonick inflammation, persevering beyond seven or, at the
utmost, fourteen days, and without any considerable remission or signs of
resolution, terminating in suppuration; of which the diagnosticks are
Page 105
hereafter marked. Authors have likewise described a malignant
peripneumony, which seems to be a complication of the preceding
deleterious symptoms, and of putrid fever.
There is, however, a species of pulmonick affliction, the specifick
diagnosticks of which it would be unpardonable to omit; because it has
often and fatally been either confounded with, and treated as genuine
pulmonick inflammation, or slighted as a catarrh. This is named
Peripneumonia Notha; whose symptoms, at the onset, are ambiguous. It is
most frequent in persons old, phlegmatick, fat, weak, emaciated, subject to
catarrh, addicted to fermented and spirituous liquors; and in foggy weather
and rainy winters. It appears in the same seasons with genuine pulmonick
inflammation, and with catarrh; that is, in spring and autumn; and
frequently under the veil of a violent catarrh. The fever and heat are
inconsiderable; the pulse not hard nor tense; but there is straitness and
difficulty of breathing, and load at the breast, with anxiety and gasping for
breath; urgent violent cough, with some expectoration, and sometimes
exciting vomiting; giddiness of the head; rending headach; sometimes
drowsiness. It is sometimes suddenly and unexpectedly aggravated, and
suffocates the patient.
The predisposing and occasional causes of pulmonick inflammation are,
epidemick state of the air; sudden vicissitudes of the seasons and weather
from heat to cold; sudden suppression of perspiration, or of pulmonary
exhalation; inspiration of cold air; sudden exposure to keen cold air,
especially after breathing in a warm room, or drinking warm liquors; cold
liquors drank when the body is heated; intemperance and sottishness,
particularly in spirituous liquors; dry cold winds; strong muscular exercise,
or manual labour; repulsion of cutaneous eruption, febrile or chronic;
exsiccation of old ulcers; suppression of habitual evacuation and eruption;
translation to and deposition of morbid matter on the lungs; consequence
and dregs of small pox and measles; symptomatick from some other
diseases.
Inflammations of the heart, mediastinum, and diaphragm, as solitary, are
very rare diseases. The symptoms of Carditis are severe fever; pain and
anxiety in the region of the heart; difficulty of breathing; cough; irregular
pulse; palpitation, syncope. Inflammation of the diaphragm, paraphrenitis:
the symptoms are, acute fever, intense pain in the breast darting to the back,
peripneumony, which seems to be a complication of the preceding
deleterious symptoms, and of putrid fever.
There is, however, a species of pulmonick affliction, the specifick
diagnosticks of which it would be unpardonable to omit; because it has
often and fatally been either confounded with, and treated as genuine
pulmonick inflammation, or slighted as a catarrh. This is named
Peripneumonia Notha; whose symptoms, at the onset, are ambiguous. It is
most frequent in persons old, phlegmatick, fat, weak, emaciated, subject to
catarrh, addicted to fermented and spirituous liquors; and in foggy weather
and rainy winters. It appears in the same seasons with genuine pulmonick
inflammation, and with catarrh; that is, in spring and autumn; and
frequently under the veil of a violent catarrh. The fever and heat are
inconsiderable; the pulse not hard nor tense; but there is straitness and
difficulty of breathing, and load at the breast, with anxiety and gasping for
breath; urgent violent cough, with some expectoration, and sometimes
exciting vomiting; giddiness of the head; rending headach; sometimes
drowsiness. It is sometimes suddenly and unexpectedly aggravated, and
suffocates the patient.
The predisposing and occasional causes of pulmonick inflammation are,
epidemick state of the air; sudden vicissitudes of the seasons and weather
from heat to cold; sudden suppression of perspiration, or of pulmonary
exhalation; inspiration of cold air; sudden exposure to keen cold air,
especially after breathing in a warm room, or drinking warm liquors; cold
liquors drank when the body is heated; intemperance and sottishness,
particularly in spirituous liquors; dry cold winds; strong muscular exercise,
or manual labour; repulsion of cutaneous eruption, febrile or chronic;
exsiccation of old ulcers; suppression of habitual evacuation and eruption;
translation to and deposition of morbid matter on the lungs; consequence
and dregs of small pox and measles; symptomatick from some other
diseases.
Inflammations of the heart, mediastinum, and diaphragm, as solitary, are
very rare diseases. The symptoms of Carditis are severe fever; pain and
anxiety in the region of the heart; difficulty of breathing; cough; irregular
pulse; palpitation, syncope. Inflammation of the diaphragm, paraphrenitis:
the symptoms are, acute fever, intense pain in the breast darting to the back,
Page 106
and increased by inspiration, coughing and sneezing, and by natural
exertion at stool and urine; restlessness, anxiety, dry cough, quick
convulsive breathing; sneezing, hiccup, nausea, vomiting; compulsive
painful grin on the countenance, delirium. When it occurs, it is generally
complicated with inflammation of the adjacent organs, in either the thorax
or the abdomen. As the heart is the main spring of the blood’s circulation,
and the diaphragm the principal agent in respiration, it is evident that
inflammation in either must be extremely dangerous.
Inflammation of the Liver, hepatitis, acute and chronic. Both species are
much more frequent in tropical climates and warm regions, than in northern
and cold; and more so in the former during the hottest seasons of the year.
The sensibility of the liver being dull, its inflammation is less painful than
that of any other viscus. The symptoms are, fever, pain in the right side
under the false ribs, and felt at the corresponding clavicle, scapula, and
hand; sensation of heat and heaviness in the hepatick region; difficulty of
breathing, more especially when the inflammation invests the superior
convex part of the liver; there is often dry cough; nausea, bilious vomiting,
and diarrhœa; the urine of a fiery or saffron-colour; and generally, but not
always, the eyes, countenance, and skin more or less of a jaundice tinge; the
pulse not remarkably disturbed; but thirst. Sometimes hepatick
inflammation is entangled with that of some contiguous organs of the lungs
or abdomen, and with their respective features. The acute hepatitis, but not
the chronic, is usually terminated in a few days, at the utmost fourteen or
twenty-one, by discussion, suppuration, or gangrene. Critical resolution
may be variously accompanied with bilious diarrhœa and urine, nasal or
hemorrhoidal hemorrhage, copious bilious sweats. Suppuration is not an
unfrequent termination: after which many survive, but with difficult and
slow recovery. The purulency may be expurgated by absorption, by the
biliary ducts, by erosion of the abdominal muscles, or by an artificial
opening when the abscess is perceptible externally; and sometimes it erodes
the diaphragm and lungs.
The predisposing and occasional causes are, burning climates; acrid viscid
bile; the blood tenacious and glutinous in consistence; calculi, steatome,
worms in the biliary ducts; bilious vomiting; sudden refrigeration of the
body when heated, and obstructed perspiration; thirst, and not sufficient
dilution of the blood; intoxication and abuse of spirituous liquors; poisons;
exertion at stool and urine; restlessness, anxiety, dry cough, quick
convulsive breathing; sneezing, hiccup, nausea, vomiting; compulsive
painful grin on the countenance, delirium. When it occurs, it is generally
complicated with inflammation of the adjacent organs, in either the thorax
or the abdomen. As the heart is the main spring of the blood’s circulation,
and the diaphragm the principal agent in respiration, it is evident that
inflammation in either must be extremely dangerous.
Inflammation of the Liver, hepatitis, acute and chronic. Both species are
much more frequent in tropical climates and warm regions, than in northern
and cold; and more so in the former during the hottest seasons of the year.
The sensibility of the liver being dull, its inflammation is less painful than
that of any other viscus. The symptoms are, fever, pain in the right side
under the false ribs, and felt at the corresponding clavicle, scapula, and
hand; sensation of heat and heaviness in the hepatick region; difficulty of
breathing, more especially when the inflammation invests the superior
convex part of the liver; there is often dry cough; nausea, bilious vomiting,
and diarrhœa; the urine of a fiery or saffron-colour; and generally, but not
always, the eyes, countenance, and skin more or less of a jaundice tinge; the
pulse not remarkably disturbed; but thirst. Sometimes hepatick
inflammation is entangled with that of some contiguous organs of the lungs
or abdomen, and with their respective features. The acute hepatitis, but not
the chronic, is usually terminated in a few days, at the utmost fourteen or
twenty-one, by discussion, suppuration, or gangrene. Critical resolution
may be variously accompanied with bilious diarrhœa and urine, nasal or
hemorrhoidal hemorrhage, copious bilious sweats. Suppuration is not an
unfrequent termination: after which many survive, but with difficult and
slow recovery. The purulency may be expurgated by absorption, by the
biliary ducts, by erosion of the abdominal muscles, or by an artificial
opening when the abscess is perceptible externally; and sometimes it erodes
the diaphragm and lungs.
The predisposing and occasional causes are, burning climates; acrid viscid
bile; the blood tenacious and glutinous in consistence; calculi, steatome,
worms in the biliary ducts; bilious vomiting; sudden refrigeration of the
body when heated, and obstructed perspiration; thirst, and not sufficient
dilution of the blood; intoxication and abuse of spirituous liquors; poisons;
Page 107
external injuries; violent exercise; passions of mind; inveterate
hypochondriasm; translation of purulent matter to the liver; symptomatick.
Inflammation of the Spleen is a rare occurrence: schirrus of that organ is far
more frequent. The Peritonitis is also an uncommon inflammatory vagrant:
it will be revived hereafter under Puerperal Fever.
Inflammation of the stomach, gastritis. Notwithstanding the incessant
irritation and distinction of this sensible organ, by innumerable varieties of
food and drink, yet its inflammation is a rare event. The symptoms, acute
fever; fixed burning pain and heat in the region of the stomach, aggravated
by pressure; frequent nausea and vomiting after taking any nourishment;
anxiety, restlessness; weak, hard, intermittent pulse; frequently delirium;
universal debility. It may prove fatal in the space of a few days, or even of a
few hours: there are different gradations of severity and danger. The
termination is by resolution, suppuration, gangrene. The predisposing and
occasional causes are, all the causes of topical inflammations in general;
poisons swallowed; cold water, ices, and fruits swallowed when the body is
much heated; repletion from food and gormandizing; crude and difficultly
digested nutriment; violent agitation of body or mind; external injuries:
from repelled gout very rarely.
The three succeeding genera of the phlogistick tribe, so far as respects mere
inflammation only, affect the external parts and circumference of the body,
and do not suppurate. In other respects there is a distinct tripartite
separation, both as to general outlines and minuter shades.
Erysipelas, ignis sanct. antonii: gutta rosacea, zoster, zona, herpes. Some
trifling pillage by this disease is noticed in the London bills. To adults it is
most hostile. The symptoms are, more or less fever; superficial
inflammation of some portion of the skin and cuticular membrane, with
pain, tumefaction, burning heat, redness, and pruriency, like that from
nettles; and variously, in different persons, assailing the face, the neck, the
trunk, or one of the extremities: the eruption seldom appears until after the
commencement of the febrile commotion; and often from a small point
spreads gradually: it never rises to any conical eminence, nor suppurates,
but often excites vesications; and if on the face and violent, blocks up the
eyelids: the pulse is frequently full and hard; and with the eruptive
expulsion the fever and heat do not cease. It is sometimes critical and
hypochondriasm; translation of purulent matter to the liver; symptomatick.
Inflammation of the Spleen is a rare occurrence: schirrus of that organ is far
more frequent. The Peritonitis is also an uncommon inflammatory vagrant:
it will be revived hereafter under Puerperal Fever.
Inflammation of the stomach, gastritis. Notwithstanding the incessant
irritation and distinction of this sensible organ, by innumerable varieties of
food and drink, yet its inflammation is a rare event. The symptoms, acute
fever; fixed burning pain and heat in the region of the stomach, aggravated
by pressure; frequent nausea and vomiting after taking any nourishment;
anxiety, restlessness; weak, hard, intermittent pulse; frequently delirium;
universal debility. It may prove fatal in the space of a few days, or even of a
few hours: there are different gradations of severity and danger. The
termination is by resolution, suppuration, gangrene. The predisposing and
occasional causes are, all the causes of topical inflammations in general;
poisons swallowed; cold water, ices, and fruits swallowed when the body is
much heated; repletion from food and gormandizing; crude and difficultly
digested nutriment; violent agitation of body or mind; external injuries:
from repelled gout very rarely.
The three succeeding genera of the phlogistick tribe, so far as respects mere
inflammation only, affect the external parts and circumference of the body,
and do not suppurate. In other respects there is a distinct tripartite
separation, both as to general outlines and minuter shades.
Erysipelas, ignis sanct. antonii: gutta rosacea, zoster, zona, herpes. Some
trifling pillage by this disease is noticed in the London bills. To adults it is
most hostile. The symptoms are, more or less fever; superficial
inflammation of some portion of the skin and cuticular membrane, with
pain, tumefaction, burning heat, redness, and pruriency, like that from
nettles; and variously, in different persons, assailing the face, the neck, the
trunk, or one of the extremities: the eruption seldom appears until after the
commencement of the febrile commotion; and often from a small point
spreads gradually: it never rises to any conical eminence, nor suppurates,
but often excites vesications; and if on the face and violent, blocks up the
eyelids: the pulse is frequently full and hard; and with the eruptive
expulsion the fever and heat do not cease. It is sometimes critical and
Page 108
salutary: the favourable crisis is usually in a few days, or within nine, by
perspiration, urine, and desquamation of the inflamed cuticle; and
sometimes without any perceptible revulsion to the excretories. Some have
this cutaneous inflammation annually, or oftener, or at wider intervals; and
those once affected, are more obnoxious to its returns. Presages of danger
are, violent inflammation and intumescence on the face, or sometimes even
on the legs, particularly in old age, or unsound constitutions; premature
retrocession of the eruption; pale colour; frequent return, and repetition of
the inflammation; delirium; coma; gangrene. On the legs it sometimes
leaves behind a chronic enlargement. The zoster and zona is a species of
erysipelatous inflammation, a hand’s breadth or more, affecting the breast,
sides, or abdomen, and various in length.
The predisposing and occasional causes of Erysipelas are, epidemick
influence of the air; obstructed perspiration; sudden refrigeration of the
body when heated; plethora; suppressed evacuations, natural or artificial;
luxurious living and indolence; intemperance; spirituous liquors in excess;
poisons; unsound constitutions; contusions, wounds, burns, punctured
nerves, blisters, acrids; dregs of fevers; scorbutick; lunar influence; passions
of mind.
Rheumatism, acute and chronic. From the Chart of diseases we may rank
rheumatism as an inferior piratical foe amongst the morbid host; or rather as
a scourge and instrument of torture than of execution. In the acute or
chronic form, multitudes are molested by it, especially in this island, and in
northern regions: and more so in winter, in spring, and autumn, and the
interchanges of the seasons: it seldom molests very young or aged persons:
adults are most annoyed by it; the male more than the female sex; the poor
and indigent more than the affluent; and those most who are exposed to the
inclemency and vicissitudes of the seasons and weather: hence, during war,
soldiers and sailors are much more afflicted with it than in peace.
In the acute rheumatism, fever may commence before or after the pain,
which variously and alternately seems to dilacerate different parts,
especially about the joints of the ancles, knees, hips, shoulders, elbows, and
wrists, sometimes the trunk; but rarely the small joints of the toes or
fingers: and commonly succeeded by swelling and redness of the distracted
joints, and with restlessness: at night the pains are exasperated, and often
suddenly abating in one joint, seize upon another; thus harassing the body
perspiration, urine, and desquamation of the inflamed cuticle; and
sometimes without any perceptible revulsion to the excretories. Some have
this cutaneous inflammation annually, or oftener, or at wider intervals; and
those once affected, are more obnoxious to its returns. Presages of danger
are, violent inflammation and intumescence on the face, or sometimes even
on the legs, particularly in old age, or unsound constitutions; premature
retrocession of the eruption; pale colour; frequent return, and repetition of
the inflammation; delirium; coma; gangrene. On the legs it sometimes
leaves behind a chronic enlargement. The zoster and zona is a species of
erysipelatous inflammation, a hand’s breadth or more, affecting the breast,
sides, or abdomen, and various in length.
The predisposing and occasional causes of Erysipelas are, epidemick
influence of the air; obstructed perspiration; sudden refrigeration of the
body when heated; plethora; suppressed evacuations, natural or artificial;
luxurious living and indolence; intemperance; spirituous liquors in excess;
poisons; unsound constitutions; contusions, wounds, burns, punctured
nerves, blisters, acrids; dregs of fevers; scorbutick; lunar influence; passions
of mind.
Rheumatism, acute and chronic. From the Chart of diseases we may rank
rheumatism as an inferior piratical foe amongst the morbid host; or rather as
a scourge and instrument of torture than of execution. In the acute or
chronic form, multitudes are molested by it, especially in this island, and in
northern regions: and more so in winter, in spring, and autumn, and the
interchanges of the seasons: it seldom molests very young or aged persons:
adults are most annoyed by it; the male more than the female sex; the poor
and indigent more than the affluent; and those most who are exposed to the
inclemency and vicissitudes of the seasons and weather: hence, during war,
soldiers and sailors are much more afflicted with it than in peace.
In the acute rheumatism, fever may commence before or after the pain,
which variously and alternately seems to dilacerate different parts,
especially about the joints of the ancles, knees, hips, shoulders, elbows, and
wrists, sometimes the trunk; but rarely the small joints of the toes or
fingers: and commonly succeeded by swelling and redness of the distracted
joints, and with restlessness: at night the pains are exasperated, and often
suddenly abating in one joint, seize upon another; thus harassing the body
Page 109
with a war of posts. In its diagnostic train also are, hard quick pulse, sizy
blood, inflammatory urine; sweats sometimes copious, but not critical. Its
continuance may be one, two, or three weeks; by which time the fever, if
not mismanaged, abates with the pains: it very rarely terminates in
suppuration, and in this instance resembles erysipelas and gout. The crisis
of the acute is generally by sweats, cuticular efflorescence, nasal
hemorrhage. It may terminate inauspiciously in chronic pains, or in
consumption: indeed, emaciation is always a consequence.
Chronic rheumatism may occupy all the stations of the acute: in the hips it
is called ischias, morbus coxendicis, and sciatica: in the loins, lumbago. In
this there is no fever, redness, nor swelling, only pain and often inability to
move the affected joints; and this aggravated by change of weather and
cold. In the lumbago there is direful pain about the loins, with difficulty in
erecting the trunk; but not, as in the nephritis, accompanied with nausea or
vomiting, nor pain of the ureters, testicles, or thighs. In the ischias there is
severe fixed pain about the hips, os sacrum, and pubis, and often extending
down the thigh and leg along the fascia aponeurotica; with difficulty or
incapacity of moving the thigh; and sometimes atrophy of that extremity, or
sciatic tabes. Chronic rheumatism may harass months, years, with various
degrees of severity and exacerbation, and interludes of ease; and is often
extremely obstinate and difficult to be dislodged. In many instances also,
we observe a contrariety and dilemma whether to affix the name of chronic
rheumatism or gout to such pains. In general, rheumatic aches are not so
periodical in their returns; and in several other features the two diseases
divaricate.
The predisposing and occasional causes of acute and chronic rheumatism,
idiopathic and symptomatick, are, sudden suppression of perspiration;
sudden heats and colds; cold damp night air, beds, houses, habitations, want
of sufficient warm cloathing and fuel in rigorous seasons, or during the
interchanges of the seasons; wet cloaths; exposure to heats and colds;
sudden vicissitudes of heat and cold; change of winds and weather; one part
of the body exposed to cold whilst the other part is heated; sleeping on
damp ground; plethora; impure blood; repelled eruption; suppressed
evacuations; habitual intoxication; intermittent; dregs of fever; arthritic;
hereditary; scorbutick; hysterical; venereal; noxious exhalation from lead or
mercury; excess of venery; tabes dorsalis; aneurism of the descending aorta
blood, inflammatory urine; sweats sometimes copious, but not critical. Its
continuance may be one, two, or three weeks; by which time the fever, if
not mismanaged, abates with the pains: it very rarely terminates in
suppuration, and in this instance resembles erysipelas and gout. The crisis
of the acute is generally by sweats, cuticular efflorescence, nasal
hemorrhage. It may terminate inauspiciously in chronic pains, or in
consumption: indeed, emaciation is always a consequence.
Chronic rheumatism may occupy all the stations of the acute: in the hips it
is called ischias, morbus coxendicis, and sciatica: in the loins, lumbago. In
this there is no fever, redness, nor swelling, only pain and often inability to
move the affected joints; and this aggravated by change of weather and
cold. In the lumbago there is direful pain about the loins, with difficulty in
erecting the trunk; but not, as in the nephritis, accompanied with nausea or
vomiting, nor pain of the ureters, testicles, or thighs. In the ischias there is
severe fixed pain about the hips, os sacrum, and pubis, and often extending
down the thigh and leg along the fascia aponeurotica; with difficulty or
incapacity of moving the thigh; and sometimes atrophy of that extremity, or
sciatic tabes. Chronic rheumatism may harass months, years, with various
degrees of severity and exacerbation, and interludes of ease; and is often
extremely obstinate and difficult to be dislodged. In many instances also,
we observe a contrariety and dilemma whether to affix the name of chronic
rheumatism or gout to such pains. In general, rheumatic aches are not so
periodical in their returns; and in several other features the two diseases
divaricate.
The predisposing and occasional causes of acute and chronic rheumatism,
idiopathic and symptomatick, are, sudden suppression of perspiration;
sudden heats and colds; cold damp night air, beds, houses, habitations, want
of sufficient warm cloathing and fuel in rigorous seasons, or during the
interchanges of the seasons; wet cloaths; exposure to heats and colds;
sudden vicissitudes of heat and cold; change of winds and weather; one part
of the body exposed to cold whilst the other part is heated; sleeping on
damp ground; plethora; impure blood; repelled eruption; suppressed
evacuations; habitual intoxication; intermittent; dregs of fever; arthritic;
hereditary; scorbutick; hysterical; venereal; noxious exhalation from lead or
mercury; excess of venery; tabes dorsalis; aneurism of the descending aorta
Page 110
near the loins; lifting great weights; internal abscess and scirrhus; abscess,
and caries at the upper articulation of the thigh-bone; sprains; luxation and
fracture of its neck; diseases of the coverings of the nerves, or of their
medullary substance, or of the muscular fibre.
Gout, arthritis, podagra; acute, chronic, regular, and irregular. Here we have
no foundation to accuse the elements, or the invisible demons of disease:
this malady either immediately, or by hereditary descent, is too often the
natural castigation and penance of voluptuousness and sensuality. In the
preceding century it was confounded with sciatica in the London bills.
During the present century, there is a considerable increase in arthritic
mortality; but, compared to some other of the morbid host, it is a mere
buccanier. Arthritic piracy must solely be imputed to the assaults of chronic
gout, either gradually breaking down the fabrick, or storming some of the
internal organs essential to life. It attacks principally the male sex;
sometimes, but rarely, females; and of the latter those of robust full habits,
the viragines, luxurious, indolent, corpulent, and generally after the final
menstrual cessation: the majority, from the peculiarity in the female
constitution, and from superiority in temperance, are exempt. It seldom
attacks before middle age; generally in the decline of life: the few
exceptions of its earlier occurrence are rare; and in them it is usually by co-
operation of hereditary, and of remote exciting causes: in adolescence, and
before puberty, it would be numbered amongst the medical miracles. It
harasses most those of robust, full, corpulent, large frame and temperament,
the voracious, gormandizing, affluent, and pampered; more of the patrician
than the plebeian orders; more of the literary and sedentary professions;
and, according to Sydenham, those of an acute genius and intellectual
eminence. The active and industrious orders of every community; those
who are exercised in daily corporeal labour, or who, from necessity, design,
custom, or religion, do not indulge to excess in animal food, or in wine and
fermented liquors, are seldom arthritick martyrs. Compared to the number
afflicted, very few die of gout; it has even been by some considered as an
omen of longevity: many, subject to it, have reached the Mosaick goal. It
has been alledged, to render men more secure from other diseases; and in
some few instances to expurgate and renovate a disordered constitution.
These observations, however, must be restricted to regular gout only, and
recurring at distant intervals.
and caries at the upper articulation of the thigh-bone; sprains; luxation and
fracture of its neck; diseases of the coverings of the nerves, or of their
medullary substance, or of the muscular fibre.
Gout, arthritis, podagra; acute, chronic, regular, and irregular. Here we have
no foundation to accuse the elements, or the invisible demons of disease:
this malady either immediately, or by hereditary descent, is too often the
natural castigation and penance of voluptuousness and sensuality. In the
preceding century it was confounded with sciatica in the London bills.
During the present century, there is a considerable increase in arthritic
mortality; but, compared to some other of the morbid host, it is a mere
buccanier. Arthritic piracy must solely be imputed to the assaults of chronic
gout, either gradually breaking down the fabrick, or storming some of the
internal organs essential to life. It attacks principally the male sex;
sometimes, but rarely, females; and of the latter those of robust full habits,
the viragines, luxurious, indolent, corpulent, and generally after the final
menstrual cessation: the majority, from the peculiarity in the female
constitution, and from superiority in temperance, are exempt. It seldom
attacks before middle age; generally in the decline of life: the few
exceptions of its earlier occurrence are rare; and in them it is usually by co-
operation of hereditary, and of remote exciting causes: in adolescence, and
before puberty, it would be numbered amongst the medical miracles. It
harasses most those of robust, full, corpulent, large frame and temperament,
the voracious, gormandizing, affluent, and pampered; more of the patrician
than the plebeian orders; more of the literary and sedentary professions;
and, according to Sydenham, those of an acute genius and intellectual
eminence. The active and industrious orders of every community; those
who are exercised in daily corporeal labour, or who, from necessity, design,
custom, or religion, do not indulge to excess in animal food, or in wine and
fermented liquors, are seldom arthritick martyrs. Compared to the number
afflicted, very few die of gout; it has even been by some considered as an
omen of longevity: many, subject to it, have reached the Mosaick goal. It
has been alledged, to render men more secure from other diseases; and in
some few instances to expurgate and renovate a disordered constitution.
These observations, however, must be restricted to regular gout only, and
recurring at distant intervals.
Page 111
That periodical local pain and inflammation called the regular arthritic
paroxism sometimes invades suddenly, without any warning; but in general
there are presages of its approach, one or two days, or even weeks; by
ceasing of usual moisture on the feet; coldness, numbness in the feet and
legs, enlargement of their veins, muscular cramps; general torpor and
languor; restlessness; headach; depression of spirits; impaired appetite;
flatulence, indigestion, cardialgy; costiveness. But frequently one or two
days preceding the paroxism, the appetite is keener than usual. The regular
and recent paroxism commonly invades by nocturnal surprize in bed, with
pain in one foot, usually the ball of the great toe, accompanied with
shivering, heat, and shortly after, conspicuous glossy redness, tension, and
spreading tumor. The pain becomes often so intense as to be compared to
premeditated dislocation, or to a dog tearing the flesh and ligaments: and
such is the exquisite tenderness in the inflamed part and foot, as not to be
able to tolerate the slightest touch or even weight of the bed-cloaths. In this
way there are more or less diurnal remissions and exacerbations of pain;
which, after one, two, three, or four weeks, recedes gradually and
insensibly, together with the redness and swelling; leaving the patient who
had been chained to a bed or couch, in perfect health; and soon after, the
foot in the exercise of its former suppleness and strength. Throughout the
paroxism the corporeal agony renders the mind more irritable and irascible:
the urine is acrid, hot, turbid, and fabulous; in many, the perspiration is
fetid; and with both general and local sweats, and desquamation of the
inflamed cuticle, the paroxism finally evaporates. In vigorous constitutions
the paroxisms are sooner terminated: indications of which are, sudden
tumefaction, throbbing pain, and frightful sleep. In recent gout the pain is
more severe than in chronic; the paroxisms shorter, with longer intervals;
and vice versa. Pustular eruptions on the foot sometimes carry off the
arthritic fuel.
At the beginning, the paroxisms are shorter, and the periods more regular
and distant; at intervals of three or four years, or longer: by degrees the
intervals are progressively reduced to two, to one; to two paroxisms
annually about the equinoxes and solstices, and during the autumn, winter,
and spring; at the same time the paroxisms are protracted to two or three
months. At length, in the chronic inveterate stages of the disease the patient
enjoys a very short respite; some few of the enervated, perhaps only two or
three months during the summer: the pains in the extremities are then
paroxism sometimes invades suddenly, without any warning; but in general
there are presages of its approach, one or two days, or even weeks; by
ceasing of usual moisture on the feet; coldness, numbness in the feet and
legs, enlargement of their veins, muscular cramps; general torpor and
languor; restlessness; headach; depression of spirits; impaired appetite;
flatulence, indigestion, cardialgy; costiveness. But frequently one or two
days preceding the paroxism, the appetite is keener than usual. The regular
and recent paroxism commonly invades by nocturnal surprize in bed, with
pain in one foot, usually the ball of the great toe, accompanied with
shivering, heat, and shortly after, conspicuous glossy redness, tension, and
spreading tumor. The pain becomes often so intense as to be compared to
premeditated dislocation, or to a dog tearing the flesh and ligaments: and
such is the exquisite tenderness in the inflamed part and foot, as not to be
able to tolerate the slightest touch or even weight of the bed-cloaths. In this
way there are more or less diurnal remissions and exacerbations of pain;
which, after one, two, three, or four weeks, recedes gradually and
insensibly, together with the redness and swelling; leaving the patient who
had been chained to a bed or couch, in perfect health; and soon after, the
foot in the exercise of its former suppleness and strength. Throughout the
paroxism the corporeal agony renders the mind more irritable and irascible:
the urine is acrid, hot, turbid, and fabulous; in many, the perspiration is
fetid; and with both general and local sweats, and desquamation of the
inflamed cuticle, the paroxism finally evaporates. In vigorous constitutions
the paroxisms are sooner terminated: indications of which are, sudden
tumefaction, throbbing pain, and frightful sleep. In recent gout the pain is
more severe than in chronic; the paroxisms shorter, with longer intervals;
and vice versa. Pustular eruptions on the foot sometimes carry off the
arthritic fuel.
At the beginning, the paroxisms are shorter, and the periods more regular
and distant; at intervals of three or four years, or longer: by degrees the
intervals are progressively reduced to two, to one; to two paroxisms
annually about the equinoxes and solstices, and during the autumn, winter,
and spring; at the same time the paroxisms are protracted to two or three
months. At length, in the chronic inveterate stages of the disease the patient
enjoys a very short respite; some few of the enervated, perhaps only two or
three months during the summer: the pains in the extremities are then
Page 112
indeed less violent; but the stomach is more disordered. In recent gout, one
foot only is assaulted; by degrees both feet, one after the other: and in the
rooted state of the disease it not only torments both feet in succession, but
capriciously deserts and re-attacks various parts; the ancle, knee, elbow,
wrist; darting often with electrical velocity and shocks through the nerves
and muscular fibres: thus, in a circle of torture and litigious warfare, teazing
the arthritick victim.
When either the inflammation of the joints has commenced in the usual
manner, but without an adequate degree of pain and inflammation, or at
least without continuing the usual time, and precipitately recedes, some
internal organ is exposed in its retreat and rebound. Or when the arthritick
fuel is occluded, and not ejected to the feet, it will, according to the various
parts and organs affected, excite corresponding vibrations and symptoms in
the natural, vital, and animal functions; as inappetency, indigestion, nausea,
vomiting, flatulence, ventricular eructation, colick, diarrhœa, nephritis, and
urinary obstructions; difficult respiration, asthma, palpitation, fainting,
general debility, low spirits, hypochondriasm, cramps and spasms in the
muscles, apoplexy, palsy. In dubious cases from what source to derive such
irregular alarms and minatory explosion; if they happen about the usual
arthritic periods, and in such temperaments, their origin may be suspected:
and it is of the highest moment to know that they are rarely of an
inflammatory nature. After the disease has continued many years with
frequent reiterated paroxisms the joints do not soon recover, but continue
weak and stiff. In many cases, chalky and calculous concretions are formed
in the joints of the extremities, and in the kidneys and urinary passages.
Racked by those combined tortures, the patient requires the auxiliary aid of
stuffed chairs, flannel, and crutches.
The predisposing and occasional causes are hereditary; inactive sedentary
life, with luxurious living and gormandizing, especially on animal food;
intemperance in wine, spirituous or fermented liquors; early or intemperate
libations to Bacchus and Venus; unremitting application to study or
business; sedentary life; nocturnal lucubrations; disturbed sleep, cares,
misfortunes, vexation, depressing passions; ceasing of usual exercise or
labour; sudden transition from an active to a sedentary life; coaches,
dissipation, luxury, effeminacy; sudden violent changes in diet; plethora;
foot only is assaulted; by degrees both feet, one after the other: and in the
rooted state of the disease it not only torments both feet in succession, but
capriciously deserts and re-attacks various parts; the ancle, knee, elbow,
wrist; darting often with electrical velocity and shocks through the nerves
and muscular fibres: thus, in a circle of torture and litigious warfare, teazing
the arthritick victim.
When either the inflammation of the joints has commenced in the usual
manner, but without an adequate degree of pain and inflammation, or at
least without continuing the usual time, and precipitately recedes, some
internal organ is exposed in its retreat and rebound. Or when the arthritick
fuel is occluded, and not ejected to the feet, it will, according to the various
parts and organs affected, excite corresponding vibrations and symptoms in
the natural, vital, and animal functions; as inappetency, indigestion, nausea,
vomiting, flatulence, ventricular eructation, colick, diarrhœa, nephritis, and
urinary obstructions; difficult respiration, asthma, palpitation, fainting,
general debility, low spirits, hypochondriasm, cramps and spasms in the
muscles, apoplexy, palsy. In dubious cases from what source to derive such
irregular alarms and minatory explosion; if they happen about the usual
arthritic periods, and in such temperaments, their origin may be suspected:
and it is of the highest moment to know that they are rarely of an
inflammatory nature. After the disease has continued many years with
frequent reiterated paroxisms the joints do not soon recover, but continue
weak and stiff. In many cases, chalky and calculous concretions are formed
in the joints of the extremities, and in the kidneys and urinary passages.
Racked by those combined tortures, the patient requires the auxiliary aid of
stuffed chairs, flannel, and crutches.
The predisposing and occasional causes are hereditary; inactive sedentary
life, with luxurious living and gormandizing, especially on animal food;
intemperance in wine, spirituous or fermented liquors; early or intemperate
libations to Bacchus and Venus; unremitting application to study or
business; sedentary life; nocturnal lucubrations; disturbed sleep, cares,
misfortunes, vexation, depressing passions; ceasing of usual exercise or
labour; sudden transition from an active to a sedentary life; coaches,
dissipation, luxury, effeminacy; sudden violent changes in diet; plethora;
Page 113
suppressed evacuations; profuse evacuations; various causes of debility;
indigestion from quantity or quality of aliment.
Of internal suppuration in the lungs, liver, stomach, intestines, kidneys.
Pulmonick suppuration, empyema, or vomica, may be predicted from
preceding inflammation, without considerable remissions, the neglect of
effectual remedies, and no signs of resolution by the efforts of nature or art,
and by remission of acute pain; the difficulty of respiration and also cough
continuing; with frequent horrors and shivering, heat and hectic, weight and
throbbing in the side, laying on the diseased side painful; dyspnœa
aggravated by a recumbent posture; disagreeable taste in the tongue; thirst;
fetid breath; emaciation. It may burst in all the intervals between fourteen
and sixty days, and either relieves or suffocates, or is gradually
expectorated: and sometimes, after absorption, may be evacuated by
diarrhœa or urine: the purulent contents may also be discharged upon the
diaphragm, or between the pleura and intercostal muscles. Sometimes there
are several small abscesses; and too frequently the final termination is
ulceration and phthisis. Suppuration in the Liver is a frequent consequence
of previous inflammation, and is not altogether so fatal as some other
internal abscesses. Its symptoms are those in common with internal
formation of pus, horror and chilliness, hectic heat, thirst, weight and load
in that region, jaundice-colour of the eyes. Sometimes the purulence erodes
the external integuments; sometimes the diaphragm, lungs, or stomach;
sometimes is discharged by the biliary ducts into the intestines, or absorbed
and washed away with the urine. Suppuration in the stomach and intestines
is rare. In the kidneys, the general symptoms, with purulent fetid urine: it
may also burst externally; or by slow ulceration and hectic, undermine the
constitution.
Of Internal Gangrene in the lungs, stomach, intestines, kidneys, liver.
Pulmonick gangrene from inflammation, is predicted by sudden cessation
of pain, without any benign crisis: expectoration either suppressed, or
yellow, green, black, and fetid; hollow noise in the breast during
respiration; dejected countenance; red and heavy eyes; foul and black
tongue; quick, languid, and intermittent pulse; fetid urine, stools, and sweat;
hiccup; cold sweats; universal debility and sinking of the vital powers.
From the preceding symptoms, from those enumerated under general febrile
prognosticks, and from the functions peculiar to the different diseased
indigestion from quantity or quality of aliment.
Of internal suppuration in the lungs, liver, stomach, intestines, kidneys.
Pulmonick suppuration, empyema, or vomica, may be predicted from
preceding inflammation, without considerable remissions, the neglect of
effectual remedies, and no signs of resolution by the efforts of nature or art,
and by remission of acute pain; the difficulty of respiration and also cough
continuing; with frequent horrors and shivering, heat and hectic, weight and
throbbing in the side, laying on the diseased side painful; dyspnœa
aggravated by a recumbent posture; disagreeable taste in the tongue; thirst;
fetid breath; emaciation. It may burst in all the intervals between fourteen
and sixty days, and either relieves or suffocates, or is gradually
expectorated: and sometimes, after absorption, may be evacuated by
diarrhœa or urine: the purulent contents may also be discharged upon the
diaphragm, or between the pleura and intercostal muscles. Sometimes there
are several small abscesses; and too frequently the final termination is
ulceration and phthisis. Suppuration in the Liver is a frequent consequence
of previous inflammation, and is not altogether so fatal as some other
internal abscesses. Its symptoms are those in common with internal
formation of pus, horror and chilliness, hectic heat, thirst, weight and load
in that region, jaundice-colour of the eyes. Sometimes the purulence erodes
the external integuments; sometimes the diaphragm, lungs, or stomach;
sometimes is discharged by the biliary ducts into the intestines, or absorbed
and washed away with the urine. Suppuration in the stomach and intestines
is rare. In the kidneys, the general symptoms, with purulent fetid urine: it
may also burst externally; or by slow ulceration and hectic, undermine the
constitution.
Of Internal Gangrene in the lungs, stomach, intestines, kidneys, liver.
Pulmonick gangrene from inflammation, is predicted by sudden cessation
of pain, without any benign crisis: expectoration either suppressed, or
yellow, green, black, and fetid; hollow noise in the breast during
respiration; dejected countenance; red and heavy eyes; foul and black
tongue; quick, languid, and intermittent pulse; fetid urine, stools, and sweat;
hiccup; cold sweats; universal debility and sinking of the vital powers.
From the preceding symptoms, from those enumerated under general febrile
prognosticks, and from the functions peculiar to the different diseased
Page 114
organs, internal gangrene in whatsoever part may be comprehended; and a
minute detail would be superfluous.
DISEASES of the Lungs and Organs of Respiration, what extensive ruin
do they yet spread! In commenting upon these, I shall, in a trifling degree,
invert the prescribed order and arrangement. Into this group are
concentrated pulmonick hemorrhage, pulmonary phthisis, the various
species of hectick, atrophy and tabes, nervous, sciatick, dorsal, and icterick;
also asthma, dyspnœa and cough, catarrh, hooping cough, croup.
Inflammation of these organs and spurious peripneumony, have already
been described. These, therefore, constitute nearly the whole combined
pulmonick host, and likewise some of those diseases closely connected with
the pneumonick machinery, or with several of its general morbid symptoms.
Behold here one of the great caravans of dead to the stygian ferry; and
tottering myriads crowding to the same shambles. View the innumerable
multitude of fable mourners and weeping relations attending them in the
last melancholy offices of friendship, to that eternal bourn, the grave! Every
introspection of general morbid registers, and the unanimous observations
of the medical profession, concord in proclaiming the notoriety of the
consumptive throng, and their ruinous uncontroulable domination.
Notwithstanding the prodigious improvement in the alphabet, subordinate
rudiments, and appendages of the medical science, consumption as yet is
one of the great oligarchy of morbid and remorseless tyrants. He would be
intitled to every terrestrial honour, and to posthumous apotheosis; he would
rival and eclipse the most celebrated tyrannicides, and expurgators of
monsters, whether demi-gods, heroes, or saints, who could dethrone or
controul this stationary monopolizer of human sacrifices, and sheathe his
deadly sword.
From one fifth to one sixth of all the mortality in London, is from
consumption; which is nearly double to that even of small pox. But
consumption is a term too lax and indefinite. Into this gulph, no doubt, are
thrown many febrile and slow hectick emaciations, from infancy to old age,
in both sexes; and there are few diseases from acute and chronic sources,
minute detail would be superfluous.
DISEASES of the Lungs and Organs of Respiration, what extensive ruin
do they yet spread! In commenting upon these, I shall, in a trifling degree,
invert the prescribed order and arrangement. Into this group are
concentrated pulmonick hemorrhage, pulmonary phthisis, the various
species of hectick, atrophy and tabes, nervous, sciatick, dorsal, and icterick;
also asthma, dyspnœa and cough, catarrh, hooping cough, croup.
Inflammation of these organs and spurious peripneumony, have already
been described. These, therefore, constitute nearly the whole combined
pulmonick host, and likewise some of those diseases closely connected with
the pneumonick machinery, or with several of its general morbid symptoms.
Behold here one of the great caravans of dead to the stygian ferry; and
tottering myriads crowding to the same shambles. View the innumerable
multitude of fable mourners and weeping relations attending them in the
last melancholy offices of friendship, to that eternal bourn, the grave! Every
introspection of general morbid registers, and the unanimous observations
of the medical profession, concord in proclaiming the notoriety of the
consumptive throng, and their ruinous uncontroulable domination.
Notwithstanding the prodigious improvement in the alphabet, subordinate
rudiments, and appendages of the medical science, consumption as yet is
one of the great oligarchy of morbid and remorseless tyrants. He would be
intitled to every terrestrial honour, and to posthumous apotheosis; he would
rival and eclipse the most celebrated tyrannicides, and expurgators of
monsters, whether demi-gods, heroes, or saints, who could dethrone or
controul this stationary monopolizer of human sacrifices, and sheathe his
deadly sword.
From one fifth to one sixth of all the mortality in London, is from
consumption; which is nearly double to that even of small pox. But
consumption is a term too lax and indefinite. Into this gulph, no doubt, are
thrown many febrile and slow hectick emaciations, from infancy to old age,
in both sexes; and there are few diseases from acute and chronic sources,
Page 115
especially in their fatal termination, without emaciation. Consumptions and
dropsies are the final wreck of a great variety of human maladies. In no two
other diseases are, what pathologists term Morbi a Morbis, more apparent:
and in multitudes of such cases, morbid dissections often detect the effect,
and not the original cause. How many of the genuine pulmonary phthisis
are consociated with this miscellaneous crowd, is difficult to guess; but,
from the concurrent testimony of physicians, and of experience, we may
safely affirm a very large proportion. There are few families in this
kingdom whom it has not, one time or other, plunged into tears. Physicians
on the continent alledge, that phthisis is more prevalent in Britain than in
any other kingdom of Europe.
The next inquiry is, in what age, sex, rank of life, season of the year, and
whether in city or country is consumption most predominant? It has been,
from the earliest chronology, the universal echo and monotony of medical
writers, to mark the principal consumptive age between 18 and 35. But,
with submission, I would considerably enlarge its limits, including from
birth to 5, and from 20 to 60. No age or stage of life is exempted; but we
might “a priori,” and from viewing the great and general scale of mortality,
assert, that between 5 and 20, a considerable number cannot possibly be
swept away in the phthisical torrent. Nor do we mean to invalidate the
general aphorism, that in the blossom and full maturity of vigour and
comeliness, phthisis is superlatively deleterious. Between the sexes no
distinction seems to be made. I conceive, however, that amongst the lower
orders universally, and more especially those penned up in the foul
atmosphere of cities, that phthisis is more fatal than amongst those who
browse in the pure air of the country. In accommodation, cloathing, noxious
trades, &c. the indigent have the disadvantage; and during sickness, from
the same causes, their recovery is more desperate. With respect to seasons,
winter and autumn in our climate is the most pernicious to pulmonick
maladies.
Pulmonary Hemorrhage, hæmoptysis, sputum sanguinis. The lungs spungy
pneumatick and hydraulick organs, in themselves passive; but by the
contraction of the diaphragm and intercostal muscles enlarging the capacity
of the thorax, this ventilator is alternately distended with atmospheric air,
and this sonorous fluid again quickly expelled, with either some noxious
emanation from the body, or decomposition of its own vital principle. Half
dropsies are the final wreck of a great variety of human maladies. In no two
other diseases are, what pathologists term Morbi a Morbis, more apparent:
and in multitudes of such cases, morbid dissections often detect the effect,
and not the original cause. How many of the genuine pulmonary phthisis
are consociated with this miscellaneous crowd, is difficult to guess; but,
from the concurrent testimony of physicians, and of experience, we may
safely affirm a very large proportion. There are few families in this
kingdom whom it has not, one time or other, plunged into tears. Physicians
on the continent alledge, that phthisis is more prevalent in Britain than in
any other kingdom of Europe.
The next inquiry is, in what age, sex, rank of life, season of the year, and
whether in city or country is consumption most predominant? It has been,
from the earliest chronology, the universal echo and monotony of medical
writers, to mark the principal consumptive age between 18 and 35. But,
with submission, I would considerably enlarge its limits, including from
birth to 5, and from 20 to 60. No age or stage of life is exempted; but we
might “a priori,” and from viewing the great and general scale of mortality,
assert, that between 5 and 20, a considerable number cannot possibly be
swept away in the phthisical torrent. Nor do we mean to invalidate the
general aphorism, that in the blossom and full maturity of vigour and
comeliness, phthisis is superlatively deleterious. Between the sexes no
distinction seems to be made. I conceive, however, that amongst the lower
orders universally, and more especially those penned up in the foul
atmosphere of cities, that phthisis is more fatal than amongst those who
browse in the pure air of the country. In accommodation, cloathing, noxious
trades, &c. the indigent have the disadvantage; and during sickness, from
the same causes, their recovery is more desperate. With respect to seasons,
winter and autumn in our climate is the most pernicious to pulmonick
maladies.
Pulmonary Hemorrhage, hæmoptysis, sputum sanguinis. The lungs spungy
pneumatick and hydraulick organs, in themselves passive; but by the
contraction of the diaphragm and intercostal muscles enlarging the capacity
of the thorax, this ventilator is alternately distended with atmospheric air,
and this sonorous fluid again quickly expelled, with either some noxious
emanation from the body, or decomposition of its own vital principle. Half
Page 116
the blood of the human body circulates thro’ this organ: its blood-vessels
are numerous and large, and rise immediately from the heart; and it is
incessantly in motion and agitation. When the body has nearly attained its
ultimate extension and altitude, pulmonary hemorrhage is most
predominant; more especially in those of narrow thorax, prominent
scapulæ, red cheeks, and acute tone of voice. Before the hemorrhage, there
are shivering, horror, heat, fever, weight, oppression, pain and heat in the
breast, difficulty of breathing, titillation of the fauces, dry cough, exspuition
of florid blood in various quantity, and slowly or suddenly, from ounces to
many pounds, or even quarts, in a few days; but the latter is rare. It may
soon totally cease, or only intermit, and again return at irregular intervals.
Relapses are frequent on any irregularity or intemperance; on acceleration
of the circulation, or expansion from heat.
This hemorrhage is very seldom in such quantities to prove precipitately
fatal, unless mismanaged. From Bleeding, at least in the London registers,
there is petty spoliation. Pulmonary hemorrhage is more frequently the
consumptive precursor. Malign omens are an eruptive torrent; ulceration in
the lungs; fever renewed; pain in the breast; difficulty of breathing; cough,
hoarseness; night sweats; peripneumony; visceral obstructions; cachexy; old
age; relapses. But pulmonary hemorrhage from temporary obstructions of
the menses, or in pregnancy, or periodical, or without load in the thorax, or
fever, are much less mischievous.
Pulmonary Phthisis. Not one hundredth part of pulmonary consumptions
commence with hemorrhage. Phthisical lineaments are emaciation, diurnal
hectic fever, obstinate rebellious cough, difficulty of breathing, and usually
some change in the voice. In the beginning, phthisis often resembles a
catarrh, or stubborn cold; and in this insidious disguise is too frequently
slighted, or neglected: but continuing longer than the usual catarrhal period,
without any considerable intermission, and especially if in summer, are
sufficient grounds of alarm. In that, from tubercles, there is frequent teazing
dry cough, exasperated at night; some difficulty of breathing, and panting
on ascending any eminence or stairs, or on exercise; some emaciation and
weakness. By degrees, there is more or less expectoration of viscid, yellow,
greenish purulence, intermixed, however, with natural mucus, and in the
progress streaked with blood. Sooner or later, uneasiness in the breast,
are numerous and large, and rise immediately from the heart; and it is
incessantly in motion and agitation. When the body has nearly attained its
ultimate extension and altitude, pulmonary hemorrhage is most
predominant; more especially in those of narrow thorax, prominent
scapulæ, red cheeks, and acute tone of voice. Before the hemorrhage, there
are shivering, horror, heat, fever, weight, oppression, pain and heat in the
breast, difficulty of breathing, titillation of the fauces, dry cough, exspuition
of florid blood in various quantity, and slowly or suddenly, from ounces to
many pounds, or even quarts, in a few days; but the latter is rare. It may
soon totally cease, or only intermit, and again return at irregular intervals.
Relapses are frequent on any irregularity or intemperance; on acceleration
of the circulation, or expansion from heat.
This hemorrhage is very seldom in such quantities to prove precipitately
fatal, unless mismanaged. From Bleeding, at least in the London registers,
there is petty spoliation. Pulmonary hemorrhage is more frequently the
consumptive precursor. Malign omens are an eruptive torrent; ulceration in
the lungs; fever renewed; pain in the breast; difficulty of breathing; cough,
hoarseness; night sweats; peripneumony; visceral obstructions; cachexy; old
age; relapses. But pulmonary hemorrhage from temporary obstructions of
the menses, or in pregnancy, or periodical, or without load in the thorax, or
fever, are much less mischievous.
Pulmonary Phthisis. Not one hundredth part of pulmonary consumptions
commence with hemorrhage. Phthisical lineaments are emaciation, diurnal
hectic fever, obstinate rebellious cough, difficulty of breathing, and usually
some change in the voice. In the beginning, phthisis often resembles a
catarrh, or stubborn cold; and in this insidious disguise is too frequently
slighted, or neglected: but continuing longer than the usual catarrhal period,
without any considerable intermission, and especially if in summer, are
sufficient grounds of alarm. In that, from tubercles, there is frequent teazing
dry cough, exasperated at night; some difficulty of breathing, and panting
on ascending any eminence or stairs, or on exercise; some emaciation and
weakness. By degrees, there is more or less expectoration of viscid, yellow,
greenish purulence, intermixed, however, with natural mucus, and in the
progress streaked with blood. Sooner or later, uneasiness in the breast,
Page 117
inability to lay on one side, pain in the side, or under the sternum, and
aggravated by inspiration and coughing.
The consuming hectic fever has generally two exacerbations during the
twenty-four hours, about noon and night; with some degree of chilliness
and shivering, and increased sensibility to cool air, notwithstanding the skin
is preternaturally hot; the palms of the hands and soles of the feet burn; a
florid redness, or circumscribed spot is perceivable in the cheeks; the other
features are partial sweats about the neck and breast, particularly in the
morning; disturbed sleep; slender, hoarse, and obscure voice; quick pulse;
sometimes vomiting after meals; thirst; salt taste in the mouth; cough and
expectoration, in frequency and quantity, varying in different persons; in
some, there is a very considerable discharge of purulency from the lungs.
Various ordeals have been proposed for the distinction of mucus from pus,
or pulmonick ulceration. Mucus is naturally more transparent, viscid, and
cohesive: pus always opake, more yellow and greenish; the odour more
disagreeable, and the expectoration accompanied with a hectick fever. The
sinking or swimming in water of the expectorated matter, is a precarious
symptom, as it depends on the quantity of entangled air.
In this island, phthisis, especially from tubercles not suppurated, may
continue one, two, or more years; appearing during the winter and spring,
and disappearing during the summer. Other consumptions are much more
rapid; in the vernacular phrase, galloping the patient to a skeleton in a few
months. Phthisical patients are rarely confined to bed, until near the
deplorable stages and fatal termination. Some have even a tolerable
appetite; and the generality are cheered with adulatory hopes of recovery to
the last extremity. The progressive encroachment is evident, by increased
debility, emaciation, and partial sweats; edematous ancles; diarrhœa;
depilation; consumption and melting away of the fat and muscular flesh: at
last sapless, and macerated into ghosts, the twinkling vital snuff is
extinguished. It is, as yet, impossible for me to apportion the comparative
mortality and recovery in real confirmed phthisis; nor could I depend upon
any of the general registers which I carefully consulted with this view. We
may, however, venture upon a gross estimate, by negative proof. Exclusive
of individual evidence, and medical attestation, we might, by a simple
algebraic process out of any specified number, with their mortal diseases,
and probable proportion of sick in each, sift out the consumptive. At all
aggravated by inspiration and coughing.
The consuming hectic fever has generally two exacerbations during the
twenty-four hours, about noon and night; with some degree of chilliness
and shivering, and increased sensibility to cool air, notwithstanding the skin
is preternaturally hot; the palms of the hands and soles of the feet burn; a
florid redness, or circumscribed spot is perceivable in the cheeks; the other
features are partial sweats about the neck and breast, particularly in the
morning; disturbed sleep; slender, hoarse, and obscure voice; quick pulse;
sometimes vomiting after meals; thirst; salt taste in the mouth; cough and
expectoration, in frequency and quantity, varying in different persons; in
some, there is a very considerable discharge of purulency from the lungs.
Various ordeals have been proposed for the distinction of mucus from pus,
or pulmonick ulceration. Mucus is naturally more transparent, viscid, and
cohesive: pus always opake, more yellow and greenish; the odour more
disagreeable, and the expectoration accompanied with a hectick fever. The
sinking or swimming in water of the expectorated matter, is a precarious
symptom, as it depends on the quantity of entangled air.
In this island, phthisis, especially from tubercles not suppurated, may
continue one, two, or more years; appearing during the winter and spring,
and disappearing during the summer. Other consumptions are much more
rapid; in the vernacular phrase, galloping the patient to a skeleton in a few
months. Phthisical patients are rarely confined to bed, until near the
deplorable stages and fatal termination. Some have even a tolerable
appetite; and the generality are cheered with adulatory hopes of recovery to
the last extremity. The progressive encroachment is evident, by increased
debility, emaciation, and partial sweats; edematous ancles; diarrhœa;
depilation; consumption and melting away of the fat and muscular flesh: at
last sapless, and macerated into ghosts, the twinkling vital snuff is
extinguished. It is, as yet, impossible for me to apportion the comparative
mortality and recovery in real confirmed phthisis; nor could I depend upon
any of the general registers which I carefully consulted with this view. We
may, however, venture upon a gross estimate, by negative proof. Exclusive
of individual evidence, and medical attestation, we might, by a simple
algebraic process out of any specified number, with their mortal diseases,
and probable proportion of sick in each, sift out the consumptive. At all
Page 118
events, it cannot possibly be thought exaggeration to alledge, that not one
out of seven consumptive recover. From hereditary entail, or tubercles, it is
still more desperate.
Species of Consumption are, hectick fever, atrophy and tabes; nervous;
icterick; dorsal. Hectick fever and atrophy is described as a very frequent
and fatal disease of infants, especially in cities; accompanied with
emaciation, often short dry cough, hot skin and palms of the hands; quick
pulse, thirst, diurnal exacerbations, sickly countenance: in some the
abdomen is tense, tumid, and considerably enlarged. In simple atrophy the
fever is not so acute; with tumid belly, irregular fecal discharge;
voraciousness, indigestion, thirst, nocturnal sweats, unhealthy countenance.
Atrophy and nervous tabes are confounded in medical diagnosticks: in both
there is emaciation; but no considerable fever, cough, or difficulty of
breathing; impaired appetite and digestion; leucophlegmatic sickly
appearance, partial sweats; general debility, and proneness to faint on any
exertion. Sometimes atrophy is circumscribed to a particular part or
member. The icterick tabes is accompanied with symptoms of jaundice; and
probably, under several disguises, is more frequent than medical authors
have represented.
Dorsal, or spermatick, is a particular tabes; miserable spectacles of which
are recorded by the celebrated Tissot. Its symptoms are, emaciation, yet
good appetite; pain and weakness in the back and loins; disturbed sleep, and
frequently interrupted by nocturnal dreams and pollution, either with or
without pleasure; weakness of the knees and trembling of the muscles on
the least exercise; sometimes a sensation as of thorns pricking the skin, and
descending down the spine; pale sickly countenance, livid circle under the
eye-lids; the feces and urine excreted with some difficulty, and often either
with semen or prostate liquor. By degrees, the appetite decays with
indigestion, hypochondriasm, melancholy; pains in various parts, headach,
lumbago, universal debility, wasting of the penis, impotency and blight of
future progeny. Females are not exempt from this disease; but it is much
more frequent amongst the male sex, from the age of puberty through
various adult stages of life: the foundation of it is often laid at schools; and
in those seminaries of vice, large cities: and in some countries it is a more
general habit of licentiousness than in others.
out of seven consumptive recover. From hereditary entail, or tubercles, it is
still more desperate.
Species of Consumption are, hectick fever, atrophy and tabes; nervous;
icterick; dorsal. Hectick fever and atrophy is described as a very frequent
and fatal disease of infants, especially in cities; accompanied with
emaciation, often short dry cough, hot skin and palms of the hands; quick
pulse, thirst, diurnal exacerbations, sickly countenance: in some the
abdomen is tense, tumid, and considerably enlarged. In simple atrophy the
fever is not so acute; with tumid belly, irregular fecal discharge;
voraciousness, indigestion, thirst, nocturnal sweats, unhealthy countenance.
Atrophy and nervous tabes are confounded in medical diagnosticks: in both
there is emaciation; but no considerable fever, cough, or difficulty of
breathing; impaired appetite and digestion; leucophlegmatic sickly
appearance, partial sweats; general debility, and proneness to faint on any
exertion. Sometimes atrophy is circumscribed to a particular part or
member. The icterick tabes is accompanied with symptoms of jaundice; and
probably, under several disguises, is more frequent than medical authors
have represented.
Dorsal, or spermatick, is a particular tabes; miserable spectacles of which
are recorded by the celebrated Tissot. Its symptoms are, emaciation, yet
good appetite; pain and weakness in the back and loins; disturbed sleep, and
frequently interrupted by nocturnal dreams and pollution, either with or
without pleasure; weakness of the knees and trembling of the muscles on
the least exercise; sometimes a sensation as of thorns pricking the skin, and
descending down the spine; pale sickly countenance, livid circle under the
eye-lids; the feces and urine excreted with some difficulty, and often either
with semen or prostate liquor. By degrees, the appetite decays with
indigestion, hypochondriasm, melancholy; pains in various parts, headach,
lumbago, universal debility, wasting of the penis, impotency and blight of
future progeny. Females are not exempt from this disease; but it is much
more frequent amongst the male sex, from the age of puberty through
various adult stages of life: the foundation of it is often laid at schools; and
in those seminaries of vice, large cities: and in some countries it is a more
general habit of licentiousness than in others.
Page 119
Of the predisposing and occasional causes of pulmonary hemorrhage,
pulmonary phthisis, hectick, atrophy and tabes. Of pulmonary hemorrhage;
hereditary; narrow thorax; weak pulmonary blood vessels, small capacity;
plethora; suppressed natural or habitual hemorrhage, as nasal,
hemorrhoidal, menstrual; amputation of a considerable extremity; luxurious
living and indolence; violent exertion and exercise of the lungs and voice in
various trades and professions; also violent efforts to cough, to exonerate
the excretories; parturition; lifting great weights; violent exercise; furious
passions of mind: external injuries on the thorax; wounds; confining the
thorax by writing-desks, by strong whalebone stays; suppressed perspiration
and exhalation of the skin and lungs by cold; light atmosphere, especially
on high mountains; pulmonick inflammation; scrophulous lymphatick
glands and tubercles in the lungs, or calculous concretions; polypus
concretions in the large pulmonary blood-vessels; schirrus and obstruction
in the abdominal viscera.
The predisposing and occasional causes of pulmonary phthisis are all the
preceding causes of pulmonick hemorrhage; hereditary; scrophulous
tubercles; suppuration in the lungs, and not with laudable pus; calculi in the
lungs; consequence of pulmonick inflammation and suppuration, of small
pox, measles, hooping cough, rickets; and of various acute and chronic
diseases; venereal, icterick; chlorosis; worms; rheumatism; chronic asthma;
internal abscesses and ulcers; catarrh and neglected colds; sudden
suppression of perspiration, especially when the body is heated; pulmonary
exhalation suppressed, and cold damp air inspired; irregularity and coldness
of the climate joined to moisture; various noxious trades and occupations;
noxious fumes and effluvia inspired; foul atmosphere of cities, coal fires;
broken ribs and blows on the thorax; indigence; cold habitations; want of
sufficient cloathing and fuel in rigorous seasons.
The predisposing and occasional causes of hectic, atrophy and tabes, are
many of the causes just now enumerated: scrophulous obstructed
mesenterick glands, and course of the chyle; colds; damp habitations; foul
atmosphere of cities; moist cloudy atmosphere; unwholesome air;
coagulated milk in the stomach and intestines; foul stomach; diseased
stomach and abdominal viscera; improper diet; gluttony, sloth,
uncleanliness, bad nursing, insufficient exercise; worms; repelled cutaneous
eruptions and ulcers; cachexy; intoxication and intemperance; depressing
pulmonary phthisis, hectick, atrophy and tabes. Of pulmonary hemorrhage;
hereditary; narrow thorax; weak pulmonary blood vessels, small capacity;
plethora; suppressed natural or habitual hemorrhage, as nasal,
hemorrhoidal, menstrual; amputation of a considerable extremity; luxurious
living and indolence; violent exertion and exercise of the lungs and voice in
various trades and professions; also violent efforts to cough, to exonerate
the excretories; parturition; lifting great weights; violent exercise; furious
passions of mind: external injuries on the thorax; wounds; confining the
thorax by writing-desks, by strong whalebone stays; suppressed perspiration
and exhalation of the skin and lungs by cold; light atmosphere, especially
on high mountains; pulmonick inflammation; scrophulous lymphatick
glands and tubercles in the lungs, or calculous concretions; polypus
concretions in the large pulmonary blood-vessels; schirrus and obstruction
in the abdominal viscera.
The predisposing and occasional causes of pulmonary phthisis are all the
preceding causes of pulmonick hemorrhage; hereditary; scrophulous
tubercles; suppuration in the lungs, and not with laudable pus; calculi in the
lungs; consequence of pulmonick inflammation and suppuration, of small
pox, measles, hooping cough, rickets; and of various acute and chronic
diseases; venereal, icterick; chlorosis; worms; rheumatism; chronic asthma;
internal abscesses and ulcers; catarrh and neglected colds; sudden
suppression of perspiration, especially when the body is heated; pulmonary
exhalation suppressed, and cold damp air inspired; irregularity and coldness
of the climate joined to moisture; various noxious trades and occupations;
noxious fumes and effluvia inspired; foul atmosphere of cities, coal fires;
broken ribs and blows on the thorax; indigence; cold habitations; want of
sufficient cloathing and fuel in rigorous seasons.
The predisposing and occasional causes of hectic, atrophy and tabes, are
many of the causes just now enumerated: scrophulous obstructed
mesenterick glands, and course of the chyle; colds; damp habitations; foul
atmosphere of cities; moist cloudy atmosphere; unwholesome air;
coagulated milk in the stomach and intestines; foul stomach; diseased
stomach and abdominal viscera; improper diet; gluttony, sloth,
uncleanliness, bad nursing, insufficient exercise; worms; repelled cutaneous
eruptions and ulcers; cachexy; intoxication and intemperance; depressing
Page 120
passions of mind, cares, and vexations; intense study; insufficient
nutriment, poverty, and want of food; frequent vomiting of food; faults in
the organs of digestion; digestive fluids defective or depraved; profuse
evacuations, as hemorrhages, diarrhœa, diabetes, fluor albus, salivation,
seminal emission; delicate women suckling; sweats; rupture of the thoracick
duct; diseases of the spinal brain; weakness of the solidum vivum; general
defect of fluids, or of oil in the cellular texture; fever and absorption of the
subcutaneous oil; old age and contraction of the small vessels; broken
constitution, from various causes; frequent manustupration; libidinous
books, prints; consequence of venereal gleets, and improper treatment.
Asthma. In the London bills, Asthma and Tissick are forced into a connubial
link: formerly it was consumption and tissick, the Italian name for
consumption, and without any mention of asthma. It would appear by the
London registers, that about one fortieth part of the memento mori’s in
church-yards is from asthma; and its proportion to consumptive mortality as
1 to 8. I have every reason to believe that the funeral catalogue in London is
not, in any outrageous degree, preternaturally overcharged with
consumption or asthma. As both these diseases are properly excluded from
in-patients of our hospitals, I applied to one of the largest dispensaries in
London, the Aldersgate; in which there is necessarily an overflow of both
these distempers; and with the intention of confronting and irradiating the
bills of mortality. Almost every page of these books presented Asthma in no
inconsiderable number; and above all, Phthisis, phthisis, phthisis, towering
with gigantic bulk.
There is, unfortunately, in medical books such an exuberance of postulata,
that I endeavoured to ascertain from facts and numbers, the sex and age in
which asthma is most predominant; and also its absolute mortality. For this
purpose I extracted and winnowed out of all the patients in the Aldersgate
Dispensary during seventeen years, from 1770 to 1788, all the cases of
asthma and dyspnœa: the result is as follows. Out of 70,000 patients,
asthma and dyspnœa were 3,192; or one twenty-third of all the diseases; of
which there were of males, 1613; females, 1536: dead, 169; relieved, 575:
discharged, 569: cured all the remainder. The sundry ages of these were,—
From birth to 10 years, 36; from 10 to 20, 25; from 20 to 30, 161; from 30
to 40, 429; from 40 to 50, 882; from 50 to 60, 949; from 60 to 70, 596; from
70 to 80, and upwards, 114.
nutriment, poverty, and want of food; frequent vomiting of food; faults in
the organs of digestion; digestive fluids defective or depraved; profuse
evacuations, as hemorrhages, diarrhœa, diabetes, fluor albus, salivation,
seminal emission; delicate women suckling; sweats; rupture of the thoracick
duct; diseases of the spinal brain; weakness of the solidum vivum; general
defect of fluids, or of oil in the cellular texture; fever and absorption of the
subcutaneous oil; old age and contraction of the small vessels; broken
constitution, from various causes; frequent manustupration; libidinous
books, prints; consequence of venereal gleets, and improper treatment.
Asthma. In the London bills, Asthma and Tissick are forced into a connubial
link: formerly it was consumption and tissick, the Italian name for
consumption, and without any mention of asthma. It would appear by the
London registers, that about one fortieth part of the memento mori’s in
church-yards is from asthma; and its proportion to consumptive mortality as
1 to 8. I have every reason to believe that the funeral catalogue in London is
not, in any outrageous degree, preternaturally overcharged with
consumption or asthma. As both these diseases are properly excluded from
in-patients of our hospitals, I applied to one of the largest dispensaries in
London, the Aldersgate; in which there is necessarily an overflow of both
these distempers; and with the intention of confronting and irradiating the
bills of mortality. Almost every page of these books presented Asthma in no
inconsiderable number; and above all, Phthisis, phthisis, phthisis, towering
with gigantic bulk.
There is, unfortunately, in medical books such an exuberance of postulata,
that I endeavoured to ascertain from facts and numbers, the sex and age in
which asthma is most predominant; and also its absolute mortality. For this
purpose I extracted and winnowed out of all the patients in the Aldersgate
Dispensary during seventeen years, from 1770 to 1788, all the cases of
asthma and dyspnœa: the result is as follows. Out of 70,000 patients,
asthma and dyspnœa were 3,192; or one twenty-third of all the diseases; of
which there were of males, 1613; females, 1536: dead, 169; relieved, 575:
discharged, 569: cured all the remainder. The sundry ages of these were,—
From birth to 10 years, 36; from 10 to 20, 25; from 20 to 30, 161; from 30
to 40, 429; from 40 to 50, 882; from 50 to 60, 949; from 60 to 70, 596; from
70 to 80, and upwards, 114.
Page 121
From the preceding valuable records, and which, in this instance, happen to
chime with the gross of medical observations, we may draw the following
inferences: That in infancy and adolescence there are very few cases of
asthma and dyspnœa: that these diseases chiefly occur in middle age and
the decline of life: that more than one half of them are reported as cured; the
relieved and discharged forming a neutral list, numbers of whom were
either surfeited with medicines, or were discharged by their physicians
when despairing of a radical cure, or fearful of their swelling the dead
catalogue: in sinking of which there is a universal rivalship throughout our
dispensaries and hospitals. Some of them, probably, were palliated,
vamped, and amended; and indeed many were aged, for whom it would be
unreasonable to expect a radical cure. I conceive, that with a part of them
we may venture to double the dead list; which would raise asthmatick
mortality to one of ten. But in the above estimate, what proportion
legitimate periodic asthma bears to the other anhelations I could not fathom.
The term Asthma has been misapplied to every species of dyspnœa: it
strictly denotes a chronic periodic difficulty of breathing, recurring and
exasperated in paroxisms; and, at least in the intervals, without fever.
Authors have subdivided it into several species; the spasmodic, convulsive,
and periodical; the dry, humid, continued, flatulent: and from the gradations
of difficulty in respiration, dyspnœa, orthopnœa. The periodick and
spasmodick is the true disease. Generally, the day preceding the paroxism
there is fulness of the stomach, impaired appetite, flatulence, eructation,
tightness, and stricture about the breast, and difficulty of respiration;
sometimes dry cough; the diaphragm descends with difficulty in inspiration:
these are all increased by wine, fires, bed, and heat: the head is stupid,
heavy, with slight pain, drowsiness, languor, yawning, restlessness of
spirits; profuse excretion of colourless urine.
Asthmatic paroxisms commonly invade suddenly, or are greatly aggravated
during the night, with constriction in the breast, anhelation and struggling in
breathing, so that all the muscles of the thorax and shoulders are roused into
action to enlarge the capacity of the lungs: this difficulty is greatest in
inspiration: the patient is compelled to sit erect, or recumbent in bed,
panting for breath, cool air, and drink; and can with extreme difficulty
cough, expectorate, or speak: the respiration is slow, laborious, wheezing,
and sonorous; with painful propensity to cough: from the interrupted
chime with the gross of medical observations, we may draw the following
inferences: That in infancy and adolescence there are very few cases of
asthma and dyspnœa: that these diseases chiefly occur in middle age and
the decline of life: that more than one half of them are reported as cured; the
relieved and discharged forming a neutral list, numbers of whom were
either surfeited with medicines, or were discharged by their physicians
when despairing of a radical cure, or fearful of their swelling the dead
catalogue: in sinking of which there is a universal rivalship throughout our
dispensaries and hospitals. Some of them, probably, were palliated,
vamped, and amended; and indeed many were aged, for whom it would be
unreasonable to expect a radical cure. I conceive, that with a part of them
we may venture to double the dead list; which would raise asthmatick
mortality to one of ten. But in the above estimate, what proportion
legitimate periodic asthma bears to the other anhelations I could not fathom.
The term Asthma has been misapplied to every species of dyspnœa: it
strictly denotes a chronic periodic difficulty of breathing, recurring and
exasperated in paroxisms; and, at least in the intervals, without fever.
Authors have subdivided it into several species; the spasmodic, convulsive,
and periodical; the dry, humid, continued, flatulent: and from the gradations
of difficulty in respiration, dyspnœa, orthopnœa. The periodick and
spasmodick is the true disease. Generally, the day preceding the paroxism
there is fulness of the stomach, impaired appetite, flatulence, eructation,
tightness, and stricture about the breast, and difficulty of respiration;
sometimes dry cough; the diaphragm descends with difficulty in inspiration:
these are all increased by wine, fires, bed, and heat: the head is stupid,
heavy, with slight pain, drowsiness, languor, yawning, restlessness of
spirits; profuse excretion of colourless urine.
Asthmatic paroxisms commonly invade suddenly, or are greatly aggravated
during the night, with constriction in the breast, anhelation and struggling in
breathing, so that all the muscles of the thorax and shoulders are roused into
action to enlarge the capacity of the lungs: this difficulty is greatest in
inspiration: the patient is compelled to sit erect, or recumbent in bed,
panting for breath, cool air, and drink; and can with extreme difficulty
cough, expectorate, or speak: the respiration is slow, laborious, wheezing,
and sonorous; with painful propensity to cough: from the interrupted
Page 122
circulation of blood through the lungs, the face and eyes are turgid and
livid, in some the face is pale and bloated; with headach, somnolency;
palpitation of the heart; weak and intermittent pulse; internal burning heat,
and often cold extremities; eructation and flatulence, sometimes vomiting;
difficult and sonorous deglutition; sweats; limpid urine; restlessness, or
disturbed sleep. Some lay easier on one side than on the other. Many are
under the necessity to sit erect in a chair during several days and nights,
gasping for breath, not daring to repose in bed. Should both lobes of the
lungs be equally constricted, the compound offices of this pneumatick and
hydraulick organ will be obstructed, with more threatening symptoms of
suffocation and strangling. A loaded stomach, close chambers, fires, beds,
wine, noxious smells, all aggravate the paroxism.
In the duration, recurrence, intermission, and remission, asthmatic
paroxisms vary. A few hours, or a few days, are the usual limits of this
pulmonick tumult. In the beginning it continues only a few hours, with a
diurnal remission and nocturnal renovation: in the chronic state, from two
to five days is the usual duration. As the paroxism mitigates, there is
flatulent explosion upwards and downwards, often with fecal discharge, and
expectoration of mucus. The intermissions are proportioned to the duration
of the paroxisms: the longer the paroxisms the longer the intervals, and vice
versa: with a copious expectoration they sooner terminate, and are less
severe. Some have had as many paroxisms in winter as in summer; and in
the country as in town. Floyer had sixty in winter and twenty in summer:
the latter, as usual, were more violent, and longer. During calm frosty
weather asthmaticks are most secure; but at all points of the compass the
paroxism may invade. Some find more ease in the city than country; others,
in low ground than mountainous. Some are never entirely liberated from
dyspnœa, and with periodical aggravations. Few, comparatively, die
immediately in the asthmatic paroxism: numbers survive many years, even
to the goal of longevity, and, emaciation excepted, without considerable
diminution of strength, spirits, or appetite. After long continuance, it seldom
admits of a radical cure; but only alleviation and respite. Its fatal
terminations are suffocation, apoplexy; pulmonick inflammation;
consumption, cachexy, partial or general dropsy; polypi in the heart and the
large vessels.
livid, in some the face is pale and bloated; with headach, somnolency;
palpitation of the heart; weak and intermittent pulse; internal burning heat,
and often cold extremities; eructation and flatulence, sometimes vomiting;
difficult and sonorous deglutition; sweats; limpid urine; restlessness, or
disturbed sleep. Some lay easier on one side than on the other. Many are
under the necessity to sit erect in a chair during several days and nights,
gasping for breath, not daring to repose in bed. Should both lobes of the
lungs be equally constricted, the compound offices of this pneumatick and
hydraulick organ will be obstructed, with more threatening symptoms of
suffocation and strangling. A loaded stomach, close chambers, fires, beds,
wine, noxious smells, all aggravate the paroxism.
In the duration, recurrence, intermission, and remission, asthmatic
paroxisms vary. A few hours, or a few days, are the usual limits of this
pulmonick tumult. In the beginning it continues only a few hours, with a
diurnal remission and nocturnal renovation: in the chronic state, from two
to five days is the usual duration. As the paroxism mitigates, there is
flatulent explosion upwards and downwards, often with fecal discharge, and
expectoration of mucus. The intermissions are proportioned to the duration
of the paroxisms: the longer the paroxisms the longer the intervals, and vice
versa: with a copious expectoration they sooner terminate, and are less
severe. Some have had as many paroxisms in winter as in summer; and in
the country as in town. Floyer had sixty in winter and twenty in summer:
the latter, as usual, were more violent, and longer. During calm frosty
weather asthmaticks are most secure; but at all points of the compass the
paroxism may invade. Some find more ease in the city than country; others,
in low ground than mountainous. Some are never entirely liberated from
dyspnœa, and with periodical aggravations. Few, comparatively, die
immediately in the asthmatic paroxism: numbers survive many years, even
to the goal of longevity, and, emaciation excepted, without considerable
diminution of strength, spirits, or appetite. After long continuance, it seldom
admits of a radical cure; but only alleviation and respite. Its fatal
terminations are suffocation, apoplexy; pulmonick inflammation;
consumption, cachexy, partial or general dropsy; polypi in the heart and the
large vessels.
Page 123
The predisposing and occasional causes are hereditary; original structure of
the pneumonick organs; narrow thorax; plethora; suppression of habitual or
natural evacuations, and cutaneous eruptions, as menses, piles, old ulcers,
sweat of the feet; consequence of catarrh and colds, and sudden suppression
of perspiration: serum, pituita in excess; cachexy; dregs of fever, small pox,
measles, and pulmonick inflammation; pulmonick tubercles; spasmodic
stricture of the diaphragm and bronchiæ; smoky rooms and houses,
especially with wood fires; noxious mineral and metallic fumes, arsenical,
nitrous, sulphureous, saturnine; smoky atmosphere of cities; pulverulent
trades, as stonecutters, lapidaries, millers, flax-dressers, chimney-sweepers;
fetid offensive smells; sudden changes of weather and winds from heavy to
a light atmosphere, portending storms, and especially snow; easterly winds;
fogs, with unsteadiness of weather and seasons; possibly some secret
alterations in the electrick fluid, and affecting electrometers; warm and
moist air; errors and intemperance in food and drink, and ingurgitation;
violent motion and agitation of body and of mind; symptomatick in various
diseases, as hystericks, hypochondriasm, gout, pectoral dropsy, empyema,
polypi in the heart or aorta; wounds of the lungs; diseases of the liver and
spleen.
Dyspnœa and Coughs are symptoms of many diseases; and they are also
primary, and very general maladies, especially in this island. It is true, we
have here no compass to steer by: these are an exploded banditti; a sort of
rebels to the symmetry of system, whose diagnosticks and therapeuticks are
as yet slovenly and imperfectly noticed by medical authors. From the
universal connection of the organs of respiration, their functions are more or
less interrupted by and warped with other diseases and morbid symptoms.
Many of the chronic impediments in breathing, and the broken-winded,
may be called asthmatic excrescences, without its periodical paroxisms,
exacerbations, and remissions; and without any rapid emaciation or hectick:
they are spurious asthmas and chronic catarrhs. All the parts about the
fauces and pharynx are crowded with mucous glands, from which, as in
angina and catarrh, there is often a profuse secretion. Many persons
advanced in life, and the aged, have a large discharge of mucus, variously,
from the fauces, pharynx, larynx, lungs, stomach; all requiring frequent
expectoration or hawking. The predisposing and occasional causes are
many of those already enumerated under consumption and asthma. To these
may be superadded cold pituitous temperament; air hot, cold, weighty, light,
the pneumonick organs; narrow thorax; plethora; suppression of habitual or
natural evacuations, and cutaneous eruptions, as menses, piles, old ulcers,
sweat of the feet; consequence of catarrh and colds, and sudden suppression
of perspiration: serum, pituita in excess; cachexy; dregs of fever, small pox,
measles, and pulmonick inflammation; pulmonick tubercles; spasmodic
stricture of the diaphragm and bronchiæ; smoky rooms and houses,
especially with wood fires; noxious mineral and metallic fumes, arsenical,
nitrous, sulphureous, saturnine; smoky atmosphere of cities; pulverulent
trades, as stonecutters, lapidaries, millers, flax-dressers, chimney-sweepers;
fetid offensive smells; sudden changes of weather and winds from heavy to
a light atmosphere, portending storms, and especially snow; easterly winds;
fogs, with unsteadiness of weather and seasons; possibly some secret
alterations in the electrick fluid, and affecting electrometers; warm and
moist air; errors and intemperance in food and drink, and ingurgitation;
violent motion and agitation of body and of mind; symptomatick in various
diseases, as hystericks, hypochondriasm, gout, pectoral dropsy, empyema,
polypi in the heart or aorta; wounds of the lungs; diseases of the liver and
spleen.
Dyspnœa and Coughs are symptoms of many diseases; and they are also
primary, and very general maladies, especially in this island. It is true, we
have here no compass to steer by: these are an exploded banditti; a sort of
rebels to the symmetry of system, whose diagnosticks and therapeuticks are
as yet slovenly and imperfectly noticed by medical authors. From the
universal connection of the organs of respiration, their functions are more or
less interrupted by and warped with other diseases and morbid symptoms.
Many of the chronic impediments in breathing, and the broken-winded,
may be called asthmatic excrescences, without its periodical paroxisms,
exacerbations, and remissions; and without any rapid emaciation or hectick:
they are spurious asthmas and chronic catarrhs. All the parts about the
fauces and pharynx are crowded with mucous glands, from which, as in
angina and catarrh, there is often a profuse secretion. Many persons
advanced in life, and the aged, have a large discharge of mucus, variously,
from the fauces, pharynx, larynx, lungs, stomach; all requiring frequent
expectoration or hawking. The predisposing and occasional causes are
many of those already enumerated under consumption and asthma. To these
may be superadded cold pituitous temperament; air hot, cold, weighty, light,
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moist, impure, stagnant; changes and vicissitudes of the winds; cold moist
climate and atmosphere, and especially in winter, autumn, and spring, and
interchanges of the seasons; sudden vicissitudes, disorders and inconstancy
of the surrounding elements; suppressed perspiration, and pulmonary
exhalation; catarrhal defluxion on the lungs, larynx, fauces; mucus in
excess, tenacious; faults in the mucus glands and ducts; trachea too sensible
or irritable; calculi, chalky concretions, and inspissated mucus in the larynx;
vascular or parenchymatous diseases of the lungs; original faults of the
lungs, bronchiæ, larynx; wasted lungs; extravasated air; spasm of the
respiratory muscles; flatulent farinaceous food, slimy food, and drink; weak
or foul stomach, voraciousness; infants swallowing saliva; symptomatick in
various diseases of the thorax, as consumption, asthma, empyema, polypus,
aneurism, cum multis aliis: symptomatick in various diseases of the
abdomen interrupting the play of the diaphragm; as full stomach, flatulence;
pregnancy; dropsy; enlarged spleen or liver; tympany; nephritis; worms;
injured abdominal muscles.
Catarrh, colds, influenza, coryza, gravedo. In our irregular climate, during
the annual revolution of the seasons, few escape slight catarrhs and colds, to
which all ages are liable. That particular epidemick species of erratick
catarrh, called Influenza, has sometimes spread suddenly over a kingdom,
and some the greatest part of Europe. In no other epidemick do so few die
in proportion to the number infected. Its continuance is generally short; and
the little depredations committed during its itinerant incursions, are
principally upon declining, consumptive, asthmatick, those of diseased
lungs, worn out constitutions, and aged. In such forlorn complaints,
catarrhal influenza has hastened the final dissolution sooner than it would
otherwise have happened. In some, from neglect or irregularity, it has
excited consumption, or pulmonick inflammation: in others, recovering
from fevers, and convalescents of various descriptions, it has occasioned
relapses. These observations are also applicable to simple catarrh
skirmishing in less formidable inroads. Frequent relapses, from imprudence,
in persons of phthisical or asthmatic constitutions, may expedite the
inflammation of latent tubercles; or in aged persons subject to pituitous
coughs, spurious peripneumony.
Catarrhal symptoms are increased secretion of mucus, from the membrane
of the nose, fauces, and bronchiæ, with slight fever. It generally begins with
climate and atmosphere, and especially in winter, autumn, and spring, and
interchanges of the seasons; sudden vicissitudes, disorders and inconstancy
of the surrounding elements; suppressed perspiration, and pulmonary
exhalation; catarrhal defluxion on the lungs, larynx, fauces; mucus in
excess, tenacious; faults in the mucus glands and ducts; trachea too sensible
or irritable; calculi, chalky concretions, and inspissated mucus in the larynx;
vascular or parenchymatous diseases of the lungs; original faults of the
lungs, bronchiæ, larynx; wasted lungs; extravasated air; spasm of the
respiratory muscles; flatulent farinaceous food, slimy food, and drink; weak
or foul stomach, voraciousness; infants swallowing saliva; symptomatick in
various diseases of the thorax, as consumption, asthma, empyema, polypus,
aneurism, cum multis aliis: symptomatick in various diseases of the
abdomen interrupting the play of the diaphragm; as full stomach, flatulence;
pregnancy; dropsy; enlarged spleen or liver; tympany; nephritis; worms;
injured abdominal muscles.
Catarrh, colds, influenza, coryza, gravedo. In our irregular climate, during
the annual revolution of the seasons, few escape slight catarrhs and colds, to
which all ages are liable. That particular epidemick species of erratick
catarrh, called Influenza, has sometimes spread suddenly over a kingdom,
and some the greatest part of Europe. In no other epidemick do so few die
in proportion to the number infected. Its continuance is generally short; and
the little depredations committed during its itinerant incursions, are
principally upon declining, consumptive, asthmatick, those of diseased
lungs, worn out constitutions, and aged. In such forlorn complaints,
catarrhal influenza has hastened the final dissolution sooner than it would
otherwise have happened. In some, from neglect or irregularity, it has
excited consumption, or pulmonick inflammation: in others, recovering
from fevers, and convalescents of various descriptions, it has occasioned
relapses. These observations are also applicable to simple catarrh
skirmishing in less formidable inroads. Frequent relapses, from imprudence,
in persons of phthisical or asthmatic constitutions, may expedite the
inflammation of latent tubercles; or in aged persons subject to pituitous
coughs, spurious peripneumony.
Catarrhal symptoms are increased secretion of mucus, from the membrane
of the nose, fauces, and bronchiæ, with slight fever. It generally begins with
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some difficulty of breathing through the nose; dull pain and weight in the
forehead; oppression in moving the eyes; distillation from the nose,
sometimes from the eyes, of a thin fluid, often acrid, and exciting frequent
sneezing; lassitude and languor of the body and spirits; sometimes shivering
and heat, and increased sensibility to cold air; hoarseness, soreness of the
trachea and fauces, with some difficulty of breathing, frequent cough and
irritation at the glottis, at first dry; sometimes slight inflammation or angina,
and pains resembling rheumatic about the neck and head. In some, the
appetite is impaired, but not considerably; but in all the smell and taste. By
degrees, the cough and sternutation are accompanied with a copious
excretion of mucus, progressively incrassating, with less laborious efforts of
coughing and hawking. Some catarrhs or colds, affect principally the
membrane of the nose, and the different sinusses or cavities communicating
with that emunctory; wherein stagnating mucus becomes more tenacious:
others are lower situated in the fauces, pharynx, and trachea. Catarrh
seldom continues beyond a few days, or weeks: that from contagion is more
febrile and chronic. The predisposing and occasional causes are, cutaneous
perspiration and pulmonary exhalation suddenly checked; cold moist
atmosphere; sudden atmospheric changes; cold habitations and beds; wet
feet; head or breast exposed or naked, thin ragged clothing; excessive
effeminacy and warm rooms; epidemick state of the air.
Hooping Cough, chincough, tussis convulsiva, epidemick, and contagious:
is generally prevalent in infancy and adolescence, and but once in life:
adults are rarely afflicted with it; and it is not confined to any particular
season of the year. In the London registers, hooping cough and cough are
confounded, and conjointly make no inconsiderable augmentation to the
funerals. By the records of Dr. Armstrong in the dispensary of infant poor,
of 732 cases of hooping cough, only 25 died; that is, about 3½ per cent. or 1
of 33. But this is too favourable a representation as a general scale of
mortality. Its beginning resembles a slight catarrh continuing some days, or
one, two, and three weeks before the formation and maturity of the
convulsive paroxisms. These consist of many successive expiratory
motions, so as to exhaust the lungs of air, succeeded by a full inspiration
and pulmonick gulp, which rushing thro’ the glottis, makes a particular loud
hooping sound. The duration of these pneumonick convulsive paroxisms, is
from one to several minutes, in which the child’s face is turgid with blood,
tears trickle down the cheeks, and it seems almost in the agony of
forehead; oppression in moving the eyes; distillation from the nose,
sometimes from the eyes, of a thin fluid, often acrid, and exciting frequent
sneezing; lassitude and languor of the body and spirits; sometimes shivering
and heat, and increased sensibility to cold air; hoarseness, soreness of the
trachea and fauces, with some difficulty of breathing, frequent cough and
irritation at the glottis, at first dry; sometimes slight inflammation or angina,
and pains resembling rheumatic about the neck and head. In some, the
appetite is impaired, but not considerably; but in all the smell and taste. By
degrees, the cough and sternutation are accompanied with a copious
excretion of mucus, progressively incrassating, with less laborious efforts of
coughing and hawking. Some catarrhs or colds, affect principally the
membrane of the nose, and the different sinusses or cavities communicating
with that emunctory; wherein stagnating mucus becomes more tenacious:
others are lower situated in the fauces, pharynx, and trachea. Catarrh
seldom continues beyond a few days, or weeks: that from contagion is more
febrile and chronic. The predisposing and occasional causes are, cutaneous
perspiration and pulmonary exhalation suddenly checked; cold moist
atmosphere; sudden atmospheric changes; cold habitations and beds; wet
feet; head or breast exposed or naked, thin ragged clothing; excessive
effeminacy and warm rooms; epidemick state of the air.
Hooping Cough, chincough, tussis convulsiva, epidemick, and contagious:
is generally prevalent in infancy and adolescence, and but once in life:
adults are rarely afflicted with it; and it is not confined to any particular
season of the year. In the London registers, hooping cough and cough are
confounded, and conjointly make no inconsiderable augmentation to the
funerals. By the records of Dr. Armstrong in the dispensary of infant poor,
of 732 cases of hooping cough, only 25 died; that is, about 3½ per cent. or 1
of 33. But this is too favourable a representation as a general scale of
mortality. Its beginning resembles a slight catarrh continuing some days, or
one, two, and three weeks before the formation and maturity of the
convulsive paroxisms. These consist of many successive expiratory
motions, so as to exhaust the lungs of air, succeeded by a full inspiration
and pulmonick gulp, which rushing thro’ the glottis, makes a particular loud
hooping sound. The duration of these pneumonick convulsive paroxisms, is
from one to several minutes, in which the child’s face is turgid with blood,
tears trickle down the cheeks, and it seems almost in the agony of
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suffocation and strangling. At the termination of each paroxism there is
usually some mucus expectoration and excreation: this, at the beginning, is
thin and not considerable; but by degrees increases in quantity and tenacity;
and frequently at the same time, the contents of the stomach are evacuated.
The pneumonick convulsions vary in their recurrence: they often return,
frequently in the course of twenty-four hours, especially during the night:
and thus may continue to persecute from one to three months, and
sometimes a much longer space. Throughout, the senses are not injured; nor
in the beginning the appetite; and in the intervals, children return to their
amusements as if nothing had happened.
The younger the child there is more danger; as also in those born of
phthisical or asthmatic parents, or in a state of debility, when seized with
the hooping cough. When it begins in the form of catarrh, and is attended
with fever, difficulty of breathing, and little expectoration, it may prove
fatal in the early immature stages, unless the convulsive cough supervenes,
and with copious expectoration. After some continuance of the disease,
fever, with nocturnal exacerbation and difficult respiration, sometimes
occur, and always with danger. Some fall down in the paroxisms; others
have convulsions: violent paroxisms of coughing have excited epilepsy,
apoplexy, or suffocation; but fever, dyspnœa, and pulmonic inflammation
are to be most dreaded. With moderate expectoration the paroxisms are
neither frequent nor violent: but expectoration in either extremes of
scantiness or excess are both unpropitious, more especially with dyspnœa.
Paroxisms terminated by vomiting, and succeeded by craving for food, are
favourable omens; and recovery may be predicted by longer intervals from
coughing, and shorter paroxisms; by restitution of natural appetite and
respiration, of tranquil sleep, of fecal excretion, by evanescence of fever,
and recruit of strength. The predisposing and occasional causes are, a
certain epidemick state of the air or specifick contagion, the nature of
which, and in truth of the disease beyond empirical observation, are as yet
very imperfectly understood.
Croup, suffocatio stridula. This disease has been particularly discriminated
by modern authors. It is principally inimical to children, seldom until after
ablactation; and never after the age of twelve, or of puberty at the utmost: it
may attack the same child more than once: it is most frequent in winter and
spring; and is not contagious nor general amongst the community. It
usually some mucus expectoration and excreation: this, at the beginning, is
thin and not considerable; but by degrees increases in quantity and tenacity;
and frequently at the same time, the contents of the stomach are evacuated.
The pneumonick convulsions vary in their recurrence: they often return,
frequently in the course of twenty-four hours, especially during the night:
and thus may continue to persecute from one to three months, and
sometimes a much longer space. Throughout, the senses are not injured; nor
in the beginning the appetite; and in the intervals, children return to their
amusements as if nothing had happened.
The younger the child there is more danger; as also in those born of
phthisical or asthmatic parents, or in a state of debility, when seized with
the hooping cough. When it begins in the form of catarrh, and is attended
with fever, difficulty of breathing, and little expectoration, it may prove
fatal in the early immature stages, unless the convulsive cough supervenes,
and with copious expectoration. After some continuance of the disease,
fever, with nocturnal exacerbation and difficult respiration, sometimes
occur, and always with danger. Some fall down in the paroxisms; others
have convulsions: violent paroxisms of coughing have excited epilepsy,
apoplexy, or suffocation; but fever, dyspnœa, and pulmonic inflammation
are to be most dreaded. With moderate expectoration the paroxisms are
neither frequent nor violent: but expectoration in either extremes of
scantiness or excess are both unpropitious, more especially with dyspnœa.
Paroxisms terminated by vomiting, and succeeded by craving for food, are
favourable omens; and recovery may be predicted by longer intervals from
coughing, and shorter paroxisms; by restitution of natural appetite and
respiration, of tranquil sleep, of fecal excretion, by evanescence of fever,
and recruit of strength. The predisposing and occasional causes are, a
certain epidemick state of the air or specifick contagion, the nature of
which, and in truth of the disease beyond empirical observation, are as yet
very imperfectly understood.
Croup, suffocatio stridula. This disease has been particularly discriminated
by modern authors. It is principally inimical to children, seldom until after
ablactation; and never after the age of twelve, or of puberty at the utmost: it
may attack the same child more than once: it is most frequent in winter and
spring; and is not contagious nor general amongst the community. It
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commonly invades like a catarrh; and sometimes with its own permanent
features, which are sudden paroxisms, as in spasmodic asthma, of laborious
struggling respiration, and wheezing, as if the air-passage was straited;
hoarseness, and shrill ringing sound, both in coughing and speaking, as if
the voice came through a brass tube; cough, if any, dry, or with excreation
of membranous fibres; thirst, quick pulse, anxiety, restlessness; and during
the intervals, the senses and appetite are unimpaired: sometimes there is
appearance, sometimes none, of inflammation in the fauces. It is always
dangerous, infinitely more so than the preceding disease: death may
suddenly ensue on the third, fourth, or fifth day, and perhaps when no such
event was suspected: the impending hurricane may be prognosticated by
laborious struggling in respiration, and symptoms of strangulation; with
anxiety, restlessness, quick weak pulse.
The predisposing and occasional causes are yet the subject of litigation;
whether inflammatory, or spasmodick, or a combination of both. On
dissection, mucus accumulated has been found lining the larynx, by degrees
incrassating, and interrupting the air from entering the lungs. We require
same additional illumination on this subject.
A Miscellaneous cluster of diseases are now to be developed. In the
majority of these, however, some few general features of affinity may be
traced: such as their affecting, directly or collaterally, the head, the brain, or
its numerous diverging chords, the nerves; or the inherent muscular energy.
But in many other circumstances of cause, diagnostick, prognostick, and
therapeutick, they are disunited. And in every possible arrangement such
defects are irremediable.
Headach. No parts of the human organization are more prone to transitory
interruption and disorder than the head and stomach: between the two there
is a close connubial sympathy: to these two important centers many other
maladies and remote perturbations converge, or reverberate their affliction.
We here treat of headach as a primary disease; or at least as the principal
symptom. From this calamity, in the extreme, the lives of many are
rendered wretched. The London bills neither convey an adequate
features, which are sudden paroxisms, as in spasmodic asthma, of laborious
struggling respiration, and wheezing, as if the air-passage was straited;
hoarseness, and shrill ringing sound, both in coughing and speaking, as if
the voice came through a brass tube; cough, if any, dry, or with excreation
of membranous fibres; thirst, quick pulse, anxiety, restlessness; and during
the intervals, the senses and appetite are unimpaired: sometimes there is
appearance, sometimes none, of inflammation in the fauces. It is always
dangerous, infinitely more so than the preceding disease: death may
suddenly ensue on the third, fourth, or fifth day, and perhaps when no such
event was suspected: the impending hurricane may be prognosticated by
laborious struggling in respiration, and symptoms of strangulation; with
anxiety, restlessness, quick weak pulse.
The predisposing and occasional causes are yet the subject of litigation;
whether inflammatory, or spasmodick, or a combination of both. On
dissection, mucus accumulated has been found lining the larynx, by degrees
incrassating, and interrupting the air from entering the lungs. We require
same additional illumination on this subject.
A Miscellaneous cluster of diseases are now to be developed. In the
majority of these, however, some few general features of affinity may be
traced: such as their affecting, directly or collaterally, the head, the brain, or
its numerous diverging chords, the nerves; or the inherent muscular energy.
But in many other circumstances of cause, diagnostick, prognostick, and
therapeutick, they are disunited. And in every possible arrangement such
defects are irremediable.
Headach. No parts of the human organization are more prone to transitory
interruption and disorder than the head and stomach: between the two there
is a close connubial sympathy: to these two important centers many other
maladies and remote perturbations converge, or reverberate their affliction.
We here treat of headach as a primary disease; or at least as the principal
symptom. From this calamity, in the extreme, the lives of many are
rendered wretched. The London bills neither convey an adequate
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representation of cephalgick fatality, and far less of its general contentious
torture of the human species. Headach has been subdivided by authors into
the idiopathick, symptomatick, general, local, internal, external, chronic,
periodic, and temporary; into cephalea, cephalalgia, hemicrania, clavus,
megrim. In the seat, duration, recurrence, and pain, there are many varieties
and gradations. Trespassing on the throne of sensation, it is evident the
corporeal and mental functions must lament the subjugation.
The predisposing and occasional causes are, hereditary; sanguineous
plethora; suppression of habitual hemorrhages, as menstrual, hemorrhoidal,
nasal; perspiration checked; cold feet; cutaneous pores blocked up, and not
sufficient perspiration; stomach foul, disordered; food or drink disagreeing;
gluttony; ebriety; unwholesome quality of fermented or distilled liquors
from accident or design; costiveness; violent exercise of body or mind,
voice and lungs; immoderate determination of blood to the head from
causes corporeal or mental; much stooping of the head; disagreeable
passions and anxiety of mind, exasperating or depressing; study in excess;
state of the winds and weather; of the points from whence winds blow; the
variations in the barometer and electrometer; the muddiness and fogs of the
atmosphere; cold; heat; foul air; crowded rooms, theatres, and other
assemblages of mankind for amusement or business; offensive smells and
vapours; fainting; inanition; excessive evacuations; intermittent;
rheumatick; arthritick, hysterical; nervous; scorbutic; impure blood;
cachexy; venereal; lunar; caries of the skull; diseases in the diploe; abscess,
insects, or inflammation in the frontal, ethmoidal, or sphenoidal sinusses;
first branch of the fifth pair of nerves particularly affected; carious teeth;
various diseases within the brain; external injuries: symptomatick in fevers;
hydrocephalus; and many other diseases besides those above enumerated.
Night Mare, incubus, ephialtis, pavor nocturnus. Oppressed breathing
during sleep and sensation of load in the breast, and of suffocation; terrifick
dreams, fantasies, apparitions, visionary encounters, and dangers; by which
the person is at length awaked in agitation, palpitation, and sweats. It
attacks generally the dormant in a supine posture. Some infants and
children, during sleep, are also disturbed with anxious groans, and
exclamation. The predisposing and occasional causes are, plethora; heavy
suppers; ventricular crudity, indigestion, gluttony, flatulence; worms; head
laid low in bed; intense application of mind, and various passions:
torture of the human species. Headach has been subdivided by authors into
the idiopathick, symptomatick, general, local, internal, external, chronic,
periodic, and temporary; into cephalea, cephalalgia, hemicrania, clavus,
megrim. In the seat, duration, recurrence, and pain, there are many varieties
and gradations. Trespassing on the throne of sensation, it is evident the
corporeal and mental functions must lament the subjugation.
The predisposing and occasional causes are, hereditary; sanguineous
plethora; suppression of habitual hemorrhages, as menstrual, hemorrhoidal,
nasal; perspiration checked; cold feet; cutaneous pores blocked up, and not
sufficient perspiration; stomach foul, disordered; food or drink disagreeing;
gluttony; ebriety; unwholesome quality of fermented or distilled liquors
from accident or design; costiveness; violent exercise of body or mind,
voice and lungs; immoderate determination of blood to the head from
causes corporeal or mental; much stooping of the head; disagreeable
passions and anxiety of mind, exasperating or depressing; study in excess;
state of the winds and weather; of the points from whence winds blow; the
variations in the barometer and electrometer; the muddiness and fogs of the
atmosphere; cold; heat; foul air; crowded rooms, theatres, and other
assemblages of mankind for amusement or business; offensive smells and
vapours; fainting; inanition; excessive evacuations; intermittent;
rheumatick; arthritick, hysterical; nervous; scorbutic; impure blood;
cachexy; venereal; lunar; caries of the skull; diseases in the diploe; abscess,
insects, or inflammation in the frontal, ethmoidal, or sphenoidal sinusses;
first branch of the fifth pair of nerves particularly affected; carious teeth;
various diseases within the brain; external injuries: symptomatick in fevers;
hydrocephalus; and many other diseases besides those above enumerated.
Night Mare, incubus, ephialtis, pavor nocturnus. Oppressed breathing
during sleep and sensation of load in the breast, and of suffocation; terrifick
dreams, fantasies, apparitions, visionary encounters, and dangers; by which
the person is at length awaked in agitation, palpitation, and sweats. It
attacks generally the dormant in a supine posture. Some infants and
children, during sleep, are also disturbed with anxious groans, and
exclamation. The predisposing and occasional causes are, plethora; heavy
suppers; ventricular crudity, indigestion, gluttony, flatulence; worms; head
laid low in bed; intense application of mind, and various passions:
Page 129
symptomatick in some fevers, in hystericks, hypochondriasm,
hydrocephalus, hydrothorax, aneurism, and polypi; sometimes is a prelude
of apoplexy, epilepsy, &c.
Apoplexy. Under this we shall aggroup several inferior species of vortex and
stupor in the imperial seat of reason and motion; as lethargy, coma, carus,
cataphora, vertigo. By apoplexy and suddenly, in the London registers,
between one eightieth and ninetieth part of the community seem to be
destroyed: and this mortality would be magnified by the addition of many
who are reported as found dead. In the last 30 years of the preceding
century, apoplexy and suddenly stands at 3010: Lethargy at 488: and
megrims now omitted at 45. This thunderbolt of death, or in the phrase of
one of the British poets, “that knocketh man down as butcher felleth ox,” is
principally hostile to those advanced in years, and the aged: to those more
especially of large heads and short necks, of corpulent habits, indolent life;
to the full feeders, or the addicted to frequent intoxication. Medical
observations also represent it as affecting more of the male than the female
sex; as more predominant in winter and spring, especially on vernal heat
succeeding winter cold; or moist rainy weather supplanting cold, and vice
versa. It is also said to be more general and fatal in the city than the
country.
Apoplexy may attack suddenly; in other cases it is preceded days, weeks, or
even months before the shock by vertigo, obscure vision, noise in the ears,
dullness of memory, faultering in the tongue, difficulty of articulation; in
some the mouth is distorted, with transient torpidness or tremor of different
muscular parts, headach, drowsiness, night mare, nasal hemorrhage,
flushing of the cheeks, lachrymation, decay of strength, alteration of
countenance and voice. In the paroxism the patient, instantaneously
stunned, falls down, with suspension of the functions of the external and
internal senses, of voluntary motion, and of voice and speech; and with
muscular relaxation; at the same time the pulse and respiration remain
nearly in the natural state, excepting that there is generally a stertor in
breathing, resembling a profound sleep from gross intoxication; and also, as
in most soporous diseases, the circulation slow. These unmolested functions
of the heart and lungs distinguish it from syncope. In the duration and
severity of the symptoms, there are different gradations. Some lay in this
lethargic state insensible to every object and impression: some when spoke
hydrocephalus, hydrothorax, aneurism, and polypi; sometimes is a prelude
of apoplexy, epilepsy, &c.
Apoplexy. Under this we shall aggroup several inferior species of vortex and
stupor in the imperial seat of reason and motion; as lethargy, coma, carus,
cataphora, vertigo. By apoplexy and suddenly, in the London registers,
between one eightieth and ninetieth part of the community seem to be
destroyed: and this mortality would be magnified by the addition of many
who are reported as found dead. In the last 30 years of the preceding
century, apoplexy and suddenly stands at 3010: Lethargy at 488: and
megrims now omitted at 45. This thunderbolt of death, or in the phrase of
one of the British poets, “that knocketh man down as butcher felleth ox,” is
principally hostile to those advanced in years, and the aged: to those more
especially of large heads and short necks, of corpulent habits, indolent life;
to the full feeders, or the addicted to frequent intoxication. Medical
observations also represent it as affecting more of the male than the female
sex; as more predominant in winter and spring, especially on vernal heat
succeeding winter cold; or moist rainy weather supplanting cold, and vice
versa. It is also said to be more general and fatal in the city than the
country.
Apoplexy may attack suddenly; in other cases it is preceded days, weeks, or
even months before the shock by vertigo, obscure vision, noise in the ears,
dullness of memory, faultering in the tongue, difficulty of articulation; in
some the mouth is distorted, with transient torpidness or tremor of different
muscular parts, headach, drowsiness, night mare, nasal hemorrhage,
flushing of the cheeks, lachrymation, decay of strength, alteration of
countenance and voice. In the paroxism the patient, instantaneously
stunned, falls down, with suspension of the functions of the external and
internal senses, of voluntary motion, and of voice and speech; and with
muscular relaxation; at the same time the pulse and respiration remain
nearly in the natural state, excepting that there is generally a stertor in
breathing, resembling a profound sleep from gross intoxication; and also, as
in most soporous diseases, the circulation slow. These unmolested functions
of the heart and lungs distinguish it from syncope. In the duration and
severity of the symptoms, there are different gradations. Some lay in this
lethargic state insensible to every object and impression: some when spoke
Page 130
to, only groan or make dumb signs: some, after a short time, are able to
articulate: in some, there is froth at the mouth: the colour of the face is
various, sometimes flushed, sometimes however pale; and the signs in
authors between the sanguine and serous apoplexy are extremely
ambiguous.
It often proves fatal at the first stroke; few can survive many attacks. Death,
recovery, or transition into palsy, are generally decided within seven days.
In magnitude of danger, perhaps no other disease can contend with this
formidable antagonist: but I shall leave it to others to graduate the
apoplectick scale. Some recover; in others it ends in death or hemiplegy,
which is but a sad alternative and capitulation for life: and too frequently is
accompanied with some lesion of the mental functions. Even of those who
recover, they are in danger of relapses from intemperance, and errors in the
non-naturals. The violence and contumacy of the symptoms indicate the
degrees of peril: the less the functions of internal and external sense, and of
voluntary motion are injured, our hopes are more flattering; whereas total
insensibility, froth at the mouth, cold sweats on the breast and face, cold
breath, involuntary excretion of feces and urine, are harbingers of
impendent wreck in the apoplectic whirlpool.
Of lethargy, coma, carus, cataphora. These denote different degrees of
profound deep sleep without delirium. Authors have often confounded them
with the febrile class, especially the “lusus naturæ” of remittents. To this
irresistible torpor and drowsiness, even at meals or in conversation, many
corpulent and fat persons are subject. We also read in authors of some
extraordinary instances of profound long protracted sleep, from which it
was impossible effectually to rouze the person. The vertigo has also been
distinguished into simplex, scotomia, caduca. In this disease all objects,
although at rest, seem to whirl round; sometimes with headach, flushing of
the face, noise in the ears; and if not supported, the patient often falls down.
It is commonly fugacious, and momentary; seldom above a minute; and in
some diseases is symptomatick. The prognostick may be deduced from that
of apoplexy.
Of the predisposing and occasional causes of apoplexy, lethargy, coma,
carus, cataphora, and vertigo: hereditary; short neck; plethora, general or
partial, sanguine or serous, especially sanguineous plethora in the vessels of
the brain; tight neckcloaths; pressure on the descending aorta, cava; serous
articulate: in some, there is froth at the mouth: the colour of the face is
various, sometimes flushed, sometimes however pale; and the signs in
authors between the sanguine and serous apoplexy are extremely
ambiguous.
It often proves fatal at the first stroke; few can survive many attacks. Death,
recovery, or transition into palsy, are generally decided within seven days.
In magnitude of danger, perhaps no other disease can contend with this
formidable antagonist: but I shall leave it to others to graduate the
apoplectick scale. Some recover; in others it ends in death or hemiplegy,
which is but a sad alternative and capitulation for life: and too frequently is
accompanied with some lesion of the mental functions. Even of those who
recover, they are in danger of relapses from intemperance, and errors in the
non-naturals. The violence and contumacy of the symptoms indicate the
degrees of peril: the less the functions of internal and external sense, and of
voluntary motion are injured, our hopes are more flattering; whereas total
insensibility, froth at the mouth, cold sweats on the breast and face, cold
breath, involuntary excretion of feces and urine, are harbingers of
impendent wreck in the apoplectic whirlpool.
Of lethargy, coma, carus, cataphora. These denote different degrees of
profound deep sleep without delirium. Authors have often confounded them
with the febrile class, especially the “lusus naturæ” of remittents. To this
irresistible torpor and drowsiness, even at meals or in conversation, many
corpulent and fat persons are subject. We also read in authors of some
extraordinary instances of profound long protracted sleep, from which it
was impossible effectually to rouze the person. The vertigo has also been
distinguished into simplex, scotomia, caduca. In this disease all objects,
although at rest, seem to whirl round; sometimes with headach, flushing of
the face, noise in the ears; and if not supported, the patient often falls down.
It is commonly fugacious, and momentary; seldom above a minute; and in
some diseases is symptomatick. The prognostick may be deduced from that
of apoplexy.
Of the predisposing and occasional causes of apoplexy, lethargy, coma,
carus, cataphora, and vertigo: hereditary; short neck; plethora, general or
partial, sanguine or serous, especially sanguineous plethora in the vessels of
the brain; tight neckcloaths; pressure on the descending aorta, cava; serous
Page 131
or sanguineous exudations or extravasations in the brain; compression of
the medullary substance, or of the origin of the nerves; suppression of
habitual evacuations or hemorrhages, nasal or hemorrhoidal; habitual
venesection neglected; old ulcers dried up; full and long continued
inspiration loading the vessels of the head; blood forced on the brain by
violent efforts of coughing, vomiting, fecal expulsion, exercise, venery,
stooping the head; salivation suddenly suppressed by cold; foul stomach,
gluttony, surfeits, luxurious living, and sedentary life; fatness, corpulency;
intoxication, sottish potations; violent passions of mind irascible or
stimulating, and also depressing, as anger, ambition, chronic melancholy
and cares; intense meditation and study; intemperate lust in old age;
noxious vapour from liquors in fermentation, from charcoal, quicklime, and
new-plastered walls; particular effluvia and odours concentrated in large
quantity; crowded rooms filled with animal steams from the lungs; thunder;
sometimes epidemick state of the air and elements, or perhaps celestial
influences not yet explained; intense cold; warm baths; blood rarified and
expanded; insolation; some narcotick poisons, as opium, hyoscyamus,
cicuta, laurus, belladonna, and some fungi: obstructed circulation through
the lungs and heart, from asthma, polypi, ossifications of the large blood
vessels or valves, and particularly of the right ventricle; external injuries of
the head; concussion, fractures. The most frequent cause is, accumulation
and congestion of blood in the brain: but sometimes, on dissection, no
disease is discernible; and effusions in the brain do not always inflict
apoplexy.
Of vertigo, the causes are several of those just enumerated: the principal,
plethora, suppressed hemorrhages; suppressed perspiration; luxurious diet,
gluttony, somnolency; foul or disordered stomach; costiveness;
intoxication; narcotick and tobacco fumes; unremitting attention of mind to
study or business; restlessness, mental distress; hunger, inanition, debility;
obstructions and diseases in the retina or optick nerves.
Palsy. Paralysis, hemiplegia, paraplegia. During the last thirty years of the
preceding century, paralytick mortality is only 630 in the London bills; but
in the present century is doubled and trebled; and some part of this surge
can be readily accounted for by the multiplication of the mechanical arts, in
which lead and quicksilver are employed. At present, its mortality seems to
stand in the proportion of one third or fourth to that of apoplexy. Of 310
the medullary substance, or of the origin of the nerves; suppression of
habitual evacuations or hemorrhages, nasal or hemorrhoidal; habitual
venesection neglected; old ulcers dried up; full and long continued
inspiration loading the vessels of the head; blood forced on the brain by
violent efforts of coughing, vomiting, fecal expulsion, exercise, venery,
stooping the head; salivation suddenly suppressed by cold; foul stomach,
gluttony, surfeits, luxurious living, and sedentary life; fatness, corpulency;
intoxication, sottish potations; violent passions of mind irascible or
stimulating, and also depressing, as anger, ambition, chronic melancholy
and cares; intense meditation and study; intemperate lust in old age;
noxious vapour from liquors in fermentation, from charcoal, quicklime, and
new-plastered walls; particular effluvia and odours concentrated in large
quantity; crowded rooms filled with animal steams from the lungs; thunder;
sometimes epidemick state of the air and elements, or perhaps celestial
influences not yet explained; intense cold; warm baths; blood rarified and
expanded; insolation; some narcotick poisons, as opium, hyoscyamus,
cicuta, laurus, belladonna, and some fungi: obstructed circulation through
the lungs and heart, from asthma, polypi, ossifications of the large blood
vessels or valves, and particularly of the right ventricle; external injuries of
the head; concussion, fractures. The most frequent cause is, accumulation
and congestion of blood in the brain: but sometimes, on dissection, no
disease is discernible; and effusions in the brain do not always inflict
apoplexy.
Of vertigo, the causes are several of those just enumerated: the principal,
plethora, suppressed hemorrhages; suppressed perspiration; luxurious diet,
gluttony, somnolency; foul or disordered stomach; costiveness;
intoxication; narcotick and tobacco fumes; unremitting attention of mind to
study or business; restlessness, mental distress; hunger, inanition, debility;
obstructions and diseases in the retina or optick nerves.
Palsy. Paralysis, hemiplegia, paraplegia. During the last thirty years of the
preceding century, paralytick mortality is only 630 in the London bills; but
in the present century is doubled and trebled; and some part of this surge
can be readily accounted for by the multiplication of the mechanical arts, in
which lead and quicksilver are employed. At present, its mortality seems to
stand in the proportion of one third or fourth to that of apoplexy. Of 310
Page 132
patients afflicted with palsy and hemiplegy, and admitted in the course of
10 years into the Bath hospital, 57 were cured; that is, 7 per cent. or 1 of 15;
there died 15, or 5 per cent.; and the remainder were found incurable and
discharged, or received some trifling relief; and several of these might be
added to the dead list. I doubt whether by the artillery of the shops we are
so successful against this crippling foe. A considerable number of the
community are rendered helpless and decrepit from this disease; to which
some trades, more than others, are obnoxious; and adults and aged infinitely
more than the young and adolescent.
Palsy and apoplexy often alternate, and may then be termed one bicipitous
disease. Severe apoplectick strokes, if not immediately fatal, frequently
remit, and pass into palsy: or the catastrophe may originate in hemiplegy,
which is the most frequent form of palsy; and when fatal, it is through the
apoplectick explosion. In palsy there is more or less diminution or privation
of muscular motion and feeling, without pain or fever, or injury of appetite.
This may affect the muscles of voluntary and of involuntary motion; the
whole, or only a portion of each: as muscular impotency of one side, or half
of the body; of one or both of the lower or upper extremities; of some
smaller portion of the face, eyelids, tongue, œsophagus, stomach, intestines,
the sphincters of the bladder and anus, the penis, bladder, kidneys, heart.
Under this deplorable calamity many linger years; some confined like a
shellfish, and motionless; others crawling upon crutches. Tremor may be
ranked as an inferior vassal of palsy.
The predisposing and occasional causes of palsy are most of those of
apoplexy; various diseases of the cerebrum, cerebellum, and medulla
oblongata; diseases of the inherent muscular power; vapours from lead,
mercury, arsenick; colica saturnina; compression of nerves; abscesses in the
lumbar vertebræ; falls, external injuries, blows on the head or loins,
luxations or sprains of the lumbar vertebræ; spinal dropsy; fractures;
venery. Of Tremor many of the causes of apoplexy and palsy; hereditary;
old age and decay of the inherent nervous and muscular energy;
compression or obstruction of the nerves; poisons; opium; employments in
lead and mercury; ebriety; suppressed evacuations; sanguine plethora;
repelled cutaneous eruptions; lurking gout; general debility; external
injuries; warm fluids; strong tea; excess of venery; long watching; anxiety;
passions of mind; sedentary life; excessive evacuations.
10 years into the Bath hospital, 57 were cured; that is, 7 per cent. or 1 of 15;
there died 15, or 5 per cent.; and the remainder were found incurable and
discharged, or received some trifling relief; and several of these might be
added to the dead list. I doubt whether by the artillery of the shops we are
so successful against this crippling foe. A considerable number of the
community are rendered helpless and decrepit from this disease; to which
some trades, more than others, are obnoxious; and adults and aged infinitely
more than the young and adolescent.
Palsy and apoplexy often alternate, and may then be termed one bicipitous
disease. Severe apoplectick strokes, if not immediately fatal, frequently
remit, and pass into palsy: or the catastrophe may originate in hemiplegy,
which is the most frequent form of palsy; and when fatal, it is through the
apoplectick explosion. In palsy there is more or less diminution or privation
of muscular motion and feeling, without pain or fever, or injury of appetite.
This may affect the muscles of voluntary and of involuntary motion; the
whole, or only a portion of each: as muscular impotency of one side, or half
of the body; of one or both of the lower or upper extremities; of some
smaller portion of the face, eyelids, tongue, œsophagus, stomach, intestines,
the sphincters of the bladder and anus, the penis, bladder, kidneys, heart.
Under this deplorable calamity many linger years; some confined like a
shellfish, and motionless; others crawling upon crutches. Tremor may be
ranked as an inferior vassal of palsy.
The predisposing and occasional causes of palsy are most of those of
apoplexy; various diseases of the cerebrum, cerebellum, and medulla
oblongata; diseases of the inherent muscular power; vapours from lead,
mercury, arsenick; colica saturnina; compression of nerves; abscesses in the
lumbar vertebræ; falls, external injuries, blows on the head or loins,
luxations or sprains of the lumbar vertebræ; spinal dropsy; fractures;
venery. Of Tremor many of the causes of apoplexy and palsy; hereditary;
old age and decay of the inherent nervous and muscular energy;
compression or obstruction of the nerves; poisons; opium; employments in
lead and mercury; ebriety; suppressed evacuations; sanguine plethora;
repelled cutaneous eruptions; lurking gout; general debility; external
injuries; warm fluids; strong tea; excess of venery; long watching; anxiety;
passions of mind; sedentary life; excessive evacuations.
Page 133
Epilepsy. Morbus sacer, demoniacus, caducus, falling-sickness. In the last
thirty years of the preceding century, thirty-five deaths only are marked in
the London bills to epilepsy; and in the first forty-five years of the present
century, they dwindle to thirteen: at present the title and disease is omitted.
Medical men know, that no inconsiderable number of the community are
tormented with this frightful convulsion, which the ancient Jews could only
ascribe to the malicious rancour of an infernal devil. In this instance also,
professional experience and erudition must interfere and correct the
omissions of the publick registers. We are certain, that epilepsy is much
more destructive to the springs of life: perhaps it is cast by the reporters into
either the apoplectick or convulsive abyss. It is alledged to be more frequent
amongst the male than female sex; and in infancy, in those of delicate
constitutions, lax habit, acute, nervous and muscular irritability. Vid.
Convulsions.
In many cases there is no previous monitory of the impending paroxisms; in
some other cases the lowering storm is portended by lassitude, headach,
giddiness, dimness of sight, broken sleep, frightful dreams, restlessness,
terror, noise in the ears, palpitation of the heart, unusual smells, murmuring
of the intestines, yawning, luminous flashes before the eyes, profuse urinary
excretion, sense of the disease ascending from a particular part to the head.
By the epileptic whirlwind the patient is suddenly and precipitously thrown
down, with suspension of the internal and external senses, and universal
convulsions of the external muscles, or those of voluntary motion: the
muscles of the head, face, eyes, and mouth, are particularly agitated; the
head is tolled in every direction, the teeth grind against each other, the eyes
roll, the mouth emits froth and slaver; the tongue, thrust out of the mouth, is
often wounded and lacerated by the teeth; the respiration is as if through a
noose on the neck; the fingers are clinched into the hand; there is perpetual
involuntary deglutition, palpitation of the heart, and sometimes involuntary
excretion of urine, semen, or feces; the motions of the heart and of
respiration are hurried, but not otherwise interrupted nor injured. Such is the
powerful coercive muscular contractions and convulsions, that several
strong assistants are requisite to secure each member. Some, at the first
struggle and uproar, emit hideous groans or yells, resembling the
bellowings of a wild beast; others, a more still and savage murmur. In most,
the aspect is horrible: nor does any other disease exhibit such truculent
spectacles of terror and abhorrence.
thirty years of the preceding century, thirty-five deaths only are marked in
the London bills to epilepsy; and in the first forty-five years of the present
century, they dwindle to thirteen: at present the title and disease is omitted.
Medical men know, that no inconsiderable number of the community are
tormented with this frightful convulsion, which the ancient Jews could only
ascribe to the malicious rancour of an infernal devil. In this instance also,
professional experience and erudition must interfere and correct the
omissions of the publick registers. We are certain, that epilepsy is much
more destructive to the springs of life: perhaps it is cast by the reporters into
either the apoplectick or convulsive abyss. It is alledged to be more frequent
amongst the male than female sex; and in infancy, in those of delicate
constitutions, lax habit, acute, nervous and muscular irritability. Vid.
Convulsions.
In many cases there is no previous monitory of the impending paroxisms; in
some other cases the lowering storm is portended by lassitude, headach,
giddiness, dimness of sight, broken sleep, frightful dreams, restlessness,
terror, noise in the ears, palpitation of the heart, unusual smells, murmuring
of the intestines, yawning, luminous flashes before the eyes, profuse urinary
excretion, sense of the disease ascending from a particular part to the head.
By the epileptic whirlwind the patient is suddenly and precipitously thrown
down, with suspension of the internal and external senses, and universal
convulsions of the external muscles, or those of voluntary motion: the
muscles of the head, face, eyes, and mouth, are particularly agitated; the
head is tolled in every direction, the teeth grind against each other, the eyes
roll, the mouth emits froth and slaver; the tongue, thrust out of the mouth, is
often wounded and lacerated by the teeth; the respiration is as if through a
noose on the neck; the fingers are clinched into the hand; there is perpetual
involuntary deglutition, palpitation of the heart, and sometimes involuntary
excretion of urine, semen, or feces; the motions of the heart and of
respiration are hurried, but not otherwise interrupted nor injured. Such is the
powerful coercive muscular contractions and convulsions, that several
strong assistants are requisite to secure each member. Some, at the first
struggle and uproar, emit hideous groans or yells, resembling the
bellowings of a wild beast; others, a more still and savage murmur. In most,
the aspect is horrible: nor does any other disease exhibit such truculent
spectacles of terror and abhorrence.
Page 134
After some few minutes, very rarely hours, a pacification ensues, and
abdication of the epileptic demon; and the patient liberated, rises up of his
own accord, languid, dejected, and ashamed, with but few traces on the
memory of the preceding tragedy; and nearly in the exercise of all his usual
faculties; which is not the case in apoplexy. In the severity and duration, but
still more in the repetition of the paroxisms, there is prodigious variation: in
some they are erratick and irregular; in others, they are periodical; and at
various intervals in diurnal paroxisms, synchronous with the tides; monthly
with the lunar revolutions; equinoctial; annual. It is often a chronic disease,
and then, much less inimical to life than might be expected from such a
universal commotion. But in infancy, epilepsy and convulsions are the most
atrocious of the morbid murderers. Sometimes it ceases after puberty. In old
persons, or where there is no previous warning of the approaching
paroxisms, the prospects are deplorable: reiterated epileptic bombardment
often makes breaches in the internal recesses of the senses; hence insanity,
apoplexy, palsy, idiotism. Authors have attempted the diagnosticks of
epileptic origin: thus, in the brain, or its spinal elongation, it is represented
as invading with stupidity, or hebetude of the internal and external senses;
headach, disturbed sleep, pale face; with suddenness in the assault, without
previous warning, and a sort of sensation of distillation from the head to the
breast and stomach: from nervous sympathy of the stomach and intestines,
and of the extremities, it is preceded by disturbance of those parts at the
approaching paroxism; by an aura epileptica, and ascending vapour, or
extraordinary sensation originating from some fixed point. To conclude, this
convulsion is sometimes feigned by begging impostors.
The predisposing and occasional causes are, hereditary, peculiar original
organization, especially of the brain and its appendages: plethora, fright,
terror, horror, anxiety and passions of mind, excess of venery, study;
passionate drunken nurses; foul stomach; acidity, acrid bile; worms,
dentition, scald head, or ulcers rashly dried up or repelled; external injuries
of the head; various diseases within the brain, or in the nervous chords;
ebriety; difficult parturition; hystericks; cachexy, dregs of intermittent
fevers; irritability and sensibility in morbid extreme; nervous sympathy and
motory vibrations; force of habit; offensive odours; poisons, narcoticks. In
those of epileptic temperament and predisposition, paroxisms are liable to
be recalled by heat, ventricular crudity, intoxication, anxiety and passions of
mind, terror, prospect of precipices, &c.
abdication of the epileptic demon; and the patient liberated, rises up of his
own accord, languid, dejected, and ashamed, with but few traces on the
memory of the preceding tragedy; and nearly in the exercise of all his usual
faculties; which is not the case in apoplexy. In the severity and duration, but
still more in the repetition of the paroxisms, there is prodigious variation: in
some they are erratick and irregular; in others, they are periodical; and at
various intervals in diurnal paroxisms, synchronous with the tides; monthly
with the lunar revolutions; equinoctial; annual. It is often a chronic disease,
and then, much less inimical to life than might be expected from such a
universal commotion. But in infancy, epilepsy and convulsions are the most
atrocious of the morbid murderers. Sometimes it ceases after puberty. In old
persons, or where there is no previous warning of the approaching
paroxisms, the prospects are deplorable: reiterated epileptic bombardment
often makes breaches in the internal recesses of the senses; hence insanity,
apoplexy, palsy, idiotism. Authors have attempted the diagnosticks of
epileptic origin: thus, in the brain, or its spinal elongation, it is represented
as invading with stupidity, or hebetude of the internal and external senses;
headach, disturbed sleep, pale face; with suddenness in the assault, without
previous warning, and a sort of sensation of distillation from the head to the
breast and stomach: from nervous sympathy of the stomach and intestines,
and of the extremities, it is preceded by disturbance of those parts at the
approaching paroxism; by an aura epileptica, and ascending vapour, or
extraordinary sensation originating from some fixed point. To conclude, this
convulsion is sometimes feigned by begging impostors.
The predisposing and occasional causes are, hereditary, peculiar original
organization, especially of the brain and its appendages: plethora, fright,
terror, horror, anxiety and passions of mind, excess of venery, study;
passionate drunken nurses; foul stomach; acidity, acrid bile; worms,
dentition, scald head, or ulcers rashly dried up or repelled; external injuries
of the head; various diseases within the brain, or in the nervous chords;
ebriety; difficult parturition; hystericks; cachexy, dregs of intermittent
fevers; irritability and sensibility in morbid extreme; nervous sympathy and
motory vibrations; force of habit; offensive odours; poisons, narcoticks. In
those of epileptic temperament and predisposition, paroxisms are liable to
be recalled by heat, ventricular crudity, intoxication, anxiety and passions of
mind, terror, prospect of precipices, &c.
Page 135
Tetanus, emprosthotonus, opisthotonus, locked jaw, trismus. This is not a
frequent disease in this island, nor in Europe: it is far more universal and
fatal in the tropical regions, and in the warmest seasons of those zones. In
such climates tetanus, and all the train of spasmodick and convulsive
diseases rage with more inveterate rancour and devastation: there the
slightest wound or scratch will frequently occasion a locked jaw. It afflicts
more adults than youth; and, as is reported, more males than females. The
emprosthotonus, or head bent forward on the breast, is much less frequent
than the reverse. Its assault is sometimes sudden and violent; but generally
by slow approaches; and with stiffness of the muscles of the back, neck, and
occiput; difficulty in rotating the head; sense of uneasiness about the root of
the tongue; difficulty of swallowing, painful spasm at the lower part of the
sternum darting to the back; spasm and rigidity of the muscles of the neck
and occiput pulling the head backwards; and also of the muscles of the
lower jaw, locking the teeth together, so that by the utmost force they
cannot be separated: the muscles also of the face, eyes, and nose, are often
violently distorted with a hideous grin. By degrees, this spasmodic
conspiracy becomes more universal, communicating to the spine, abdomen,
and extremities; and the contracted abdominal muscles feel as a hard-board.
In the spasms there are repeated exacerbations, with excruciating pain;
followed by remissions or transitory reprieves; but the latter seldom an hour
in duration: and sometimes with these paroxisms, internal murmuring of the
voice.
Seldom any fever accompanies this spasm, unless from cold; and in this
case the disease commences a few days after such accident: but if from
wounded nerves, frequently not until some days after the lesion, and even
when the vulnerary pain and uneasiness was removed. The external and
internal senses are seldom interrupted until the last and perilous stages,
when the brain shares in the general disorder. But the natural functions and
also those of respiration and circulation are unmolested. It may prove fatal
in a few hours; generally, if not relieved, in a few days; and rarely is
protracted beyond fourteen. Until of late years, and the discovery of more
effectual remedies, few recovered. Its danger is increased by the sudden
impetuosity of the assault; or from wounded nerves: the final tragedy is
closed by convulsions.
frequent disease in this island, nor in Europe: it is far more universal and
fatal in the tropical regions, and in the warmest seasons of those zones. In
such climates tetanus, and all the train of spasmodick and convulsive
diseases rage with more inveterate rancour and devastation: there the
slightest wound or scratch will frequently occasion a locked jaw. It afflicts
more adults than youth; and, as is reported, more males than females. The
emprosthotonus, or head bent forward on the breast, is much less frequent
than the reverse. Its assault is sometimes sudden and violent; but generally
by slow approaches; and with stiffness of the muscles of the back, neck, and
occiput; difficulty in rotating the head; sense of uneasiness about the root of
the tongue; difficulty of swallowing, painful spasm at the lower part of the
sternum darting to the back; spasm and rigidity of the muscles of the neck
and occiput pulling the head backwards; and also of the muscles of the
lower jaw, locking the teeth together, so that by the utmost force they
cannot be separated: the muscles also of the face, eyes, and nose, are often
violently distorted with a hideous grin. By degrees, this spasmodic
conspiracy becomes more universal, communicating to the spine, abdomen,
and extremities; and the contracted abdominal muscles feel as a hard-board.
In the spasms there are repeated exacerbations, with excruciating pain;
followed by remissions or transitory reprieves; but the latter seldom an hour
in duration: and sometimes with these paroxisms, internal murmuring of the
voice.
Seldom any fever accompanies this spasm, unless from cold; and in this
case the disease commences a few days after such accident: but if from
wounded nerves, frequently not until some days after the lesion, and even
when the vulnerary pain and uneasiness was removed. The external and
internal senses are seldom interrupted until the last and perilous stages,
when the brain shares in the general disorder. But the natural functions and
also those of respiration and circulation are unmolested. It may prove fatal
in a few hours; generally, if not relieved, in a few days; and rarely is
protracted beyond fourteen. Until of late years, and the discovery of more
effectual remedies, few recovered. Its danger is increased by the sudden
impetuosity of the assault; or from wounded nerves: the final tragedy is
closed by convulsions.
Page 136
Authors describe a spasm of the lower jaw and tetanus of infants, which
they term Trismus: this is most frequent and dangerous early after birth: the
aperture of the mouth and gums is contracted, and with difficulty separable:
its lips and mouth remain nearly motionless, with contention or
impracticability in suction: and sometimes the spasm becomes general
amongst the muscles. I read in authors the diagnosticks of another species
of tetanus, which they represent as not unfrequent in the European regions,
and especially amongst infants; the symptoms agitation, trembling,
convulsions, distortion of the lips, grinding of the teeth, difficulty of suction
and deglutition, regurgitation of milk by the nose; the jaws locked together;
spastic respiration, and with groans; the muscles of the neck rigid, with
flushed face, tumid abdomen, vomiting, fetid stools. This, in some features,
resembles what we term Inward Spasms. In fact, the history and accurate
diagnosticks of infant diseases are as yet imperfect.
The predisposing and occasional causes of tetanus and its species, are
wounds, particularly of the fingers and toes; surgical operations, fractures,
luxations, burns, injuries of a nervous tendinous and sensible part, bruised
testicle; suppuration, abscess; cold and moisture applied to the body when
heated; sudden suppression of perspiration; sudden vicissitudes of heat and
cold; repletion, foul stomach and intestines in infants; dentition; bile in the
stomach; worms; poisons; ebriety; excessive evacuations, hemorrhages;
suppressed salutary evacuations, exanthemata and cutaneous eruptions;
abortion; difficult parturition; violent mental emotion; angina; lurking gout;
hemorrhoides; hypochondriasm, hystericks, melancholy. In many of these it
is merely symptomatick.
Spasms and cramps are idiopathick as well as symptomatick; fugacious, or
more fixed and constant; and may affect various portions of the external and
of the internal muscular fibres; of the head, neck, face, eye, lower jaw, lips,
arms, hands, fingers, thighs, legs, feet, penis; the tongue, fauces, pharynx,
œsophagus, lungs, stomach, intestines, kidneys, ureters, bladder. Fugitive
cramps in the legs excite excruciating pain, tumor and rigidity of the
muscle.
St. Vitus’s Dance. Chorea sancti Viti. This very uncommon disease may
afflict either of the sexes about the period of adolescence and puberty;
rarely afterwards. Its symptoms are lameness of one leg, which, when
attempts are made to walk, is dragged as if paralytick; and is then, more or
they term Trismus: this is most frequent and dangerous early after birth: the
aperture of the mouth and gums is contracted, and with difficulty separable:
its lips and mouth remain nearly motionless, with contention or
impracticability in suction: and sometimes the spasm becomes general
amongst the muscles. I read in authors the diagnosticks of another species
of tetanus, which they represent as not unfrequent in the European regions,
and especially amongst infants; the symptoms agitation, trembling,
convulsions, distortion of the lips, grinding of the teeth, difficulty of suction
and deglutition, regurgitation of milk by the nose; the jaws locked together;
spastic respiration, and with groans; the muscles of the neck rigid, with
flushed face, tumid abdomen, vomiting, fetid stools. This, in some features,
resembles what we term Inward Spasms. In fact, the history and accurate
diagnosticks of infant diseases are as yet imperfect.
The predisposing and occasional causes of tetanus and its species, are
wounds, particularly of the fingers and toes; surgical operations, fractures,
luxations, burns, injuries of a nervous tendinous and sensible part, bruised
testicle; suppuration, abscess; cold and moisture applied to the body when
heated; sudden suppression of perspiration; sudden vicissitudes of heat and
cold; repletion, foul stomach and intestines in infants; dentition; bile in the
stomach; worms; poisons; ebriety; excessive evacuations, hemorrhages;
suppressed salutary evacuations, exanthemata and cutaneous eruptions;
abortion; difficult parturition; violent mental emotion; angina; lurking gout;
hemorrhoides; hypochondriasm, hystericks, melancholy. In many of these it
is merely symptomatick.
Spasms and cramps are idiopathick as well as symptomatick; fugacious, or
more fixed and constant; and may affect various portions of the external and
of the internal muscular fibres; of the head, neck, face, eye, lower jaw, lips,
arms, hands, fingers, thighs, legs, feet, penis; the tongue, fauces, pharynx,
œsophagus, lungs, stomach, intestines, kidneys, ureters, bladder. Fugitive
cramps in the legs excite excruciating pain, tumor and rigidity of the
muscle.
St. Vitus’s Dance. Chorea sancti Viti. This very uncommon disease may
afflict either of the sexes about the period of adolescence and puberty;
rarely afterwards. Its symptoms are lameness of one leg, which, when
attempts are made to walk, is dragged as if paralytick; and is then, more or
Page 137
less, convulsed: at the same time, whenever the patient attempts to convey
any food or drink to the mouth with the corresponding arm, it is incessantly
convulsed, with a rapid succession of gesticulations. Some are even
compelled to dance, leap, run, sing, or laugh. The paroxisms vary in
duration and frequency: sometimes they are terminated in half an hour:
sometimes they continue several days, rarely a week, without intermission:
sometimes they recur several times daily, leaving behind debility and
weakness. Delirium and a degree of fatuity are not unusual in the
paroxisms. The predisposing and occasional causes are mostly unknown:
sometimes worms.
Catalepsis, and extasis. It falls to the lot of very few physicians, at least in
this island, to see a single instance of this phenomenon, a living statue fixed
in whatever situation and posture they happen to be in when seized: the legs
and arms flexible, remain sometime in whatever posture they are placed by
a spectator: the functions of internal and external sensation are suspended;
the eyes are open; the countenance and colour are nearly natural; the pulse
and respiration alone continue in motion, but obscure. The duration of the
paroxism is from a minute to hours, very rarely days: and the recovery as if
from a profound sleep: in some with confused ideas of surrounding objects
during the chasm. In the extasis strange visions are seen: and of these
trances there are extraordinary instances on record. It may be complicated
with somnambulismus, and hystericks. The causes, deep meditation,
fanaticism, mental passions, intense cold, worms, foul stomach, suppressed
evacuations: it is feigned by impostors.
Fainting and asphyxy: syncope, leipothymia, asphyxia, idiopathick,
symptomatick. In syncope the action of the heart and of respiration become
considerably weaker than usual, or for a short time suspended: the pulse and
breathing are sometimes so weak as to be imperceptible; the countenance
pale and cold, with a clammy sweat, especially on the forehead; the
functions of external and internal sense, and of voluntary motion, during
this vital chasm, are interrupted or suspended. It sometimes arrests
suddenly, sometimes with preceding languor and anxiety about the heart,
giddiness, and dimness of sight; objects are seen as through a mist, sounds
are scarcely audible; and there is confused noise in the ears. In the gradation
and duration of vital suspension, there are diversities: after the lapse of a
few or more minutes they gradually revive, yawning, sighing; some with
any food or drink to the mouth with the corresponding arm, it is incessantly
convulsed, with a rapid succession of gesticulations. Some are even
compelled to dance, leap, run, sing, or laugh. The paroxisms vary in
duration and frequency: sometimes they are terminated in half an hour:
sometimes they continue several days, rarely a week, without intermission:
sometimes they recur several times daily, leaving behind debility and
weakness. Delirium and a degree of fatuity are not unusual in the
paroxisms. The predisposing and occasional causes are mostly unknown:
sometimes worms.
Catalepsis, and extasis. It falls to the lot of very few physicians, at least in
this island, to see a single instance of this phenomenon, a living statue fixed
in whatever situation and posture they happen to be in when seized: the legs
and arms flexible, remain sometime in whatever posture they are placed by
a spectator: the functions of internal and external sensation are suspended;
the eyes are open; the countenance and colour are nearly natural; the pulse
and respiration alone continue in motion, but obscure. The duration of the
paroxism is from a minute to hours, very rarely days: and the recovery as if
from a profound sleep: in some with confused ideas of surrounding objects
during the chasm. In the extasis strange visions are seen: and of these
trances there are extraordinary instances on record. It may be complicated
with somnambulismus, and hystericks. The causes, deep meditation,
fanaticism, mental passions, intense cold, worms, foul stomach, suppressed
evacuations: it is feigned by impostors.
Fainting and asphyxy: syncope, leipothymia, asphyxia, idiopathick,
symptomatick. In syncope the action of the heart and of respiration become
considerably weaker than usual, or for a short time suspended: the pulse and
breathing are sometimes so weak as to be imperceptible; the countenance
pale and cold, with a clammy sweat, especially on the forehead; the
functions of external and internal sense, and of voluntary motion, during
this vital chasm, are interrupted or suspended. It sometimes arrests
suddenly, sometimes with preceding languor and anxiety about the heart,
giddiness, and dimness of sight; objects are seen as through a mist, sounds
are scarcely audible; and there is confused noise in the ears. In the gradation
and duration of vital suspension, there are diversities: after the lapse of a
few or more minutes they gradually revive, yawning, sighing; some with
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vomiting; and some without vestiges of reminiscence during the temporary
interreign. This partial cessation of the vital functions distinguishes it, at the
first glance, from apoplexy. Asphyxy is only a more violent degree of
syncope in which the intire human machinery is stopped: the counterfeit of
death; but in which there are embers capable of being fanned and vivified
into vital renovation. The first exertions towards a restitution of the vital
energy when suspended, are sometimes with symptoms of epilepsy and
convulsions.
The predisposing and occasional causes of syncope and asphyxy,
idiopathick and symptomatick are, profuse evacuations and hemorrhages;
venesection; tapping the abdomen in ascites; strong emeticks and
purgatives; exhausted strength; violent exertions of strength, or muscular
action; excessive fatigue; venery in excess; sudden terror or joy, or other
mental emotions; intense anxiety; severe pain; offensive smells; foul air;
close rooms and crowds, and the air contaminated with their breath, and
effluvia; charcoal fumes; foul stagnant confined air, and gas of old damp
pits, wells, subterranean caverns, mines; mephitick vapours from
fermenting liquors in considerable quantity; lightening, thunder-shocks;
excessive heat; excessive cold; sanguineous plethora; various diseases of
the stomach; poisons, narcoticks; repelled cutaneous eruptions; hysterick,
scorbutick, arthritick, febrile; wounds or blows on the head, spine, or
stomach; severe labour and parturition, in which the infant’s head and brain
is compressed, injured, or mouldshot, or the navel-string compressed, and
the circulation interrupted; hydrocephalus; internal aneurism, polypi of the
heart, or large arterial trunks; rupture of large blood vessels, or of internal
abscess; palsy of the heart, dropsy of the pericardium; gangrene; drowning;
hanging.
Palpitation of the Heart. Chronic is here meant, not transitory, which may
occur on every sudden emotion of body or mind. In this the contraction of
the heart is with preternatural outrageous rapidity and force, and often with
audible strokes against the ribs, and intermittent pulse. It is generally
periodical; and by continuance, it is evident that, from the convulsion of
this important motory pendulum, the entire subordinate series of hydraulick
offices, together with those of sense and motion, must share in the disorder.
The predisposing and occasional causes are, plethora; repletion,
intemperance in food or drink; suppression of habitual evacuations;
interreign. This partial cessation of the vital functions distinguishes it, at the
first glance, from apoplexy. Asphyxy is only a more violent degree of
syncope in which the intire human machinery is stopped: the counterfeit of
death; but in which there are embers capable of being fanned and vivified
into vital renovation. The first exertions towards a restitution of the vital
energy when suspended, are sometimes with symptoms of epilepsy and
convulsions.
The predisposing and occasional causes of syncope and asphyxy,
idiopathick and symptomatick are, profuse evacuations and hemorrhages;
venesection; tapping the abdomen in ascites; strong emeticks and
purgatives; exhausted strength; violent exertions of strength, or muscular
action; excessive fatigue; venery in excess; sudden terror or joy, or other
mental emotions; intense anxiety; severe pain; offensive smells; foul air;
close rooms and crowds, and the air contaminated with their breath, and
effluvia; charcoal fumes; foul stagnant confined air, and gas of old damp
pits, wells, subterranean caverns, mines; mephitick vapours from
fermenting liquors in considerable quantity; lightening, thunder-shocks;
excessive heat; excessive cold; sanguineous plethora; various diseases of
the stomach; poisons, narcoticks; repelled cutaneous eruptions; hysterick,
scorbutick, arthritick, febrile; wounds or blows on the head, spine, or
stomach; severe labour and parturition, in which the infant’s head and brain
is compressed, injured, or mouldshot, or the navel-string compressed, and
the circulation interrupted; hydrocephalus; internal aneurism, polypi of the
heart, or large arterial trunks; rupture of large blood vessels, or of internal
abscess; palsy of the heart, dropsy of the pericardium; gangrene; drowning;
hanging.
Palpitation of the Heart. Chronic is here meant, not transitory, which may
occur on every sudden emotion of body or mind. In this the contraction of
the heart is with preternatural outrageous rapidity and force, and often with
audible strokes against the ribs, and intermittent pulse. It is generally
periodical; and by continuance, it is evident that, from the convulsion of
this important motory pendulum, the entire subordinate series of hydraulick
offices, together with those of sense and motion, must share in the disorder.
The predisposing and occasional causes are, plethora; repletion,
intemperance in food or drink; suppression of habitual evacuations;
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excessive evacuations; inanition; passions of mind; long continued grief,
terror, venery, pain, anxiety, thirst, immoderate exercise; light cloathing;
extreme irritability, peculiar irritability of the heart, and debility, spasm;
pressure on the aorta; aneurism; ossification and straitness of the aorta;
tumors about the great vessels; polypi; dropsy of the pericardium; impeded
respiration and circulation through the lungs; broken ribs; weak disordered
stomach, flatulence; diseases of the abdominal viscera; sweat of the feet,
ulcers, scabs prematurely repressed; cachexy; hysterick, hypochondriack,
melancholick, scorbutick, arthritick, atrabilarious, inflammatory.
Polypi of the Heart, internal Aneurism, and Ossification. Polypi are solid
coagulums of blood, of a firm or fleshy consistence: aneurism a distention
and weakness in some portion of the arterial coats, and partial enlargement
or bulge in the sanguineous canal; the usual seat of the first is in the auricles
and ventricles; of the second, in the large trunks, and more about their
origin: ossification of the valves, and of the aorta, or the smaller branches,
is more frequent in old age. The symptoms of polypi and aneurism are often
ambiguous; most of them are common to some other diseases; such as
difficulty of breathing, violent palpitation of the heart, and anxiety
aggravated by the least motion, with propensity to faint, intermittent pulse,
pain under the sternum, torpor of the arm, pale face, edematous ancles,
frightful dreams, timidity to walk alone without support. These, together
with syncope and asphyxy, no doubt make a part of the sudden deaths, and
some other casualties in the London bills.
I had nearly omitted the description of two diseases in which we are not
personally interested; the Berbiers of Indostan, and the Raphania, once a
European meteor. In the berbiers there is chronic tremulous motion of the
hands and feet, sometimes of the whole body: at the same time pricking and
formication, and some degree of insensibility; weakened voice; anhelation:
it usually originates from suppressed perspiration. The raphania was once a
transient epidemick, and principally noxious to infants; the symptoms
stupor of the spine, sensation of pricking pain in the muscular fibres; the
lower extremities rigid, sometimes convulsed; eyes rigid and distorted;
pharynx constricted; tongue retracted.
Hypochondriasm, hips, spleen, and vapours, imaginary maladies. This
chronic valetudinary infatuation is very frequent in our island: it occurs
principally in the adult and middle age; seldom early in life; in the male
terror, venery, pain, anxiety, thirst, immoderate exercise; light cloathing;
extreme irritability, peculiar irritability of the heart, and debility, spasm;
pressure on the aorta; aneurism; ossification and straitness of the aorta;
tumors about the great vessels; polypi; dropsy of the pericardium; impeded
respiration and circulation through the lungs; broken ribs; weak disordered
stomach, flatulence; diseases of the abdominal viscera; sweat of the feet,
ulcers, scabs prematurely repressed; cachexy; hysterick, hypochondriack,
melancholick, scorbutick, arthritick, atrabilarious, inflammatory.
Polypi of the Heart, internal Aneurism, and Ossification. Polypi are solid
coagulums of blood, of a firm or fleshy consistence: aneurism a distention
and weakness in some portion of the arterial coats, and partial enlargement
or bulge in the sanguineous canal; the usual seat of the first is in the auricles
and ventricles; of the second, in the large trunks, and more about their
origin: ossification of the valves, and of the aorta, or the smaller branches,
is more frequent in old age. The symptoms of polypi and aneurism are often
ambiguous; most of them are common to some other diseases; such as
difficulty of breathing, violent palpitation of the heart, and anxiety
aggravated by the least motion, with propensity to faint, intermittent pulse,
pain under the sternum, torpor of the arm, pale face, edematous ancles,
frightful dreams, timidity to walk alone without support. These, together
with syncope and asphyxy, no doubt make a part of the sudden deaths, and
some other casualties in the London bills.
I had nearly omitted the description of two diseases in which we are not
personally interested; the Berbiers of Indostan, and the Raphania, once a
European meteor. In the berbiers there is chronic tremulous motion of the
hands and feet, sometimes of the whole body: at the same time pricking and
formication, and some degree of insensibility; weakened voice; anhelation:
it usually originates from suppressed perspiration. The raphania was once a
transient epidemick, and principally noxious to infants; the symptoms
stupor of the spine, sensation of pricking pain in the muscular fibres; the
lower extremities rigid, sometimes convulsed; eyes rigid and distorted;
pharynx constricted; tongue retracted.
Hypochondriasm, hips, spleen, and vapours, imaginary maladies. This
chronic valetudinary infatuation is very frequent in our island: it occurs
principally in the adult and middle age; seldom early in life; in the male
Page 140
more than in the female sex, especially in those of melancholick
temperaments; and much more amongst persons of independent fortunes,
and amongst literary and sedentary professions, than the exercised and
industrious. Vapours are often complicated with diseases of the stomach,
hystericks, melancholy. But in the true hypochondriasm, the valetudinary
dyspepsy, and diseases of the digestive organs, seem rather a natural
consequence and sequel of the lugubrious mental temperament: besides, in
dyspepsy the mental perturbation is slight; it is also a far more universal
disease than hypochondriasm, affecting equally both sexes; and the young
as well as the old.
Hypochondriacks feel, or imagine they feel, all diseases; against these they
combat with a thousand remedies, and exhaust the whole pharmaceutical
rotine. They exaggerate with minute narrative these morbid phantoms,
which no other person can perceive, nor account for; examining their pulse,
fatiguing and harassing their physicians, visitors, and domesticks; on the
slightest grounds haunted with apprehensive forebodings of misfortunes,
misery, and death; and in the utmost anxiety about the event, at the time
perhaps that the appetite is not much impaired: in most things, however,
their judgment is correct; their health and diseases excepted, which are the
constant objects of their fears.
By such anxious solicitude, and passive submission to fanciful and
imperative chimeras, a luxuriant brood of symptoms, like irregular hysteria,
are engendered: they at length convert, or at least aggravate, accelerate, and
multiply imaginary into real evils, deranging the complicated offices of
digestion and circulation: hence flatulence, eructation, indigestion, nausea,
acid bilious vomiting, exspuition of watery fluid, irregular appetite; profuse,
irregular excretions and secretions by urine, perspiration, saliva, mucus,
diarrhœa, or its reverse costiveness; with palpitation of the heart, flushing of
heat and cold, fugacious spasms, anhelation; obscure vision, vertigo, noise
in the ears, headach, disturbed sleep, frightful dreams; slothfulness,
pusillanimity, want of resolution and activity, disposition to seriousness and
sadness, shyness, suspicion, peevishness, moroseness: the mind often
dejected and in despair, so as not to be solaced with hopes of relief. It
sometimes ceases, or at least abates weeks and months, recurring in
periodical exacerbations on any exciting cause or mental distress,
intemperance, or vicissitudes and irregularity of the seasons. Costiveness
temperaments; and much more amongst persons of independent fortunes,
and amongst literary and sedentary professions, than the exercised and
industrious. Vapours are often complicated with diseases of the stomach,
hystericks, melancholy. But in the true hypochondriasm, the valetudinary
dyspepsy, and diseases of the digestive organs, seem rather a natural
consequence and sequel of the lugubrious mental temperament: besides, in
dyspepsy the mental perturbation is slight; it is also a far more universal
disease than hypochondriasm, affecting equally both sexes; and the young
as well as the old.
Hypochondriacks feel, or imagine they feel, all diseases; against these they
combat with a thousand remedies, and exhaust the whole pharmaceutical
rotine. They exaggerate with minute narrative these morbid phantoms,
which no other person can perceive, nor account for; examining their pulse,
fatiguing and harassing their physicians, visitors, and domesticks; on the
slightest grounds haunted with apprehensive forebodings of misfortunes,
misery, and death; and in the utmost anxiety about the event, at the time
perhaps that the appetite is not much impaired: in most things, however,
their judgment is correct; their health and diseases excepted, which are the
constant objects of their fears.
By such anxious solicitude, and passive submission to fanciful and
imperative chimeras, a luxuriant brood of symptoms, like irregular hysteria,
are engendered: they at length convert, or at least aggravate, accelerate, and
multiply imaginary into real evils, deranging the complicated offices of
digestion and circulation: hence flatulence, eructation, indigestion, nausea,
acid bilious vomiting, exspuition of watery fluid, irregular appetite; profuse,
irregular excretions and secretions by urine, perspiration, saliva, mucus,
diarrhœa, or its reverse costiveness; with palpitation of the heart, flushing of
heat and cold, fugacious spasms, anhelation; obscure vision, vertigo, noise
in the ears, headach, disturbed sleep, frightful dreams; slothfulness,
pusillanimity, want of resolution and activity, disposition to seriousness and
sadness, shyness, suspicion, peevishness, moroseness: the mind often
dejected and in despair, so as not to be solaced with hopes of relief. It
sometimes ceases, or at least abates weeks and months, recurring in
periodical exacerbations on any exciting cause or mental distress,
intemperance, or vicissitudes and irregularity of the seasons. Costiveness
Page 141
and hardened feces indicate the obstinacy of the disease. It is not
immediately dangerous to life; but when of inveterate continuance, may
terminate in insanity, cachexy, jaundice, dropsy, tympany, consumption.
The predisposing and occasional causes are morbid extreme of sensibility;
hereditary; various depressing passions of mind; studious sedentary life and
abstruse meditation; retirement to an inactive after a bustling busy life;
excess of venery, manustupration; wealth, indolence, transient,
unsatisfactory amusements; revelling in pleasures, and cloyed with satiety;
November fogs, easterly winds, sirocco winds; intemperance in food or
drink, suppression of usual and solitary evacuations, as menses,
hemorrhoids; repulsion of cutaneous eruptions; obstruction in the
circulation through the vena porta and liver, and in the biliary secretion;
obstruction in the abdominal viscera; debility in the stomach and intestines,
and consequently vitiated chyle; pituita in excess; worms; irregular gout;
hystericks; intermittent fever.
Insanity, lunacy, mania, melancholia, and complex insanity. During the
preceding century, distracted and lunatick was the term in the London
registers; and in the last thirty years of that century, amounted in the
funerals to 544; but in the present century, are quadruple. We must reflect,
that two of the largest lunatick hospitals in Europe are erected in this
metropolis, exclusive of several large private madhouses; all of which are of
late years enlarged and multiplied in London and its suburbs. Into these
publick and private receptacles many lunaticks, from sundry parts of the
kingdom, are congregated; amounting in all, by the nearest calculation
which I can form, to upwards of one thousand. Perhaps those whom nature
originally, or disease branded as idiots, are also included in the lunatick
catalogue of mortality. The coroner’s inquest generally returns suicides as
lunaticks, after reciting the mode of their death; but the searcher’s reports in
the bills of mortality, have invariably ranged lunatick and self-murder under
two distinct heads. I have reason to believe that many lunatick deaths in
London are not reported, from their being interred in dissenting and
unregistered burying grounds, or in other places of interment without the
verge of the bills; others intentionally suppressed, and a considerable
remnant sunk amongst the suicides and drowned. It is probable, that in
lunaticks and suicides, this island may challenge any other in Europe,
whether in modern or in ancient times.
immediately dangerous to life; but when of inveterate continuance, may
terminate in insanity, cachexy, jaundice, dropsy, tympany, consumption.
The predisposing and occasional causes are morbid extreme of sensibility;
hereditary; various depressing passions of mind; studious sedentary life and
abstruse meditation; retirement to an inactive after a bustling busy life;
excess of venery, manustupration; wealth, indolence, transient,
unsatisfactory amusements; revelling in pleasures, and cloyed with satiety;
November fogs, easterly winds, sirocco winds; intemperance in food or
drink, suppression of usual and solitary evacuations, as menses,
hemorrhoids; repulsion of cutaneous eruptions; obstruction in the
circulation through the vena porta and liver, and in the biliary secretion;
obstruction in the abdominal viscera; debility in the stomach and intestines,
and consequently vitiated chyle; pituita in excess; worms; irregular gout;
hystericks; intermittent fever.
Insanity, lunacy, mania, melancholia, and complex insanity. During the
preceding century, distracted and lunatick was the term in the London
registers; and in the last thirty years of that century, amounted in the
funerals to 544; but in the present century, are quadruple. We must reflect,
that two of the largest lunatick hospitals in Europe are erected in this
metropolis, exclusive of several large private madhouses; all of which are of
late years enlarged and multiplied in London and its suburbs. Into these
publick and private receptacles many lunaticks, from sundry parts of the
kingdom, are congregated; amounting in all, by the nearest calculation
which I can form, to upwards of one thousand. Perhaps those whom nature
originally, or disease branded as idiots, are also included in the lunatick
catalogue of mortality. The coroner’s inquest generally returns suicides as
lunaticks, after reciting the mode of their death; but the searcher’s reports in
the bills of mortality, have invariably ranged lunatick and self-murder under
two distinct heads. I have reason to believe that many lunatick deaths in
London are not reported, from their being interred in dissenting and
unregistered burying grounds, or in other places of interment without the
verge of the bills; others intentionally suppressed, and a considerable
remnant sunk amongst the suicides and drowned. It is probable, that in
lunaticks and suicides, this island may challenge any other in Europe,
whether in modern or in ancient times.
Page 142
In illustrating this disease, above all others so little understood by the
community, by the medical profession, or, in truth, by the greatest part of
the authors on the subject, I shall rather trespass beyond the limits of a
concise systematic survey of diseases. I had long since procured the printed
annual reports of Bedlam during thirty years, from 1750 to 1780, wherein it
appeared, that out of 6000 lunaticks, the deaths amounted to 1200, or 1 of 5.
This information, so far as it went, was partly truth, but it was not the whole
truth; and, in confirmation of the general proverb, I was compelled to
search for it in a well. I was anxious to extend my inquiries to a vast variety
of particulars, not one of which could be learned from the crowd of authors,
good, bad, and indifferent, whom I perused for this purpose; from the
remote era of the Greek and Roman Catholicon, the Hellebore, down to the
present time.
Chagrined with this unprofitable research, I waited upon the learned and
venerable physician of Bedlam, Dr. Monro; who, with his accustomed
liberality and affability, recommended me to his son, upon whom the
principal medical department of Bedlam now devolves; and in whom the
hereditary virtue and exalted medical reputation of the father, are not likely
to suffer any diminution. Dr. Monro, junior, introduced me to Mr. Gonza,
the apothecary of Bedlam; whose curiosity and learning induced him to
keep a private register of all the patients; and with all which Mr. Gonza
most obligingly furnished me. It is from the records of this respectable and
well-informed gentleman, especially on the subject of insanity, that I am
enabled to form all the following Tables and data respecting a disease,
wherein, except to the few high-priests of those temples, the rest of the
Esculapian train are nearly as ignorant as the ancients; and the
unenlightened mass of the community stare with superstitious amazement
as the Israelites formerly on the epilepsy.
In penetrating this untrodden wilderness, and reconnoitering an unexplored
host of morbid foes, I shall proceed with the cautious investigation of
astronomers and natural philosophers; first to establish the facts and
phenomena previous to any deduction or inference. From Bedlam, the
largest palace and congregation of insane in any part of the globe; and from
its valuable, but hitherto dormant archives, I shall attempt to settle all the
leading and important data, by analyzing its internal history and
transactions during fifteen years, or half a generation; which is sufficient to
community, by the medical profession, or, in truth, by the greatest part of
the authors on the subject, I shall rather trespass beyond the limits of a
concise systematic survey of diseases. I had long since procured the printed
annual reports of Bedlam during thirty years, from 1750 to 1780, wherein it
appeared, that out of 6000 lunaticks, the deaths amounted to 1200, or 1 of 5.
This information, so far as it went, was partly truth, but it was not the whole
truth; and, in confirmation of the general proverb, I was compelled to
search for it in a well. I was anxious to extend my inquiries to a vast variety
of particulars, not one of which could be learned from the crowd of authors,
good, bad, and indifferent, whom I perused for this purpose; from the
remote era of the Greek and Roman Catholicon, the Hellebore, down to the
present time.
Chagrined with this unprofitable research, I waited upon the learned and
venerable physician of Bedlam, Dr. Monro; who, with his accustomed
liberality and affability, recommended me to his son, upon whom the
principal medical department of Bedlam now devolves; and in whom the
hereditary virtue and exalted medical reputation of the father, are not likely
to suffer any diminution. Dr. Monro, junior, introduced me to Mr. Gonza,
the apothecary of Bedlam; whose curiosity and learning induced him to
keep a private register of all the patients; and with all which Mr. Gonza
most obligingly furnished me. It is from the records of this respectable and
well-informed gentleman, especially on the subject of insanity, that I am
enabled to form all the following Tables and data respecting a disease,
wherein, except to the few high-priests of those temples, the rest of the
Esculapian train are nearly as ignorant as the ancients; and the
unenlightened mass of the community stare with superstitious amazement
as the Israelites formerly on the epilepsy.
In penetrating this untrodden wilderness, and reconnoitering an unexplored
host of morbid foes, I shall proceed with the cautious investigation of
astronomers and natural philosophers; first to establish the facts and
phenomena previous to any deduction or inference. From Bedlam, the
largest palace and congregation of insane in any part of the globe; and from
its valuable, but hitherto dormant archives, I shall attempt to settle all the
leading and important data, by analyzing its internal history and
transactions during fifteen years, or half a generation; which is sufficient to
Page 143
decide every ambiguity nearly as well as half a century. The materials are
extracted from many volumes; they are condensed, classed, and arranged
into a concise compendium, with no little trouble and fatigue to the author.
In number, and consequently in magnitude of information, they must be as
superior to any solitary individual observations on this subject, as the
swelling flood of the Thames is to one of the thousand smaller rills which
are swallowed up in its majestic stream. In this way we shall not be
confounded with contradictory affirmation and negation, and the clash of
oracles.
The following, therefore, are the general proportions which I shall
endeavour to demonstrate, and upon them to found a multitude of others:
the comparative proportion of insane males and females; their ages; the
cured; incurable, and dead; the length of time they were insane before
admission; the mischievous; those who attempted suicide; and the harmless;
the relapses; the periods when recovery may be despaired of; the various
remote causes. Mr. Gonza had distinguished the married and single; but in a
treatise of this nature, these, and many other minutiæ, must be omitted.
The usual number, on a general average, of patients in Bedlam is 250; of
which 110 are stationary incurables, male and female; and who remain there
until they either die, or are discharged, for reasons hereafter to be explained.
The remainder are a moving body, upwards of 200 of whom are annually
admitted, and the same number annually discharged: the difference of males
and females is very inconsiderable; in general the latter rather preponderate.
During fifteen years, from 1772 to 1787, of 2829 insane males and females,
their respective ages and numbers in each interval of life, when classed,
were as follows:—Under 10 years of age, 1; from 10 to 20, 132; from 20 to
30, 813; from 30 to 40, 908; from 40 to 50, 632; from 50 to 60, 266; from
60 and upwards, 78. Of these the cured were, 934; the incurable, 1694; the
dead, 230. Of these also, the mischievous were 743; attempted suicide, 323;
not mischievous, 886; committed shocking murders, upwards of 20;
relapsed, 535.
It seems necessary to be first mentioned, that I made memorandums of all
the different periods, and time elapsed, from the invasion of the disease, or
insane paroxism, to their admission into Bedlam, from one week to one
year and upwards. I do not, however, think it important to form a distinct
class, or table, of these, but merely to observe in the aggregate, that of the
extracted from many volumes; they are condensed, classed, and arranged
into a concise compendium, with no little trouble and fatigue to the author.
In number, and consequently in magnitude of information, they must be as
superior to any solitary individual observations on this subject, as the
swelling flood of the Thames is to one of the thousand smaller rills which
are swallowed up in its majestic stream. In this way we shall not be
confounded with contradictory affirmation and negation, and the clash of
oracles.
The following, therefore, are the general proportions which I shall
endeavour to demonstrate, and upon them to found a multitude of others:
the comparative proportion of insane males and females; their ages; the
cured; incurable, and dead; the length of time they were insane before
admission; the mischievous; those who attempted suicide; and the harmless;
the relapses; the periods when recovery may be despaired of; the various
remote causes. Mr. Gonza had distinguished the married and single; but in a
treatise of this nature, these, and many other minutiæ, must be omitted.
The usual number, on a general average, of patients in Bedlam is 250; of
which 110 are stationary incurables, male and female; and who remain there
until they either die, or are discharged, for reasons hereafter to be explained.
The remainder are a moving body, upwards of 200 of whom are annually
admitted, and the same number annually discharged: the difference of males
and females is very inconsiderable; in general the latter rather preponderate.
During fifteen years, from 1772 to 1787, of 2829 insane males and females,
their respective ages and numbers in each interval of life, when classed,
were as follows:—Under 10 years of age, 1; from 10 to 20, 132; from 20 to
30, 813; from 30 to 40, 908; from 40 to 50, 632; from 50 to 60, 266; from
60 and upwards, 78. Of these the cured were, 934; the incurable, 1694; the
dead, 230. Of these also, the mischievous were 743; attempted suicide, 323;
not mischievous, 886; committed shocking murders, upwards of 20;
relapsed, 535.
It seems necessary to be first mentioned, that I made memorandums of all
the different periods, and time elapsed, from the invasion of the disease, or
insane paroxism, to their admission into Bedlam, from one week to one
year and upwards. I do not, however, think it important to form a distinct
class, or table, of these, but merely to observe in the aggregate, that of the
Page 144
patients admitted into Bedlam, the majority were not above six months
unremittingly deprived of reason; and those, in all the intervals, from one
week to six months. The second great class were, in the intervals, from six
to twelve months. After one year, and upwards, there are comparatively
very few admissions, except on the incurable list.
The ages at which insanity predominates are obvious, and require no
comment. During the first period under 20, the greatest part of this small
group were between 15 and 20. The ages of about 300, as also of their
cures, incurables, and deaths, are omitted in the records: fractional
exactness cannot be expected: but for gross calculation there is abundant
accuracy. With respect to the cured, incurable, and dead, I shall make a few
remarks: amongst the discharged I found a considerable number reported as
sick and weak; others, and amounting to some hundreds, as troubled with
fits, or with paralytick strokes, and some with a complication of both the
latter maladies; and also a small fragment of pregnant females; and none of
these liberated from insanity. All these I threw into the incurable list, as I
could discover very few of them ever to return back again. Many of the sick
and weak may safely be added to the dead list; being on the confines of the
grave when dismissed. The incurables likewise contain those admitted on
the incurable list of Bedlam, as well as the great mass discharged from
thence incurable, after one year’s trial.
About one of every three are reported as cured; but from them we must
subtract for relapses, which probably would sink the cured, radically, to one
of 4. The cured are reported in all the intervals, from one month to one year.
Formerly the mortality in Bedlam was swelled by adventitious diseases,
particularly the small pox and scurvy; both of which are now prevented.
Melancholy and confinement are known to predispose to scurvy, but by an
increase of vegetable diet, this disease is no longer in the mortal catalogue
of Bedlam. The mental derangement, no doubt, must add to the mortality:
numbers discharged, as troubled with epilepsy and palsy, must have fallen
into these afflictions posterior to their admission, as they are always an
exception: and it is observed, that few are cured without the fits also. The
insane generally die of epileptick, apoplectick, and paralytick strokes, and
convulsions, of frenzy, atrophy, or nervous tabes. If we were to add the sick
and weak, the fits and palsy, I believe lunatick mortality would be doubled;
unremittingly deprived of reason; and those, in all the intervals, from one
week to six months. The second great class were, in the intervals, from six
to twelve months. After one year, and upwards, there are comparatively
very few admissions, except on the incurable list.
The ages at which insanity predominates are obvious, and require no
comment. During the first period under 20, the greatest part of this small
group were between 15 and 20. The ages of about 300, as also of their
cures, incurables, and deaths, are omitted in the records: fractional
exactness cannot be expected: but for gross calculation there is abundant
accuracy. With respect to the cured, incurable, and dead, I shall make a few
remarks: amongst the discharged I found a considerable number reported as
sick and weak; others, and amounting to some hundreds, as troubled with
fits, or with paralytick strokes, and some with a complication of both the
latter maladies; and also a small fragment of pregnant females; and none of
these liberated from insanity. All these I threw into the incurable list, as I
could discover very few of them ever to return back again. Many of the sick
and weak may safely be added to the dead list; being on the confines of the
grave when dismissed. The incurables likewise contain those admitted on
the incurable list of Bedlam, as well as the great mass discharged from
thence incurable, after one year’s trial.
About one of every three are reported as cured; but from them we must
subtract for relapses, which probably would sink the cured, radically, to one
of 4. The cured are reported in all the intervals, from one month to one year.
Formerly the mortality in Bedlam was swelled by adventitious diseases,
particularly the small pox and scurvy; both of which are now prevented.
Melancholy and confinement are known to predispose to scurvy, but by an
increase of vegetable diet, this disease is no longer in the mortal catalogue
of Bedlam. The mental derangement, no doubt, must add to the mortality:
numbers discharged, as troubled with epilepsy and palsy, must have fallen
into these afflictions posterior to their admission, as they are always an
exception: and it is observed, that few are cured without the fits also. The
insane generally die of epileptick, apoplectick, and paralytick strokes, and
convulsions, of frenzy, atrophy, or nervous tabes. If we were to add the sick
and weak, the fits and palsy, I believe lunatick mortality would be doubled;
Page 145
and would then be about one of five or six. More comparatively die of the
insane patients recently admitted, than of the stationary incurables.
The greatest proportion of patients in Bedlam, especially at the beginning,
have attempted some mischief against themselves, or their relations and
keepers: in the above list there are above a score of atrocious murderers,
exclusive of suicides. There are parricides, and butchers of their own
offspring. Their mischievous acts and attempts were in various ways, by
jumping out of windows, hanging, drowning, stabbing, shooting, tearing off
their cloaths, setting fire to houses, and several other overt acts of malignity.
Some were mischievous by open acts of violence; others by threats only.
Some not mischievous at first, have become so, and “vice versa;” and
several reported as not mischievous, have afterwards hanged themselves.
Females, as well as males, are mischievous; but I do not observe so many
dreadful murders committed by the female sex. By far the greater majority
of patients in Bedlam, except at temporary intervals and exacerbations,
walk peaceably about the wards: separate confinement in their cells, strait
waistcoats, or in the ferocious maniac, handcuffs and chains, soon render
them tractable and obedient: a very small number, even of incurables, are
kept as wild beasts, constantly in fetters. Some, by time and long
confinement in the incurables, and who were extremely vicious and
dangerous, become harmless, and are then discharged. From all the variety
of causes, depressing or stimulating, I perceive mischievous or harmless.
This circumstance seems to make no material difference in the curable or
incurable. Numbers who had attempted suicide, some who had committed
murders, are in the list of cured.
I also perceive recoveries after reiterated relapses; and the prognosticks are
then nearly as favourable as though it had been the first attack. No disease
is more prone to relapse: these are, at various intervals, in different persons,
from one to upwards of twenty years, and during this period, either one or
many relapses. Multitudes of the relapses are either after being discharged
cured from Bedlam, or before they were brought there for admission. There
are some few instances, wherein the sagacious physician of Bedlam has
been deceived; and when, after apparent recovery, and the subsequent
lunatick quarantine, patients have been discharged with sound bills of
health, but on the same day have relapsed; and even before departure from
the house. They are in danger of relapses from all the causes which give
insane patients recently admitted, than of the stationary incurables.
The greatest proportion of patients in Bedlam, especially at the beginning,
have attempted some mischief against themselves, or their relations and
keepers: in the above list there are above a score of atrocious murderers,
exclusive of suicides. There are parricides, and butchers of their own
offspring. Their mischievous acts and attempts were in various ways, by
jumping out of windows, hanging, drowning, stabbing, shooting, tearing off
their cloaths, setting fire to houses, and several other overt acts of malignity.
Some were mischievous by open acts of violence; others by threats only.
Some not mischievous at first, have become so, and “vice versa;” and
several reported as not mischievous, have afterwards hanged themselves.
Females, as well as males, are mischievous; but I do not observe so many
dreadful murders committed by the female sex. By far the greater majority
of patients in Bedlam, except at temporary intervals and exacerbations,
walk peaceably about the wards: separate confinement in their cells, strait
waistcoats, or in the ferocious maniac, handcuffs and chains, soon render
them tractable and obedient: a very small number, even of incurables, are
kept as wild beasts, constantly in fetters. Some, by time and long
confinement in the incurables, and who were extremely vicious and
dangerous, become harmless, and are then discharged. From all the variety
of causes, depressing or stimulating, I perceive mischievous or harmless.
This circumstance seems to make no material difference in the curable or
incurable. Numbers who had attempted suicide, some who had committed
murders, are in the list of cured.
I also perceive recoveries after reiterated relapses; and the prognosticks are
then nearly as favourable as though it had been the first attack. No disease
is more prone to relapse: these are, at various intervals, in different persons,
from one to upwards of twenty years, and during this period, either one or
many relapses. Multitudes of the relapses are either after being discharged
cured from Bedlam, or before they were brought there for admission. There
are some few instances, wherein the sagacious physician of Bedlam has
been deceived; and when, after apparent recovery, and the subsequent
lunatick quarantine, patients have been discharged with sound bills of
health, but on the same day have relapsed; and even before departure from
the house. They are in danger of relapses from all the causes which give
Page 146
birth to insanity. From the proportion of cured and incurable, and successive
relapses, many of which at length become incurable, we see how difficult it
is, as yet, to expel this mental usurper, and to restore chaos into order.
I do not observe so great a difference in the recovery, from either age or
cause, as might be expected: there are cured and incurable, promiscuously
at all ages; and from all the different causes, whether adventitious or
hereditary. Even from hereditary insanity, they seem to recover nearly as
well as from the less inherent causes: there are several instances of recovery
when hereditary from the parents on both sides. In some, where the disease
was entailed, it has made its first appearance in all the intervals from
puberty to fifty years of age. I was struck with one curious instance of
hereditary insanity from both parents, in a brother and sister, and nearly
about the same time; the one twenty, the other twenty-three years of age;
one of whom was melancholic, the other maniac. There are some few
instances of recovery after one, two, or even three years pertinacious
privation of reason: some few of the incurable in Bedlam have recovered;
but all these are very rare. After only one year’s uninterrupted perseverance
of the disease, they are generally refused admission into Bedlam, except as
incurables; and of such I cannot perceive the cured above one or two per
cent.
Many features and particulars of the insane character and history have now
been developed. But I have not yet, as in other diseases, ventured to affix a
nosological signature, or definition, and to circumscribe the limits between
the insane and the multitude of others reputed as rational beings. In such an
attempt I might probably appear as ridiculous as the Greek philosopher in
his concise definition of man. It is not confined within the porticoes of
Bedlam and madhouses: we might find it sprinkled over the earth; not only
amongst the fanaticks of Asia, the Bonzes and Faquirs, and some of the
austere cloistered devotees of Europe; but thro’ every rank and station of
civilized communities.
Insanity has been usually described in the two extremes of mania, and
melancholia: but it is frequently of a complex nature, with alternating
exacerbations of frenzy, and of melancholy. It is termed a delirium without
fever; of which mental anarchy there are innumerable symptoms,
gradations, shades, species, and varieties: the enumeration of which would
be as infinite as the diversity of their faces and ideas. Sometimes insanity
relapses, many of which at length become incurable, we see how difficult it
is, as yet, to expel this mental usurper, and to restore chaos into order.
I do not observe so great a difference in the recovery, from either age or
cause, as might be expected: there are cured and incurable, promiscuously
at all ages; and from all the different causes, whether adventitious or
hereditary. Even from hereditary insanity, they seem to recover nearly as
well as from the less inherent causes: there are several instances of recovery
when hereditary from the parents on both sides. In some, where the disease
was entailed, it has made its first appearance in all the intervals from
puberty to fifty years of age. I was struck with one curious instance of
hereditary insanity from both parents, in a brother and sister, and nearly
about the same time; the one twenty, the other twenty-three years of age;
one of whom was melancholic, the other maniac. There are some few
instances of recovery after one, two, or even three years pertinacious
privation of reason: some few of the incurable in Bedlam have recovered;
but all these are very rare. After only one year’s uninterrupted perseverance
of the disease, they are generally refused admission into Bedlam, except as
incurables; and of such I cannot perceive the cured above one or two per
cent.
Many features and particulars of the insane character and history have now
been developed. But I have not yet, as in other diseases, ventured to affix a
nosological signature, or definition, and to circumscribe the limits between
the insane and the multitude of others reputed as rational beings. In such an
attempt I might probably appear as ridiculous as the Greek philosopher in
his concise definition of man. It is not confined within the porticoes of
Bedlam and madhouses: we might find it sprinkled over the earth; not only
amongst the fanaticks of Asia, the Bonzes and Faquirs, and some of the
austere cloistered devotees of Europe; but thro’ every rank and station of
civilized communities.
Insanity has been usually described in the two extremes of mania, and
melancholia: but it is frequently of a complex nature, with alternating
exacerbations of frenzy, and of melancholy. It is termed a delirium without
fever; of which mental anarchy there are innumerable symptoms,
gradations, shades, species, and varieties: the enumeration of which would
be as infinite as the diversity of their faces and ideas. Sometimes insanity
Page 147
bursts out unexpectedly, like a squall of wind or thunder-storm: but in
general the paroxism is preceded days, weeks, or even months, by few or
many of the following symptoms, which vary in different persons; quick
motion of the eyelids, redness or wildness in the eyes and looks,
restlessness, headach, vertigo, by something unusual and different from
their ordinary conduct in the speech, gestures, actions, looks; by high or low
spirits, loquacity, or taciturnity: in some, the appetite is voracious; in others,
there is aversion to food.
On the first ebullition of frantick mania, the looks, voice, and gestures are
wild and impetuous; in many audacious and ferocious: they are irascible,
impatient, and violent on any contradiction or restraint: they ramble with
wonderful rapidity of ideas, and garrulity of speech, from one object to
another; shouting, singing, laughing: some, transported with extacy, roam in
incoherent rhapsody through all the fairy regions of enchantment and
romance: we observe maniacks in idea personating every being and object
celestial and terrestrial, animate and inanimate. But by such numbers either
attempting or committing mischief upon themselves or others, it is evident
that the disagreeable, turbulent, malevolent, and desponding passions do
often predominate; there is more of the jarring and discordant than of the
harmonick notes and keys: some maniacks are distracted with malevolence,
antipathy, animosity, rancour, and revenge. In the melancholia, the mind is
generally rivetted upon one object and train of thought, about which they
incessantly rave or ponder: many are cogitative, taciturn, morose, or fixed
like statues: and more of this character are said to commit suicide. Some,
plunged into despair, are haunted with all the horrors of tartarus; or even
chained within the gloomy dungeons and inexorable bars of Cerberus.
In mania the strength is prodigiously increased. In general, insane persons
endure hunger, cold, nakedness, want of sleep, with astonishing
perseverance and impunity. During the exacerbation, most are restless; and
most are costive. Some obstinately refuse all food and medicine, and are
drenched by compulsion, as horses taking physick; which at length renders
them more docile. Some, if indulged, are ravenous and insatiable as wolves.
Some melancholick, on relapses, have only a periodical invasion of
profound grief, want of sleep and appetite, restlessness and anxiety. Many
persons, universally considered as insane, will however, at times, act, speak,
converse, and reason acutely on various subjects, until some particular
general the paroxism is preceded days, weeks, or even months, by few or
many of the following symptoms, which vary in different persons; quick
motion of the eyelids, redness or wildness in the eyes and looks,
restlessness, headach, vertigo, by something unusual and different from
their ordinary conduct in the speech, gestures, actions, looks; by high or low
spirits, loquacity, or taciturnity: in some, the appetite is voracious; in others,
there is aversion to food.
On the first ebullition of frantick mania, the looks, voice, and gestures are
wild and impetuous; in many audacious and ferocious: they are irascible,
impatient, and violent on any contradiction or restraint: they ramble with
wonderful rapidity of ideas, and garrulity of speech, from one object to
another; shouting, singing, laughing: some, transported with extacy, roam in
incoherent rhapsody through all the fairy regions of enchantment and
romance: we observe maniacks in idea personating every being and object
celestial and terrestrial, animate and inanimate. But by such numbers either
attempting or committing mischief upon themselves or others, it is evident
that the disagreeable, turbulent, malevolent, and desponding passions do
often predominate; there is more of the jarring and discordant than of the
harmonick notes and keys: some maniacks are distracted with malevolence,
antipathy, animosity, rancour, and revenge. In the melancholia, the mind is
generally rivetted upon one object and train of thought, about which they
incessantly rave or ponder: many are cogitative, taciturn, morose, or fixed
like statues: and more of this character are said to commit suicide. Some,
plunged into despair, are haunted with all the horrors of tartarus; or even
chained within the gloomy dungeons and inexorable bars of Cerberus.
In mania the strength is prodigiously increased. In general, insane persons
endure hunger, cold, nakedness, want of sleep, with astonishing
perseverance and impunity. During the exacerbation, most are restless; and
most are costive. Some obstinately refuse all food and medicine, and are
drenched by compulsion, as horses taking physick; which at length renders
them more docile. Some, if indulged, are ravenous and insatiable as wolves.
Some melancholick, on relapses, have only a periodical invasion of
profound grief, want of sleep and appetite, restlessness and anxiety. Many
persons, universally considered as insane, will however, at times, act, speak,
converse, and reason acutely on various subjects, until some particular
Page 148
mental string or chord is touched. With respect to general prognosticks in
insanity, we have been already copious and diffuse; and shall only add, that
in some degree of mania, more favourable hopes are entertained than in
gloomy melancholy: indecency, no intermissions or remissions, epilepsy,
palsy, tabes, frenzy, are all inauspicious. The piercing and intuitive eye of
the experienced physiognomist, will also discern presages which are
concealed from ordinary comprehension and observation.
Of the predisposing and occasional causes of insanity. We all know by
demonstration and reading, that one eighth part of the blood is circulated
through the head: we know the origin and distribution of its spinal
elongation, and forty pairs of nerves; its internal structure to the most
minute discernible filaments; its division into cavities and prominences,
many of them with uncouth names, and swelling the nauseous vocabulary
of anatomy. But still the latent predisposition or frailty in the recesses of the
brain, which render some more than others liable to this mutiny of reason,
on the application of remote and obvious causes, are totally unknown. Most
of the proximate causes assigned in authors for madness, are mere
hypotheses; and of no active use to the community, or to medicine. The
pretended discoveries of the anatomical knife; and the specific gravity or
levity of the brain in scales, are equally conjectural. The great master,
decypherer, and physiologist of the intellectual functions, Mr. Locke, has
here taught us to despair, and to be convinced of the imperfection of our
senses and faculties. Literature, however, ancient and modern, abounds with
madmen and authors, especially on the intellectual operations, and springs
of sense and motion. Many other subjects yet remain to engage our
attention, and to prevent our digressing into the jaded topick of
temperaments; of original organization; or the progressive revolutions,
corporeal and mental, by age and time. This is an inexhaustible theme for
observation and lucubration.
The late Dr. Mead broached a proposition, which has been transfused
through most succeeding authors: that from sudden transports of joy, and
the exhilirating passions, more were insane than from contrary causes: and
he quotes Bedlam as an instance during the year of the South-Sea scheme,
when great fortunes were suddenly acquired and lost. I took the trouble, so
far as they are recorded, to class the different causes of insanity; which
contain nearly one third of the whole patients during the fifteen years of our
insanity, we have been already copious and diffuse; and shall only add, that
in some degree of mania, more favourable hopes are entertained than in
gloomy melancholy: indecency, no intermissions or remissions, epilepsy,
palsy, tabes, frenzy, are all inauspicious. The piercing and intuitive eye of
the experienced physiognomist, will also discern presages which are
concealed from ordinary comprehension and observation.
Of the predisposing and occasional causes of insanity. We all know by
demonstration and reading, that one eighth part of the blood is circulated
through the head: we know the origin and distribution of its spinal
elongation, and forty pairs of nerves; its internal structure to the most
minute discernible filaments; its division into cavities and prominences,
many of them with uncouth names, and swelling the nauseous vocabulary
of anatomy. But still the latent predisposition or frailty in the recesses of the
brain, which render some more than others liable to this mutiny of reason,
on the application of remote and obvious causes, are totally unknown. Most
of the proximate causes assigned in authors for madness, are mere
hypotheses; and of no active use to the community, or to medicine. The
pretended discoveries of the anatomical knife; and the specific gravity or
levity of the brain in scales, are equally conjectural. The great master,
decypherer, and physiologist of the intellectual functions, Mr. Locke, has
here taught us to despair, and to be convinced of the imperfection of our
senses and faculties. Literature, however, ancient and modern, abounds with
madmen and authors, especially on the intellectual operations, and springs
of sense and motion. Many other subjects yet remain to engage our
attention, and to prevent our digressing into the jaded topick of
temperaments; of original organization; or the progressive revolutions,
corporeal and mental, by age and time. This is an inexhaustible theme for
observation and lucubration.
The late Dr. Mead broached a proposition, which has been transfused
through most succeeding authors: that from sudden transports of joy, and
the exhilirating passions, more were insane than from contrary causes: and
he quotes Bedlam as an instance during the year of the South-Sea scheme,
when great fortunes were suddenly acquired and lost. I took the trouble, so
far as they are recorded, to class the different causes of insanity; which
contain nearly one third of the whole patients during the fifteen years of our
Page 149
scrutiny; wherein I do not find a single example in proof of Dr. Mead’s
aphorism, but hundreds in direct contradiction to it; as appears in the
following table of causes:—Misfortunes, troubles, disappointments, grief,
206; religion and Methodism, 90; love, 74; jealousy, 6; fright, 51; study, 15;
pride, 8; drink and intoxication, 58; fever, 110; parturition, 79; obstruction,
10; family and hereditary, 115; contusion and fracture, 12; venereal, 14;
small pox, 7; ulcers and scab dried up, 5.—I have not time to comment
upon these causes: to them may be added all the train of exasperating
passions; long attention of mind rivetted upon one object; faults of the
blood or bile, and circulation in the vena porta; plethora in the vessels of the
head; furor uterin; in some of the Asiatic nations, opium; also intoxicating
poisons snuffed by the nose; “cum multis aliis.” The revolution of the
seasons seem to have no effect on insanity; nor are the effect of the moon
conspicuous in Bedlam.
DISEASES of the External Senses; including vision, hearing, smell, taste;
to these we shall add the diseases of the voice and speech; obstructed
deglutition; sterility, and morbid irritability of the generative organs. The
derangement of those delicate and precious senses through which we derive
such supreme delight; through whose avenues are conveyed into man the
first rudiments of all his variegated ideas and knowledge, are important
objects of medical scrutiny; notwithstanding very few from these causes are
precipitated into the crater of mortality. I could, however, have wished to
ascertain from registers, in conformity with my general plan, the proportion
of cured and incurable; and especially the average of blind in a community.
Vision. The principal diseases may be comprehended under opthalmia,
fistula-lachrymalis, gutta-serena, cataract, specks on the cornea. I exclude
some other natural defects, rather than diseases, such as myops, presbyops;
for the cure of which the optician is the best physician.
Opthalmy, or inflammation of the eyes is a frequent complaint: it may be in
the exterior membranes of the globe, or in the edges of the eye-lids; or may
be a complication of both; it may be in one, or in both eyes; it may be
general, partial, external, internal, temporary, chronic, idiopathick,
aphorism, but hundreds in direct contradiction to it; as appears in the
following table of causes:—Misfortunes, troubles, disappointments, grief,
206; religion and Methodism, 90; love, 74; jealousy, 6; fright, 51; study, 15;
pride, 8; drink and intoxication, 58; fever, 110; parturition, 79; obstruction,
10; family and hereditary, 115; contusion and fracture, 12; venereal, 14;
small pox, 7; ulcers and scab dried up, 5.—I have not time to comment
upon these causes: to them may be added all the train of exasperating
passions; long attention of mind rivetted upon one object; faults of the
blood or bile, and circulation in the vena porta; plethora in the vessels of the
head; furor uterin; in some of the Asiatic nations, opium; also intoxicating
poisons snuffed by the nose; “cum multis aliis.” The revolution of the
seasons seem to have no effect on insanity; nor are the effect of the moon
conspicuous in Bedlam.
DISEASES of the External Senses; including vision, hearing, smell, taste;
to these we shall add the diseases of the voice and speech; obstructed
deglutition; sterility, and morbid irritability of the generative organs. The
derangement of those delicate and precious senses through which we derive
such supreme delight; through whose avenues are conveyed into man the
first rudiments of all his variegated ideas and knowledge, are important
objects of medical scrutiny; notwithstanding very few from these causes are
precipitated into the crater of mortality. I could, however, have wished to
ascertain from registers, in conformity with my general plan, the proportion
of cured and incurable; and especially the average of blind in a community.
Vision. The principal diseases may be comprehended under opthalmia,
fistula-lachrymalis, gutta-serena, cataract, specks on the cornea. I exclude
some other natural defects, rather than diseases, such as myops, presbyops;
for the cure of which the optician is the best physician.
Opthalmy, or inflammation of the eyes is a frequent complaint: it may be in
the exterior membranes of the globe, or in the edges of the eye-lids; or may
be a complication of both; it may be in one, or in both eyes; it may be
general, partial, external, internal, temporary, chronic, idiopathick,
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symptomatick: of all which species there are various gradations. In this
local malady there is commonly little or no fever; but heat, pain, redness,
and inflammation; the vessels of the eyes seem gorged with blood; the
anterior portion of the tunica sclerotica, and the conjunctiva, resemble a
scarlet cloth, with impediment in vision, intolerance of light, lachrymation.
In the inflammation of the cartilaginous ring of the eye-lids or tarsus, there
is frequently some remains of small ulcerations in the sebaceous glands.
The external is by far the most frequent form of opthalmy; and, under
discreet management, is attended with trifling danger: sometimes, however,
it is followed by specks on the cornea, or callosity, and blindness; and
violent inflammation has extended to the interior parts of the eyes and
retina. In the internal inflammation of the choroid and retina, no redness is
perceptible externally; but there is excruciating pain, headach, intolerance
of light, restlessness, often delirium, in a few instances, insanity: and if not
relieved in the course of fourteen days, there is danger of incurable
blindness.
Fistula lachrymalis. In this partial inflammation affecting the lachrymal sac
and ducts, and obstructing the descent of the tears, or superfluous moisture
of the eyes into the nose, this fluid necessarily trickles down the cheeks, and
the eye is overflowed with water: on pressure of the internal angle and
puncta lachrymalia, there is a discharge of glareous serum, by which the
eye-lids, during sleep, are glewed together. The degrees of inflammation
and obstruction are various. In the inveterate stages it may terminate in
abscess, ulcers, and caries of the contiguous nasal bone.
Gutta-serena, amaurosis; in one or in both eyes, and in various gradations,
from obscure vision to cheerless tenebrosity. To a spectator the eyes appear
nearly as in health, only that the pupil is dilated and inanimate; the retina
insensible to the rays of light, and the iris mute, without corresponding
contraction or enlargement: a physiognomist might say, there are no
sensitive emanations or magnetick rays emitted through this mental mirror.
It attacks suddenly or gradually, and sometimes intermits; but in general it
is chronic, and always dangerous; often irremediable: sometimes it is
accompanied with headach in the anterior part over the eye-brows.
Cataract may affect one eye, but in general both: it arises from disease or
opacity of the crystalline lens obstructing the visual rays in their course to
the retina: the consistence and colour of the lens is various, white, pearl,
local malady there is commonly little or no fever; but heat, pain, redness,
and inflammation; the vessels of the eyes seem gorged with blood; the
anterior portion of the tunica sclerotica, and the conjunctiva, resemble a
scarlet cloth, with impediment in vision, intolerance of light, lachrymation.
In the inflammation of the cartilaginous ring of the eye-lids or tarsus, there
is frequently some remains of small ulcerations in the sebaceous glands.
The external is by far the most frequent form of opthalmy; and, under
discreet management, is attended with trifling danger: sometimes, however,
it is followed by specks on the cornea, or callosity, and blindness; and
violent inflammation has extended to the interior parts of the eyes and
retina. In the internal inflammation of the choroid and retina, no redness is
perceptible externally; but there is excruciating pain, headach, intolerance
of light, restlessness, often delirium, in a few instances, insanity: and if not
relieved in the course of fourteen days, there is danger of incurable
blindness.
Fistula lachrymalis. In this partial inflammation affecting the lachrymal sac
and ducts, and obstructing the descent of the tears, or superfluous moisture
of the eyes into the nose, this fluid necessarily trickles down the cheeks, and
the eye is overflowed with water: on pressure of the internal angle and
puncta lachrymalia, there is a discharge of glareous serum, by which the
eye-lids, during sleep, are glewed together. The degrees of inflammation
and obstruction are various. In the inveterate stages it may terminate in
abscess, ulcers, and caries of the contiguous nasal bone.
Gutta-serena, amaurosis; in one or in both eyes, and in various gradations,
from obscure vision to cheerless tenebrosity. To a spectator the eyes appear
nearly as in health, only that the pupil is dilated and inanimate; the retina
insensible to the rays of light, and the iris mute, without corresponding
contraction or enlargement: a physiognomist might say, there are no
sensitive emanations or magnetick rays emitted through this mental mirror.
It attacks suddenly or gradually, and sometimes intermits; but in general it
is chronic, and always dangerous; often irremediable: sometimes it is
accompanied with headach in the anterior part over the eye-brows.
Cataract may affect one eye, but in general both: it arises from disease or
opacity of the crystalline lens obstructing the visual rays in their course to
the retina: the consistence and colour of the lens is various, white, pearl,
Page 151
green, yellow; and from these the oculist forms his prognostick: in couching
the eye the pearl-coloured is preferred: the white is too soft; the green and
yellow incurable; as is also that species wherein the strongest rays of light
excite no contraction of the pupil. Cataracts in general are gradual in their
formation; weeks, months.
The predisposing and occasional causes of injured vision and of opthalmy,
external violence and blows; sudden suppression of perspiration; extraneous
bodies or acrids admitted within the eye-lids; acrid metallic fumes, and
noxious exhalations; long exposure to confined smoke, especially from
wood fires; smoky houses and cottages; acrid collyria; epidemick state of
the air, and infection; long continuance of wet weather; long exposure of the
eyes to the rays of strong light, to snow, or luminous objects; cold streams
of air; suppression of salutary evacuations, or cutaneous eruptions, and of
chronic ulcers; acrimony of the blood; interruption to the free return of
blood from the head; frequent intoxication: nocturnal studies; long want of
sleep, grief, tears; small tubercles within the eye-lids; ulcerated eye-lids;
variolous: morbillous; scrophulous; venereal; erysipelatous; rheumatick;
catarrhal; intermittent; herpes; cancerous. Of fistula-lachrymalis,
inflammation of the lachrymal sac, or ducts. Of gutta-serena, plethora,
distention of the vessels of the retina; palsy of the optick nerves, general or
partial; diseases of the brain, or of the retina; profuse and suppressed
evacuations; excess of venery; chronic headach; ebriety; cachexy; venereal;
intermittent; symptomatick in the irregular gout, apoplexy, &c. Of the
cataract, opacity of the crystalline lens. The general causes of injured
vision, exclusive of opthalmy, may be briefly enumerated; and are long
attention to minute objects; weakness of the power to contract the pupil;
faults of the globe; defect of the aqueous humour, its impurity or density;
opacity of the lens, or of the vitreous humour; the retina callous or too
sensible; faults of the optic nerves; contraction, concretion, flaccidity of the
pupil; gibbous or convex lens, or too near and flat; dropsical eye; spasm, or
palsy of the ocular muscles; diseases and ulcerations of the eye-lids and
ciliary glands; ulcers and fistula, specks and scars, in the cornea; films
growing from the angle of the eye; the eye-lids inverted, elongated,
concreted; various diseases of the brain from internal or external causes.
Hearing, injured by deafness; noise in the ears, inflammation. The first is a
frequent infirmity in old age. The causes, faults in the original structure of
the eye the pearl-coloured is preferred: the white is too soft; the green and
yellow incurable; as is also that species wherein the strongest rays of light
excite no contraction of the pupil. Cataracts in general are gradual in their
formation; weeks, months.
The predisposing and occasional causes of injured vision and of opthalmy,
external violence and blows; sudden suppression of perspiration; extraneous
bodies or acrids admitted within the eye-lids; acrid metallic fumes, and
noxious exhalations; long exposure to confined smoke, especially from
wood fires; smoky houses and cottages; acrid collyria; epidemick state of
the air, and infection; long continuance of wet weather; long exposure of the
eyes to the rays of strong light, to snow, or luminous objects; cold streams
of air; suppression of salutary evacuations, or cutaneous eruptions, and of
chronic ulcers; acrimony of the blood; interruption to the free return of
blood from the head; frequent intoxication: nocturnal studies; long want of
sleep, grief, tears; small tubercles within the eye-lids; ulcerated eye-lids;
variolous: morbillous; scrophulous; venereal; erysipelatous; rheumatick;
catarrhal; intermittent; herpes; cancerous. Of fistula-lachrymalis,
inflammation of the lachrymal sac, or ducts. Of gutta-serena, plethora,
distention of the vessels of the retina; palsy of the optick nerves, general or
partial; diseases of the brain, or of the retina; profuse and suppressed
evacuations; excess of venery; chronic headach; ebriety; cachexy; venereal;
intermittent; symptomatick in the irregular gout, apoplexy, &c. Of the
cataract, opacity of the crystalline lens. The general causes of injured
vision, exclusive of opthalmy, may be briefly enumerated; and are long
attention to minute objects; weakness of the power to contract the pupil;
faults of the globe; defect of the aqueous humour, its impurity or density;
opacity of the lens, or of the vitreous humour; the retina callous or too
sensible; faults of the optic nerves; contraction, concretion, flaccidity of the
pupil; gibbous or convex lens, or too near and flat; dropsical eye; spasm, or
palsy of the ocular muscles; diseases and ulcerations of the eye-lids and
ciliary glands; ulcers and fistula, specks and scars, in the cornea; films
growing from the angle of the eye; the eye-lids inverted, elongated,
concreted; various diseases of the brain from internal or external causes.
Hearing, injured by deafness; noise in the ears, inflammation. The first is a
frequent infirmity in old age. The causes, faults in the original structure of
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this curious and complex organ; defect of the auricle, straitness of the
external auditory tube, its obstruction or concretion: the tympanum relaxed,
callous, obstructed with hardened wax, mucus, serum, ulcers, luxuriant
flesh; caries, luxation of the small auditory bones; obstruction of the
vestibule, cochlea, labrynth: the membranes lax, dry, indurated; palsy, and
spasm of the internal auditory muscles; constriction and obstruction of the
eustachian tube; colds, catarrh, obstructed perspiration, rheumatism,
plethora, suppressed evacuations; disorders of the stomach, costiveness;
nervous, loud explosions, age, fever, soporous diseases, and diseases of the
auditory nerves, and of the brain; symptomatick in several diseases.
Inflammation of the ear excites excruciating pain, sometimes delirium.
Smelling too acute, or blunt, or unnatural. The causes, the membrane lining
the nose rigid, dry, deficiency or excess of its mucus tense, irritable,
obstructed, scirrhous, callous, carious, stifled with polypus, snuff; palsy of
the olfactory nerves; diseases of the brain; sordes and pus in the olfactory
sinusses; and also in the mouth, gums, teeth, tongue, larynx, fauces; foul
effluvia from the stomach.
Sternutation is symptomatick in several diseases; but sometimes, is a
primary malady, it has been known to infest hours, days, or even weeks.
The causes, epidemick influence of the air; suppressed nasal hemorrhage,
or cutaneous eruptions; venereal; worms, or abscess in the sinusses; disease
of the brain.
Taste. The causes affecting the principal gustatory organ, the tongue: sordes
of the tongue and mouth in various diseases; the saliva in quantity or quality
diseased, and either depraved from the blood, or from washing over
diseased parts of the mouth or palate; tension or laxity of the gustatory
organ, or papillæ; faults of the lingual nerves; diseases of the stomach,
fauces, nose, tongue, lips, &c.
Voice and Speech. The immense multiplicity of objects, and the distance to
the end of our literary journey, check us from expatiating upon this prolifick
topick. Under it may be included hoarse, guttural, stridulous, deadened,
stifled voice, or sound at the glottis; stammering, lisping, defect and
impediments in articulation, muteness. The causes, defect or waste of
mucus by exertion of the voice; destruction of the mucus ducts of the
larynx; its cartilages ossified; injury of the recurrent nerves; laxity and palsy
external auditory tube, its obstruction or concretion: the tympanum relaxed,
callous, obstructed with hardened wax, mucus, serum, ulcers, luxuriant
flesh; caries, luxation of the small auditory bones; obstruction of the
vestibule, cochlea, labrynth: the membranes lax, dry, indurated; palsy, and
spasm of the internal auditory muscles; constriction and obstruction of the
eustachian tube; colds, catarrh, obstructed perspiration, rheumatism,
plethora, suppressed evacuations; disorders of the stomach, costiveness;
nervous, loud explosions, age, fever, soporous diseases, and diseases of the
auditory nerves, and of the brain; symptomatick in several diseases.
Inflammation of the ear excites excruciating pain, sometimes delirium.
Smelling too acute, or blunt, or unnatural. The causes, the membrane lining
the nose rigid, dry, deficiency or excess of its mucus tense, irritable,
obstructed, scirrhous, callous, carious, stifled with polypus, snuff; palsy of
the olfactory nerves; diseases of the brain; sordes and pus in the olfactory
sinusses; and also in the mouth, gums, teeth, tongue, larynx, fauces; foul
effluvia from the stomach.
Sternutation is symptomatick in several diseases; but sometimes, is a
primary malady, it has been known to infest hours, days, or even weeks.
The causes, epidemick influence of the air; suppressed nasal hemorrhage,
or cutaneous eruptions; venereal; worms, or abscess in the sinusses; disease
of the brain.
Taste. The causes affecting the principal gustatory organ, the tongue: sordes
of the tongue and mouth in various diseases; the saliva in quantity or quality
diseased, and either depraved from the blood, or from washing over
diseased parts of the mouth or palate; tension or laxity of the gustatory
organ, or papillæ; faults of the lingual nerves; diseases of the stomach,
fauces, nose, tongue, lips, &c.
Voice and Speech. The immense multiplicity of objects, and the distance to
the end of our literary journey, check us from expatiating upon this prolifick
topick. Under it may be included hoarse, guttural, stridulous, deadened,
stifled voice, or sound at the glottis; stammering, lisping, defect and
impediments in articulation, muteness. The causes, defect or waste of
mucus by exertion of the voice; destruction of the mucus ducts of the
larynx; its cartilages ossified; injury of the recurrent nerves; laxity and palsy
Page 153
of the muscles of the glottis and contiguous cartilages; venereal; changes of
weather; symptomatic in several diseases. Voice and speech may be injured
in all the various parts of their complicated organization; the larynx, the
pharynx, the tongue, uvula, fauces, nose, palate, gums, teeth, lips.
Sterility of the sexes: no inconsiderable number of both sexes are
incapacitated from exercising that important and divine function of giving
creation to their own species. The causes in the male sex are, palsy, or
torpidity of the penis, or its nerves, or generative organs; the penis short,
monstrous in size, its prepuce straitned; impediments in the urethra and
seminal ducts; testicles, epididymidis, vasa deferentia; the semen inert,
vapid, aqueous, scanty; weakness of the ejecting or accelerator muscles;
corpulency; too tense erection; old age; castration, manustupration, too
frequent coition, extreme chastity, venereal disease, inebriety, broken
constitution, tabes-dorsalis. In the female sex, original structure of some
part of the generative machinery of the ovarium, fallopian tubes, womb,
vagina, labia, clitoris; straitness, concretion, obstruction of the vagina or
womb from inflammation, scirrhus, polypus; cold frigid temperament;
promiscuous coition; excess of venery, irritability; fluor albus, obstructed
menses, irregular menstruation, cachexy.
Morbid irritability of the genitals, including priapism, pollution, furor
uterinus. Of involuntary pollution we have treated under dorsal tabes. In our
climate the uterine mania rarely occurs in that extreme of indecency
described by authors. The woman at first is bashful and silent; the pulse and
circulation are agitated on mentioning a venereal topick; by significant
looks and gestures she betrays her passion; and if disappointed, becomes
low-spirited, anxious, and wastes in flesh. The same has happened to some
women who had the mortification to be linked with impotent husbands.
Sometimes, however, this universal passion has burst into a flame; the
woman losing all sense of shame, soliciting, with obscenity in speech and
gestures, the embraces of the other sex; and raving on this theme with
maniacal insanity. The causes, acrid serum, spasm, inflammation of the
urethra, vagina, or other generative organs; irritation of the bladder, womb,
rectum; obstructed menses; fluor albus, heat, excoriation of the vagina,
venereal; stimulating, acrid, diureticks, and emmenagogues; stimulating
diet and drink, excess of venery, manustupration, libidinous books, prints;
protrusion of the vagina.
weather; symptomatic in several diseases. Voice and speech may be injured
in all the various parts of their complicated organization; the larynx, the
pharynx, the tongue, uvula, fauces, nose, palate, gums, teeth, lips.
Sterility of the sexes: no inconsiderable number of both sexes are
incapacitated from exercising that important and divine function of giving
creation to their own species. The causes in the male sex are, palsy, or
torpidity of the penis, or its nerves, or generative organs; the penis short,
monstrous in size, its prepuce straitned; impediments in the urethra and
seminal ducts; testicles, epididymidis, vasa deferentia; the semen inert,
vapid, aqueous, scanty; weakness of the ejecting or accelerator muscles;
corpulency; too tense erection; old age; castration, manustupration, too
frequent coition, extreme chastity, venereal disease, inebriety, broken
constitution, tabes-dorsalis. In the female sex, original structure of some
part of the generative machinery of the ovarium, fallopian tubes, womb,
vagina, labia, clitoris; straitness, concretion, obstruction of the vagina or
womb from inflammation, scirrhus, polypus; cold frigid temperament;
promiscuous coition; excess of venery, irritability; fluor albus, obstructed
menses, irregular menstruation, cachexy.
Morbid irritability of the genitals, including priapism, pollution, furor
uterinus. Of involuntary pollution we have treated under dorsal tabes. In our
climate the uterine mania rarely occurs in that extreme of indecency
described by authors. The woman at first is bashful and silent; the pulse and
circulation are agitated on mentioning a venereal topick; by significant
looks and gestures she betrays her passion; and if disappointed, becomes
low-spirited, anxious, and wastes in flesh. The same has happened to some
women who had the mortification to be linked with impotent husbands.
Sometimes, however, this universal passion has burst into a flame; the
woman losing all sense of shame, soliciting, with obscenity in speech and
gestures, the embraces of the other sex; and raving on this theme with
maniacal insanity. The causes, acrid serum, spasm, inflammation of the
urethra, vagina, or other generative organs; irritation of the bladder, womb,
rectum; obstructed menses; fluor albus, heat, excoriation of the vagina,
venereal; stimulating, acrid, diureticks, and emmenagogues; stimulating
diet and drink, excess of venery, manustupration, libidinous books, prints;
protrusion of the vagina.
Page 154
Deglutition interrupted: we very rarely meet with this similitude of tantalus,
wherein food or drink is either swallowed with difficulty and pain, or totally
interrupted in its descent to the stomach, and regurgitated by the mouth or
nose. The causes spasmodick constriction of the œsophagus, and in various
parts of the tube; palsy of the muscles of deglutition; tumors or scirrhus in
the pharynx, œsophagus, pylorus, trachea, thyroid or dorsal glands;
aneurism and enlargement of the aorta, ulcers in the œsophagus; luxation of
the os hyoides; compression of the pharyngeal nerves; cachexy, worms,
crudity, passions, extraneous substances stuck in the throat. The spasmodick
is periodical and painful; and also affects the voice: in the lower part of the
œsophagus it excites pain between the shoulders; sometimes eructation and
vomiting.
Manducation. Diseases of the teeth are the principal impediments to the
exercise of this function. There are few adults who cannot describe the
pangs of tooth-ach from their own feelings. It is generally intermittent,
seldom dangerous to life, except during the first dentition of infancy. Its
constant symptoms, pain, flow of saliva, restlessness: its variable
symptoms, swelled face, carious loosened teeth; fistula, exostoses of the
gums and jaws. The causes, inflammation of the periosteum of the teeth,
gums, or jaw; suppressed perspiration; moist air; catarrhal defluxion;
suppressed habitual evacuations, nasal hemorrhage and venesection;
plethora; intermittent, scorbutick, arthritick; rheumatick; caries of the teeth;
sugar eat; beetle and tobacco chewed, acrimony of blood or saliva;
spirituous liquors; mercury; suppuration in the maxillary sinusses and
gums; spunginess and flaccidity of the gums and periosteum; irritation and
disorder of the fifth pair of nerves.
DISEASES of the Stomach and Intestinal Tube, are very universal and
frequent maladies in both sexes, and throughout all orders and ages. The
stomach and alimentary canal are furnished with numerous nerves; and the
sensibility of the former very acute, especially at its upper extremity. The
length of the human alimentary tube, from the mouth to the anus, is five or
six times the length of the whole body: it is folded into many convolutions,
as may be daily seen at shambles, on the opening of animals. Into this
wherein food or drink is either swallowed with difficulty and pain, or totally
interrupted in its descent to the stomach, and regurgitated by the mouth or
nose. The causes spasmodick constriction of the œsophagus, and in various
parts of the tube; palsy of the muscles of deglutition; tumors or scirrhus in
the pharynx, œsophagus, pylorus, trachea, thyroid or dorsal glands;
aneurism and enlargement of the aorta, ulcers in the œsophagus; luxation of
the os hyoides; compression of the pharyngeal nerves; cachexy, worms,
crudity, passions, extraneous substances stuck in the throat. The spasmodick
is periodical and painful; and also affects the voice: in the lower part of the
œsophagus it excites pain between the shoulders; sometimes eructation and
vomiting.
Manducation. Diseases of the teeth are the principal impediments to the
exercise of this function. There are few adults who cannot describe the
pangs of tooth-ach from their own feelings. It is generally intermittent,
seldom dangerous to life, except during the first dentition of infancy. Its
constant symptoms, pain, flow of saliva, restlessness: its variable
symptoms, swelled face, carious loosened teeth; fistula, exostoses of the
gums and jaws. The causes, inflammation of the periosteum of the teeth,
gums, or jaw; suppressed perspiration; moist air; catarrhal defluxion;
suppressed habitual evacuations, nasal hemorrhage and venesection;
plethora; intermittent, scorbutick, arthritick; rheumatick; caries of the teeth;
sugar eat; beetle and tobacco chewed, acrimony of blood or saliva;
spirituous liquors; mercury; suppuration in the maxillary sinusses and
gums; spunginess and flaccidity of the gums and periosteum; irritation and
disorder of the fifth pair of nerves.
DISEASES of the Stomach and Intestinal Tube, are very universal and
frequent maladies in both sexes, and throughout all orders and ages. The
stomach and alimentary canal are furnished with numerous nerves; and the
sensibility of the former very acute, especially at its upper extremity. The
length of the human alimentary tube, from the mouth to the anus, is five or
six times the length of the whole body: it is folded into many convolutions,
as may be daily seen at shambles, on the opening of animals. Into this
Page 155
alimentary muscular and contractile sewer are incessantly heaped food and
drink, besides a variety of copious secretions from the body, requisite in the
process of digestion and assimilation of chyle, as saliva, pancreatick fluid,
bile, mucus, and arterial exhalation from the whole of its internal surface.
Within the short space of a few weeks, the generality of mankind consume
more food and drink than amounts to the whole weight of their bodies. This
diurnal superfluity and load, together with the corrupted and abraded animal
parts of the body, and the different secreted fluids, must again, in a few
hours, be expelled through the principal human excretories; the fecal,
urinary, perspiratory. In the healthy state, by far the smallest proportion of
this diurnal superfluity is through the intestinal excretion: the greatest part
is absorbed by the lacteals and lymphaticks, intermixed with the blood, and
afterwards filtered by urine, perspiration, and in the puerperal state, milk. In
cold climates and winters, especially if moist, the urine; in warm climates,
the perspiration preponderates. But in these prodigious diversities ensue
from exercise or rest, sleep and waking, passions of mind, the quantity or
quality of food, cleanness of the skin, constitution, atmosphere, and the
alternation with each other of these excretions. Again, when we reflect that
from the small parotid glands, between a pint and a quart of saliva is
secerned during the twenty-four hours; and on the prodigious secretion
through the kidneys, we may easily conceive in the natural and morbid
state, what a considerable quantity may be secerned from the liver, the
largest of the abdominal viscera: making, however, some deduction for the
slower circulation through the vena porta.
The chart of London diseases demand some criticism on that inextricable
miscellany surfeits, stoppage of the stomach, vomiting, cholick and gripes,
bloody flux. In the last century, surfeits make a monstrous article in the
chronicle of deaths, amounting in some years to four hundred; whereas,
during fifteen years of the present century, they sink down to only fifteen.
Yet all are witnesses that good eating and gormandizing are not worn out of
fashion in this metropolis. Medical men know that surfeits and
intemperance are often merely predisposing or occasional causes of
diseases: they may rouse latent disorders, or dispose the body to receive
noxious impressions externally. The searches therefore formerly, as I
suspect, made many of these reports from the ostensible cause which they
imagined gave birth to the disease and mortality. At the same time, I am not
drink, besides a variety of copious secretions from the body, requisite in the
process of digestion and assimilation of chyle, as saliva, pancreatick fluid,
bile, mucus, and arterial exhalation from the whole of its internal surface.
Within the short space of a few weeks, the generality of mankind consume
more food and drink than amounts to the whole weight of their bodies. This
diurnal superfluity and load, together with the corrupted and abraded animal
parts of the body, and the different secreted fluids, must again, in a few
hours, be expelled through the principal human excretories; the fecal,
urinary, perspiratory. In the healthy state, by far the smallest proportion of
this diurnal superfluity is through the intestinal excretion: the greatest part
is absorbed by the lacteals and lymphaticks, intermixed with the blood, and
afterwards filtered by urine, perspiration, and in the puerperal state, milk. In
cold climates and winters, especially if moist, the urine; in warm climates,
the perspiration preponderates. But in these prodigious diversities ensue
from exercise or rest, sleep and waking, passions of mind, the quantity or
quality of food, cleanness of the skin, constitution, atmosphere, and the
alternation with each other of these excretions. Again, when we reflect that
from the small parotid glands, between a pint and a quart of saliva is
secerned during the twenty-four hours; and on the prodigious secretion
through the kidneys, we may easily conceive in the natural and morbid
state, what a considerable quantity may be secerned from the liver, the
largest of the abdominal viscera: making, however, some deduction for the
slower circulation through the vena porta.
The chart of London diseases demand some criticism on that inextricable
miscellany surfeits, stoppage of the stomach, vomiting, cholick and gripes,
bloody flux. In the last century, surfeits make a monstrous article in the
chronicle of deaths, amounting in some years to four hundred; whereas,
during fifteen years of the present century, they sink down to only fifteen.
Yet all are witnesses that good eating and gormandizing are not worn out of
fashion in this metropolis. Medical men know that surfeits and
intemperance are often merely predisposing or occasional causes of
diseases: they may rouse latent disorders, or dispose the body to receive
noxious impressions externally. The searches therefore formerly, as I
suspect, made many of these reports from the ostensible cause which they
imagined gave birth to the disease and mortality. At the same time, I am not
Page 156
contending for the delicacy and moderation of our forefathers appetites.
They were unquestionably in the last century, and partly indeed from the
cheapness of flesh-meat, and scarcity of vegetable nutriment, more
carnivorous in their diet than the present generation.
Stoppage of the stomach also, is a morbid centaur in the last century. It
would baffle the ingenuity of an antiquarian to decypher the true import of
this term: severe sickness, or the word Abracadabra, would be full as
intelligible. It is a vulgar name for rejection of food; and there are few
diseases in which the stomach does not sympathize. What proportion of the
mortality of infants, adults, or the sexes, are crammed into this absurd
article, I submit to the reader’s criticism.
An important circumstance, and overlooked so far as I know, by all the
calculators and criticks on the rise and fall of infant diseases in London, and
especially of convulsions, is this. In the first column of 15 years, at the
beginning of the present century, colick and gripes of the guts amount to
13668, but continue through every succeeding column to diminish; and in
the last or fifth, dwindle to 769 only. What is meant by this complaint,
colick and gripes? was it dysentery? We observe that bloody flux makes a
separate, though small group, through all the five columns. Were these two
diseases confounded in the annual reports? or may it not be alledged, that
many infant diseases and deaths, which were formerly crowded into colick
and gripes, are in modern times transferred to the vortex of convulsions? I
am aware that, in reply, it may be suggested that drains, sewers, drier
lodgings, less damp, alteration in diet, and the more plentiful use of
vegetable and fermented liquors, have decreased dysenteric complaints in
this city; and also, that Dr. Sydenham, in 1670 and 71, describes an
autumnal dysentery as annually prevailing in London, and about two
months in duration. Turning the subject into every possible view, I continue
to suspect that numbers of infant diseases, and commonly terminating
fatally in convulsions, were formerly heaped into gripes and colick; for
during the last thirty years of the preceding century, they amount to the
enormous number of 69,799.
Diseases of the Stomach are idiopathick and symptomatick. Under the
present head we shall include inappetency, indigestion, nausea, vomiting,
eructation, acidity, cardialgy, heartburn, regurgitation of bile, pica, soda,
pyrosis, hiccup, rumination. Several of these are obvious symptoms, and are
They were unquestionably in the last century, and partly indeed from the
cheapness of flesh-meat, and scarcity of vegetable nutriment, more
carnivorous in their diet than the present generation.
Stoppage of the stomach also, is a morbid centaur in the last century. It
would baffle the ingenuity of an antiquarian to decypher the true import of
this term: severe sickness, or the word Abracadabra, would be full as
intelligible. It is a vulgar name for rejection of food; and there are few
diseases in which the stomach does not sympathize. What proportion of the
mortality of infants, adults, or the sexes, are crammed into this absurd
article, I submit to the reader’s criticism.
An important circumstance, and overlooked so far as I know, by all the
calculators and criticks on the rise and fall of infant diseases in London, and
especially of convulsions, is this. In the first column of 15 years, at the
beginning of the present century, colick and gripes of the guts amount to
13668, but continue through every succeeding column to diminish; and in
the last or fifth, dwindle to 769 only. What is meant by this complaint,
colick and gripes? was it dysentery? We observe that bloody flux makes a
separate, though small group, through all the five columns. Were these two
diseases confounded in the annual reports? or may it not be alledged, that
many infant diseases and deaths, which were formerly crowded into colick
and gripes, are in modern times transferred to the vortex of convulsions? I
am aware that, in reply, it may be suggested that drains, sewers, drier
lodgings, less damp, alteration in diet, and the more plentiful use of
vegetable and fermented liquors, have decreased dysenteric complaints in
this city; and also, that Dr. Sydenham, in 1670 and 71, describes an
autumnal dysentery as annually prevailing in London, and about two
months in duration. Turning the subject into every possible view, I continue
to suspect that numbers of infant diseases, and commonly terminating
fatally in convulsions, were formerly heaped into gripes and colick; for
during the last thirty years of the preceding century, they amount to the
enormous number of 69,799.
Diseases of the Stomach are idiopathick and symptomatick. Under the
present head we shall include inappetency, indigestion, nausea, vomiting,
eructation, acidity, cardialgy, heartburn, regurgitation of bile, pica, soda,
pyrosis, hiccup, rumination. Several of these are obvious symptoms, and are
Page 157
often complicated. Inappetency is generally accompanied with nausea.
Foulness or feculence in the stomach, is indicated by weight and load in
that region, anxiety, nausea, eructation, disagreeable taste in the mouth, foul
tongue: the state of the gustatory organ is some index to that of the stomach.
Acidity in excess will excite eructation, flatulence, heartburn, gnawing pain
in that part, irregular appetite and craving, colicks, gripes, diarrhœa,
vomiting. In infants, acidity is very frequently predominant; hence acid
eructation, restlessness, gripes, green curdled feces, tumor of the abdomen,
dyspnœa, sometimes costiveness, or diarrhœa, and sometimes dry cough,
and muscular paleness and flaccidity. Of bilious regurgitation there are
various gradations: with severe sickness at the stomach, nausea, bilious
vomiting, bitter taste on the tongue, and its surface furred; inappetency,
frequently colick; sometimes temporary jaundice. The cardialgy is a severe
pain, threatening syncope. The pica an aversion to natural aliment, and
craving for unusual. The bulimy is a monstrous appetency for food. The
heartburn denotes a sensation of uneasiness, heat, and acrimony: the soda,
or water-brash, a burning heat in the stomach and fauces, anxiety, acid
eructation, exspuition of lymph, and fretting the edge of the teeth.
The pyrosis, or cardialgia-sputatoria, is more frequent and endemic in some
countries than others; and, it is alledged, more amongst the poor than
affluent, and amongst females than males; and of the former, the single and
barren: it rarely occurs in puberty, or in old age. The pain at the stomach
and back is often very severe, and with anxiety, until the torrent of watery
fluid bursts forth, which, after continuing one or two days, intermits: but
relapses are frequent, and the disease is contumacious. The hiccup, or
sudden convulsive inspiration, is a complicated affliction of the stomach
and diaphragm. Of rumination in the human species, there is scarce an
instance in a generation.
The predisposing and occasional causes of the preceding diseases of the
stomach are in general, weakness of the muscular coats; diseases of its
nerves; small omentum; the digestive menstrua as bile, saliva, mucus,
defective or depraved; frequent exspuition and waste of saliva; slow
digestion, and food corrupted in the stomach; crudities in the stomach;
vitiated chyle; excess of pituita, acidity, bile; relaxed pylorus, large
stomach, calculi in the biliary ducts; scirrhus stomach, pancreas, liver,
spleen, duodenum; mucus of the stomach abraded; ulcers, cancer,
Foulness or feculence in the stomach, is indicated by weight and load in
that region, anxiety, nausea, eructation, disagreeable taste in the mouth, foul
tongue: the state of the gustatory organ is some index to that of the stomach.
Acidity in excess will excite eructation, flatulence, heartburn, gnawing pain
in that part, irregular appetite and craving, colicks, gripes, diarrhœa,
vomiting. In infants, acidity is very frequently predominant; hence acid
eructation, restlessness, gripes, green curdled feces, tumor of the abdomen,
dyspnœa, sometimes costiveness, or diarrhœa, and sometimes dry cough,
and muscular paleness and flaccidity. Of bilious regurgitation there are
various gradations: with severe sickness at the stomach, nausea, bilious
vomiting, bitter taste on the tongue, and its surface furred; inappetency,
frequently colick; sometimes temporary jaundice. The cardialgy is a severe
pain, threatening syncope. The pica an aversion to natural aliment, and
craving for unusual. The bulimy is a monstrous appetency for food. The
heartburn denotes a sensation of uneasiness, heat, and acrimony: the soda,
or water-brash, a burning heat in the stomach and fauces, anxiety, acid
eructation, exspuition of lymph, and fretting the edge of the teeth.
The pyrosis, or cardialgia-sputatoria, is more frequent and endemic in some
countries than others; and, it is alledged, more amongst the poor than
affluent, and amongst females than males; and of the former, the single and
barren: it rarely occurs in puberty, or in old age. The pain at the stomach
and back is often very severe, and with anxiety, until the torrent of watery
fluid bursts forth, which, after continuing one or two days, intermits: but
relapses are frequent, and the disease is contumacious. The hiccup, or
sudden convulsive inspiration, is a complicated affliction of the stomach
and diaphragm. Of rumination in the human species, there is scarce an
instance in a generation.
The predisposing and occasional causes of the preceding diseases of the
stomach are in general, weakness of the muscular coats; diseases of its
nerves; small omentum; the digestive menstrua as bile, saliva, mucus,
defective or depraved; frequent exspuition and waste of saliva; slow
digestion, and food corrupted in the stomach; crudities in the stomach;
vitiated chyle; excess of pituita, acidity, bile; relaxed pylorus, large
stomach, calculi in the biliary ducts; scirrhus stomach, pancreas, liver,
spleen, duodenum; mucus of the stomach abraded; ulcers, cancer,
Page 158
depression of the xiphoid cartilage; frequent emeticks and purgatives;
valetudinarian regimen, too much physick, quackery, and care about health;
gluttony, epicurism, pampered indulgence of that passion and appetite;
frequent surfeits; dram-drinking; malt liquors in excess; the aliment in
quantity or quality, or in multiplicity at one meal, injurious; ravenous
ingurgitation at meals, and imperfect manducation; fat, rancid, corrupted,
salted, and indigestible farinaceous food; tea, tobacco, watery liquids: in
infancy, acid milk, sucking to excess, curdled milk in the stomach;
superfluous acid generated in the stomach; too violent agitation in the
nurse’s arms; passions of the nurse; too tight bandages; saliva swallowed in
excess during dentition; too much vegetable diet and milk: to the catalogue
of general causes may be added various depressing and cankering passions
of mind; cares and troubles; want of sleep, intemperate study, sedentary life,
unremitting application to sedentary business; moist cold air, foul air of
cities; leaning forward on the stomach, and improper postures of the body;
costiveness; suppression of salutary evacuations and cutaneous
exanthemata; sanguineous plethora; conference of hereditary infirmity, bad
health, old age, chlorosis, worms, gout, rheumatism, intermittent and
remittent fevers, and of various other acute and chronic diseases; poisons;
extraneous substances swallowed, contusions on the head; external injuries;
blows and falls.
Cholera Morbus is much more frequent in tropical and warm climates; and
in northern regions in the summer and autumnal seasons; especially in
unusually hot summers. The disease is not unfrequent in this island and
metropolis; nor is it entirely restricted to the warm season only. The
symptoms are sickness and nausea, succeeded by violent vomiting and
purging, of a bilious nature, with gripes, tenesmus, tension of the abdomen,
anxiety, great prostration of strength, intense thirst, cardialgy, and
sometimes muscular spasms in the lower extremities. The vomiting and
purging either commence about the same time, or alternate with each other:
and throughout its rapid race there is seldom any fever. It is often a salutary
effort of nature, by which a superfluity of bile is disembogued; and in cases
of ordinary violence, may continue a day or two, and then cease. In more
tremendous assaults it sometimes proves fatal in twenty-four hours;
portentous omens of which are violent vomiting and purging, sudden
prostration of strength, quick weak pulse, hiccup, fainting, cold sweats and
extremities. The predisposing and occasional causes are, hot climate and
valetudinarian regimen, too much physick, quackery, and care about health;
gluttony, epicurism, pampered indulgence of that passion and appetite;
frequent surfeits; dram-drinking; malt liquors in excess; the aliment in
quantity or quality, or in multiplicity at one meal, injurious; ravenous
ingurgitation at meals, and imperfect manducation; fat, rancid, corrupted,
salted, and indigestible farinaceous food; tea, tobacco, watery liquids: in
infancy, acid milk, sucking to excess, curdled milk in the stomach;
superfluous acid generated in the stomach; too violent agitation in the
nurse’s arms; passions of the nurse; too tight bandages; saliva swallowed in
excess during dentition; too much vegetable diet and milk: to the catalogue
of general causes may be added various depressing and cankering passions
of mind; cares and troubles; want of sleep, intemperate study, sedentary life,
unremitting application to sedentary business; moist cold air, foul air of
cities; leaning forward on the stomach, and improper postures of the body;
costiveness; suppression of salutary evacuations and cutaneous
exanthemata; sanguineous plethora; conference of hereditary infirmity, bad
health, old age, chlorosis, worms, gout, rheumatism, intermittent and
remittent fevers, and of various other acute and chronic diseases; poisons;
extraneous substances swallowed, contusions on the head; external injuries;
blows and falls.
Cholera Morbus is much more frequent in tropical and warm climates; and
in northern regions in the summer and autumnal seasons; especially in
unusually hot summers. The disease is not unfrequent in this island and
metropolis; nor is it entirely restricted to the warm season only. The
symptoms are sickness and nausea, succeeded by violent vomiting and
purging, of a bilious nature, with gripes, tenesmus, tension of the abdomen,
anxiety, great prostration of strength, intense thirst, cardialgy, and
sometimes muscular spasms in the lower extremities. The vomiting and
purging either commence about the same time, or alternate with each other:
and throughout its rapid race there is seldom any fever. It is often a salutary
effort of nature, by which a superfluity of bile is disembogued; and in cases
of ordinary violence, may continue a day or two, and then cease. In more
tremendous assaults it sometimes proves fatal in twenty-four hours;
portentous omens of which are violent vomiting and purging, sudden
prostration of strength, quick weak pulse, hiccup, fainting, cold sweats and
extremities. The predisposing and occasional causes are, hot climate and
Page 159
seasons; in warm climates extreme heat and dry weather, succeeded by a
fall of rain and coolness of the atmosphere; sudden changes of weather;
increased secretion of bile and corrupted bile; surfeits, intemperance,
accumulation of feculence in the intestines and liver; excess of food or
drink without sufficient exercise; indolence, luxurious living and sedentary
life; malt liquors; passions of mind; repulsion of cutaneous eruptions; gout;
poisons; worms; symptomatick in intermittent and remittent fevers.
Dysentery, bloody flux, spurious remittent. This contagious disease has
been before mentioned, under remitting and autumnal fevers. It is called by
the sagacious Morton, the Spurious Remittent turned on the intestines; and
by Sydenham also, who, perhaps undeservedly, is panegyrized as a superior
oracle, the Fever of the Season turned on the bowels. The general symptoms
are, frequent stools with severe colick, gripes, and tenesmus, or urgency to
exonerate the intestines: these evacuations are slimy, generally with
intermixture of blood, and fragments of feces concreted into hard globules,
and unusually fetid. It is also accompanied with sickness at the stomach and
pain, inappetency, vomiting, flatulence, restlessness, foul tongue, and more
or less fever. When fatal, many are destroyed between the seventh and
twentieth days; but when moderate, it may be protracted much longer.
Relapses are frequent on any irregularity or intemperance. The causes,
warm climates and seasons, marshy effluvia; cold nights followed by warm
days; sudden suppression of perspiration, especially in warm climates;
exposure to cold and moist air and rains, and wet cloaths and beds; long
continuance of sultry and dry weather; excess and corruption of bile;
symptomatick; dysenterick contagion from privies, beds, &c.——Vid.
Remittent Fevers.
Diarrhœa, ventris profluvium; including the different species, the celiaca,
lienteria, morbus hepaticus, niger, atrabilis. In the simple diarrhœa, the
evacuation by the anus is unnaturally frequent and liquid. In the celiaca, or
chylous diarrhœa, the aliments and chyle are ejected: and in the lienteria,
like a bucket whirling into a well, food is no sooner taken than discharged.
The morbus hepaticus is without pain or tenesmus, with flux of blood and
serum, or like ink; in colour and consistence various. Diarrhœa is
accompanied with gripes; but not so excruciating as in the dysentery, with
inappetency, dry skin, thirst, hectic heat: but no considerable fever; nor is it
contagious. In the severity and evacuation there are varieties: and in some
fall of rain and coolness of the atmosphere; sudden changes of weather;
increased secretion of bile and corrupted bile; surfeits, intemperance,
accumulation of feculence in the intestines and liver; excess of food or
drink without sufficient exercise; indolence, luxurious living and sedentary
life; malt liquors; passions of mind; repulsion of cutaneous eruptions; gout;
poisons; worms; symptomatick in intermittent and remittent fevers.
Dysentery, bloody flux, spurious remittent. This contagious disease has
been before mentioned, under remitting and autumnal fevers. It is called by
the sagacious Morton, the Spurious Remittent turned on the intestines; and
by Sydenham also, who, perhaps undeservedly, is panegyrized as a superior
oracle, the Fever of the Season turned on the bowels. The general symptoms
are, frequent stools with severe colick, gripes, and tenesmus, or urgency to
exonerate the intestines: these evacuations are slimy, generally with
intermixture of blood, and fragments of feces concreted into hard globules,
and unusually fetid. It is also accompanied with sickness at the stomach and
pain, inappetency, vomiting, flatulence, restlessness, foul tongue, and more
or less fever. When fatal, many are destroyed between the seventh and
twentieth days; but when moderate, it may be protracted much longer.
Relapses are frequent on any irregularity or intemperance. The causes,
warm climates and seasons, marshy effluvia; cold nights followed by warm
days; sudden suppression of perspiration, especially in warm climates;
exposure to cold and moist air and rains, and wet cloaths and beds; long
continuance of sultry and dry weather; excess and corruption of bile;
symptomatick; dysenterick contagion from privies, beds, &c.——Vid.
Remittent Fevers.
Diarrhœa, ventris profluvium; including the different species, the celiaca,
lienteria, morbus hepaticus, niger, atrabilis. In the simple diarrhœa, the
evacuation by the anus is unnaturally frequent and liquid. In the celiaca, or
chylous diarrhœa, the aliments and chyle are ejected: and in the lienteria,
like a bucket whirling into a well, food is no sooner taken than discharged.
The morbus hepaticus is without pain or tenesmus, with flux of blood and
serum, or like ink; in colour and consistence various. Diarrhœa is
accompanied with gripes; but not so excruciating as in the dysentery, with
inappetency, dry skin, thirst, hectic heat: but no considerable fever; nor is it
contagious. In the severity and evacuation there are varieties: and in some
Page 160
cases it is salutary. The causes, excess of food and drink, or acrid putrescent
aliment; new fermented liquors; vegetable laxative food; feculence in the
intestines, stercorous, pituitous; vitiated digestion, with morbid irritability
of the intestinal tube; irritability of this muscular canal, and increase of its
peristaltic motion; atonia; excess and acrimony of bile, warm climates,
broken constitutions, cachexy, chronic dysentery, immoderate flux of
humours to the intestinal tube, and exhalation by the arterial extremities of
that canal; suppression of perspiration, and of other evacuations; superfluity
of serous humours; impediments in the absorption and passages of the
chyle; obstruction in the vena portarum; laxity of the pylorus; palsy of the
sphincter ani; ulcers of the stomach, repelled gout, and rash; sudden
passions of mind; nervous irritation; erosion or rupture of the blood-vessels
on the interior surface; obstruction of the spleen; acrid dissolution of the
blood; colliquative; worms; symptomatic in fevers; purgatives; poisons. In
infancy, acidity, dentition, and saliva swallowed to excess; corrupted milk
and chyle, thin laxative vegetable diet; errors of the nurse in diet; gravel in
the kidneys.
Colick. From slight or serious attacks of this torture, few of the community
are exempted. We here associate together the inflammatory, spasmodic,
saturnine, bilious, flatulent, the infantile colick, and other species. Colick is
generally a temporary disease; and with which some, much more than
others, are afflicted at intervals. Inflammation of the intestines ileus,
volvulus, enteritis; generally sudden assault of excruciating, fixed, and
increasing pain, in some degree affecting the whole abdomen, but more
pungent about the navel; with nausea, frequent vomiting of food and drink,
and sometimes of intestinal feculence; obstinate costiveness, severe gripes,
eructation, flatulence: the fever sometimes succeeding, sometimes
preceding, the local pain; and of which there are exacerbations and
remissions, and various gradations. The pulse at the beginning is not
remarkably full nor frequent, from which fatal mistakes and irremediable
procrastination, have often ensued in medical practice: the urine is in small
quantity, or suppressed. It is much more frequent in the narrow than the
wide part of the intestinal tube. In the rectum, constant tenesmus, excretion
of mucus; and in the male sex strangury are natural consequences and
symptoms. Inflammation or nephritick paroxisms in the kidneys and
ureters, with which it has been confounded, are hereafter discriminated.
aliment; new fermented liquors; vegetable laxative food; feculence in the
intestines, stercorous, pituitous; vitiated digestion, with morbid irritability
of the intestinal tube; irritability of this muscular canal, and increase of its
peristaltic motion; atonia; excess and acrimony of bile, warm climates,
broken constitutions, cachexy, chronic dysentery, immoderate flux of
humours to the intestinal tube, and exhalation by the arterial extremities of
that canal; suppression of perspiration, and of other evacuations; superfluity
of serous humours; impediments in the absorption and passages of the
chyle; obstruction in the vena portarum; laxity of the pylorus; palsy of the
sphincter ani; ulcers of the stomach, repelled gout, and rash; sudden
passions of mind; nervous irritation; erosion or rupture of the blood-vessels
on the interior surface; obstruction of the spleen; acrid dissolution of the
blood; colliquative; worms; symptomatic in fevers; purgatives; poisons. In
infancy, acidity, dentition, and saliva swallowed to excess; corrupted milk
and chyle, thin laxative vegetable diet; errors of the nurse in diet; gravel in
the kidneys.
Colick. From slight or serious attacks of this torture, few of the community
are exempted. We here associate together the inflammatory, spasmodic,
saturnine, bilious, flatulent, the infantile colick, and other species. Colick is
generally a temporary disease; and with which some, much more than
others, are afflicted at intervals. Inflammation of the intestines ileus,
volvulus, enteritis; generally sudden assault of excruciating, fixed, and
increasing pain, in some degree affecting the whole abdomen, but more
pungent about the navel; with nausea, frequent vomiting of food and drink,
and sometimes of intestinal feculence; obstinate costiveness, severe gripes,
eructation, flatulence: the fever sometimes succeeding, sometimes
preceding, the local pain; and of which there are exacerbations and
remissions, and various gradations. The pulse at the beginning is not
remarkably full nor frequent, from which fatal mistakes and irremediable
procrastination, have often ensued in medical practice: the urine is in small
quantity, or suppressed. It is much more frequent in the narrow than the
wide part of the intestinal tube. In the rectum, constant tenesmus, excretion
of mucus; and in the male sex strangury are natural consequences and
symptoms. Inflammation or nephritick paroxisms in the kidneys and
ureters, with which it has been confounded, are hereafter discriminated.
Page 161
It is extremely dangerous and precipitate; frequently destroying in a few
days, sometimes in one day, and is seldom protracted beyond nine. There is
less danger in young than in old persons: abatement of pain, cessation of
nausea and vomiting, discharge of flatulence and of feces, softer and freer
pulse, are favourable symptoms: unfavourable are, unconquerable
costiveness, immoderate vomiting, tumid belly, eructation, hiccup, cold
extremities, gangrene; abscess rarely. Inflammation is sometimes the effect,
and not the original cause of colick.
Under the spasmodick colick may be classed the colica pictonum, saturnina,
plumbeia, and dry belly-ach of the West Indies. The symptoms, writhing
pain in the abdomen, about the loins and back; retraction of the navel
towards the spine, dysury, ischury, or strangury; costiveness with difficulty
removed, and the feces in conglobated lumps, vomiting, anxiety, depression
of spirits. In the saturnine the countenance is sometimes of a leaden colour,
and there is a saccharine taste on the tongue. This infests various classes of
artificers: sometimes terminating in chronic colick, in palsy of the lower
extremities, and in convulsions.
Bilious colick is accompanied with severe pain in the stomach and
intestines, nausea, sickness, vomiting of bile, costiveness, bitter taste on the
tongue, anxiety, dejection of spirits, dysury, often flatulence. Its duration is
short, but it is prone to return on any intemperance or irregularity;
sometimes it ends in jaundice. Flatulent colick is distinguished by the pain
being mobile, without much nausea or vomiting, or hard pulse and thirst, or
fever; by considerable unusual distention of the abdomen, and flatulent
explosion upwards and downwards; and sometimes efforts to vomit until
the flatulence is ejected: respiration is also more or less interrupted.
The infant colick is very frequent, and infinitely more fatal in those years
than the London bills represent. Infants scream lamentably, and cannot be
appeased; they contract and draw up their legs to the belly, are restless,
sometimes costive; but often there is concomitant diarrhœa and green feces,
vomiting, flatulent explosion; and sometimes the breath smells sour; in
some the urine is suppressed; and many die convulsed.
The predisposing and occasional causes of colick, inflammatory,
spasmodick, bilious, and of most other species are, acrid matter of aliment,
medicines, poisons; acrid putrid bile; obstruction of the intestinal tube by
days, sometimes in one day, and is seldom protracted beyond nine. There is
less danger in young than in old persons: abatement of pain, cessation of
nausea and vomiting, discharge of flatulence and of feces, softer and freer
pulse, are favourable symptoms: unfavourable are, unconquerable
costiveness, immoderate vomiting, tumid belly, eructation, hiccup, cold
extremities, gangrene; abscess rarely. Inflammation is sometimes the effect,
and not the original cause of colick.
Under the spasmodick colick may be classed the colica pictonum, saturnina,
plumbeia, and dry belly-ach of the West Indies. The symptoms, writhing
pain in the abdomen, about the loins and back; retraction of the navel
towards the spine, dysury, ischury, or strangury; costiveness with difficulty
removed, and the feces in conglobated lumps, vomiting, anxiety, depression
of spirits. In the saturnine the countenance is sometimes of a leaden colour,
and there is a saccharine taste on the tongue. This infests various classes of
artificers: sometimes terminating in chronic colick, in palsy of the lower
extremities, and in convulsions.
Bilious colick is accompanied with severe pain in the stomach and
intestines, nausea, sickness, vomiting of bile, costiveness, bitter taste on the
tongue, anxiety, dejection of spirits, dysury, often flatulence. Its duration is
short, but it is prone to return on any intemperance or irregularity;
sometimes it ends in jaundice. Flatulent colick is distinguished by the pain
being mobile, without much nausea or vomiting, or hard pulse and thirst, or
fever; by considerable unusual distention of the abdomen, and flatulent
explosion upwards and downwards; and sometimes efforts to vomit until
the flatulence is ejected: respiration is also more or less interrupted.
The infant colick is very frequent, and infinitely more fatal in those years
than the London bills represent. Infants scream lamentably, and cannot be
appeased; they contract and draw up their legs to the belly, are restless,
sometimes costive; but often there is concomitant diarrhœa and green feces,
vomiting, flatulent explosion; and sometimes the breath smells sour; in
some the urine is suppressed; and many die convulsed.
The predisposing and occasional causes of colick, inflammatory,
spasmodick, bilious, and of most other species are, acrid matter of aliment,
medicines, poisons; acrid putrid bile; obstruction of the intestinal tube by
Page 162
indurated feculence, hair-balls, cherry-stones, calculi, steatome, volvulus,
intusesception, contraction of the intestines in some part; scirrhus, cancer,
severe colick, spasm, ruptures; wounds of the intestines; the aliments,
pickles, condiments, and luxuries of the table, cooked, prepared, or
preserved in lead or copper vessels not well tinned; the lead corroded from
clayed vessels used for domestick purposes; wine adulterated with lead;
cyder pressed in leaden cisterns; effluvia of lead to which painters and some
metallurgies are exposed; excess or acrimony of bile; broken constitutions
in tropical climates; acrid chyle; particular food or drink; new fermented
liquors; sudden suppression of perspiration; cold wet feet; sudden passions
of mind; flatulence and elastic air pent up; muscular and nervous spasms;
plethora menstrual, lacteal, hemorrhoidal, scorbutick, rheumatick,
arthritick, hysterick, nephritick; calculi in the biliary ducts; epidemick;
aneurism of the aorta; turgid gall-bladder; spasm in the abdominal muscles,
violent vomiting. In infancy, corrupted meconium, crudity, and sour or
adulterated milk; suction to excess; acrid bile; the mother or nurse fasting
too long before the infant sucks; corrupted unwholesome milk of nurses;
nurses addicted to passion, to dram-drinking; insufficient exercise of the
infant; tight rollers round its abdomen; dentition; worms.
Gall-Stones, calculi cystici. We have no account of this disease in ancient
records. Until the beginning of the present century, it had escaped the
vigilance of medical observation. But it is now known, that biliary
concretions are, perhaps, not less frequent than those in the urinary organs.
Gall-stones infest more the adult, old, and sedentary; and it is alledged,
more females than males. The symptoms at first are dubious, and are all to
be weighed together in forming a diagnostick. In attempting to descend
throughout the gall-ducts, they excite direful pain at the pit of the stomach
and hepatick region, darting to the back, with restlessness, anxiety,
dyspnœa, jaundice-colour of the eyes, costiveness, and commonly
vomiting: the pain is aggravated by coughing or sneezing, and sometimes
ascends to the right shoulder and arm; but the pulse and circulation are not
accelerated.
In the expulsion of these calculi, there are usually reiterated paroxisms, or
exacerbations and remissions of pain. The continuance of the paroxisms is
from a few hours to days, weeks, or even months; but the latter is rare;
during which period either no stone is discharged, or one or many stones are
intusesception, contraction of the intestines in some part; scirrhus, cancer,
severe colick, spasm, ruptures; wounds of the intestines; the aliments,
pickles, condiments, and luxuries of the table, cooked, prepared, or
preserved in lead or copper vessels not well tinned; the lead corroded from
clayed vessels used for domestick purposes; wine adulterated with lead;
cyder pressed in leaden cisterns; effluvia of lead to which painters and some
metallurgies are exposed; excess or acrimony of bile; broken constitutions
in tropical climates; acrid chyle; particular food or drink; new fermented
liquors; sudden suppression of perspiration; cold wet feet; sudden passions
of mind; flatulence and elastic air pent up; muscular and nervous spasms;
plethora menstrual, lacteal, hemorrhoidal, scorbutick, rheumatick,
arthritick, hysterick, nephritick; calculi in the biliary ducts; epidemick;
aneurism of the aorta; turgid gall-bladder; spasm in the abdominal muscles,
violent vomiting. In infancy, corrupted meconium, crudity, and sour or
adulterated milk; suction to excess; acrid bile; the mother or nurse fasting
too long before the infant sucks; corrupted unwholesome milk of nurses;
nurses addicted to passion, to dram-drinking; insufficient exercise of the
infant; tight rollers round its abdomen; dentition; worms.
Gall-Stones, calculi cystici. We have no account of this disease in ancient
records. Until the beginning of the present century, it had escaped the
vigilance of medical observation. But it is now known, that biliary
concretions are, perhaps, not less frequent than those in the urinary organs.
Gall-stones infest more the adult, old, and sedentary; and it is alledged,
more females than males. The symptoms at first are dubious, and are all to
be weighed together in forming a diagnostick. In attempting to descend
throughout the gall-ducts, they excite direful pain at the pit of the stomach
and hepatick region, darting to the back, with restlessness, anxiety,
dyspnœa, jaundice-colour of the eyes, costiveness, and commonly
vomiting: the pain is aggravated by coughing or sneezing, and sometimes
ascends to the right shoulder and arm; but the pulse and circulation are not
accelerated.
In the expulsion of these calculi, there are usually reiterated paroxisms, or
exacerbations and remissions of pain. The continuance of the paroxisms is
from a few hours to days, weeks, or even months; but the latter is rare;
during which period either no stone is discharged, or one or many stones are
Page 163
successively protruded. Their immediate expulsion is accompanied with a
sensation, as of something bursting in that part, or of a fluid rushing into the
intestines; and often some tenderness is there left behind. The calculi vary
in shape, colour, consistence, size, and number; from a pea to a walnut, and
from one to dozens and scores. It is generally a tedious and chronic disease,
and may continue many years; often thro’ life. It is seldom immediately
dangerous, unless, as in nephritis, inflammation is kindled, or during
pregnancy. When chronic and inveterate, it may terminate in jaundice,
cachexy, dropsy. The symptoms of calculi in the gall-bladder are obscure;
such as weight, uneasiness, dull heavy pain at intervals, sometimes
temporary jaundice, cachexy, and diseases of the stomach. The causes,
hereditary, viscid, tenacious bile, sedentary life, depressing passions,
spirituous liquors; often ambiguous.
Whether any calculous concretions are formed in the pancreatick duct, is
yet unexplored by authors. The pancreatick fluid is nearly similar to the
saliva, which separates a tartarous sediment on the teeth.
Jaundice, icterus, morbus regius. Some of the eastern nations have naturally
this complexion. The mortality by jaundice is not inconsiderable,
amounting in the London bills, in the last thirty years of the preceding
century, to 2169; and in the present century is doubled. The symptoms,
heaviness and aversion to motion, itching and dryness of the skin,
yellowness of the tunica-conjunctiva of the eyes, and also of the skin; the
urine of a saffron-colour, and tinging linen; objects appear yellow; there is
thirst, bitter taste in the tongue, bitter and yellow saliva, inappetency,
indigestion, costiveness, and frequently pale-coloured feces. Sometimes,
though very rarely, jaundice is local and not general. Jaundice may be
critical, symptomatick, idiopathick, periodick, chronick. From gall-stones it
is generally periodical; and such are prone to relapses. The prognosticks are
more favourable with natural sweats; in recent than in chronic; in youth
than in old age; in robust than in weak persons; in yellow than mulatto
tinge; and when not complicated with other dangerous diseases, especially
dropsy. Its duration and termination is various; from a few days to weeks,
and months.
The predisposing and occasional causes are, sand, mucus, or inspissated
bile in the biliary ducts, especially the ductus communis; tumors
compressing the biliary ducts, or their concretion; scirrhous duodenum;
sensation, as of something bursting in that part, or of a fluid rushing into the
intestines; and often some tenderness is there left behind. The calculi vary
in shape, colour, consistence, size, and number; from a pea to a walnut, and
from one to dozens and scores. It is generally a tedious and chronic disease,
and may continue many years; often thro’ life. It is seldom immediately
dangerous, unless, as in nephritis, inflammation is kindled, or during
pregnancy. When chronic and inveterate, it may terminate in jaundice,
cachexy, dropsy. The symptoms of calculi in the gall-bladder are obscure;
such as weight, uneasiness, dull heavy pain at intervals, sometimes
temporary jaundice, cachexy, and diseases of the stomach. The causes,
hereditary, viscid, tenacious bile, sedentary life, depressing passions,
spirituous liquors; often ambiguous.
Whether any calculous concretions are formed in the pancreatick duct, is
yet unexplored by authors. The pancreatick fluid is nearly similar to the
saliva, which separates a tartarous sediment on the teeth.
Jaundice, icterus, morbus regius. Some of the eastern nations have naturally
this complexion. The mortality by jaundice is not inconsiderable,
amounting in the London bills, in the last thirty years of the preceding
century, to 2169; and in the present century is doubled. The symptoms,
heaviness and aversion to motion, itching and dryness of the skin,
yellowness of the tunica-conjunctiva of the eyes, and also of the skin; the
urine of a saffron-colour, and tinging linen; objects appear yellow; there is
thirst, bitter taste in the tongue, bitter and yellow saliva, inappetency,
indigestion, costiveness, and frequently pale-coloured feces. Sometimes,
though very rarely, jaundice is local and not general. Jaundice may be
critical, symptomatick, idiopathick, periodick, chronick. From gall-stones it
is generally periodical; and such are prone to relapses. The prognosticks are
more favourable with natural sweats; in recent than in chronic; in youth
than in old age; in robust than in weak persons; in yellow than mulatto
tinge; and when not complicated with other dangerous diseases, especially
dropsy. Its duration and termination is various; from a few days to weeks,
and months.
The predisposing and occasional causes are, sand, mucus, or inspissated
bile in the biliary ducts, especially the ductus communis; tumors
compressing the biliary ducts, or their concretion; scirrhous duodenum;
Page 164
spasmodic, and flatulent colick obstructing the intestinal orifice of the
biliary ducts; violent passions of mind; strong emeticks or purgatives;
sudden refrigeration of the body; hepatic obstruction and inflammation;
languid circulation through the vena porta, sedentary life; warm climates
and broken constitutions; excess of bile and re-absorption; cachexy;
depraved state of the blood; symptomatick in some intermittent and
remittent fevers, pregnancy, scurvy, obstructed spleen; venomous bites and
stings. In infants, excess of bile and meconium, or distention of the
duodenum obstructing the biliary excretory.
Worms. In assigning an adequate share of mortality to worms, the London
bills, probably, are defective. During the last thirty years of the preceding
century, they are rated at only fourteen hundred; and continue decreasing
throughout the present century. Perhaps a portion of verminous mortality is
confounded with colick and gripes, or with hectic emaciation. Worms infest
most in infancy and childhood; but seldom until after ablactation; and then,
probably, more of the children of the necessitous than of the affluent. The
principal species of human worms are the rotunda, or lumbricalis, the tænia
or lata, the cucurbitina, and the ascarides: these are again, but with
superfluous subtility, subdivided by nosologists. The rotunda or lumbricalis,
has most resemblance to an earth-worm; it is forked at both ends, but paler:
in length various, from inches to feet: and often many are entangled
together in clusters. The tænia has some resemblance to tape, consisting of
numerous joints, or coherent links, about an inch or more distant, and often
many yards in length: this is most frequent in the adult age. The ascarides
are extremely numerous, active, and minute, like fine needles, or the
cuttings of white thread; and generally burrow in the lower extremity of the
intestinal tube of children: the former species wallow through all parts of
the alimentary canal.
Verminous symptoms are numerous, various, and all extremely ambiguous,
unless worms are discharged with the feces: feculence in the stomach and
intestines may occasion all the other symptoms: such as pale countenance;
fugaceous flushing of the face and cheeks, and circumscribed spots of
redness; itching of the nose; swelling of the upper lip and nose, and lower
eye-lids; dilatation of the pupil; grinding of the teeth; fetid breath, and
eructation; flow of saliva; irregular, impaired, or voracious appetite, nausea,
vomiting, colick, gripes and sudden screams from the violence of pain;
biliary ducts; violent passions of mind; strong emeticks or purgatives;
sudden refrigeration of the body; hepatic obstruction and inflammation;
languid circulation through the vena porta, sedentary life; warm climates
and broken constitutions; excess of bile and re-absorption; cachexy;
depraved state of the blood; symptomatick in some intermittent and
remittent fevers, pregnancy, scurvy, obstructed spleen; venomous bites and
stings. In infants, excess of bile and meconium, or distention of the
duodenum obstructing the biliary excretory.
Worms. In assigning an adequate share of mortality to worms, the London
bills, probably, are defective. During the last thirty years of the preceding
century, they are rated at only fourteen hundred; and continue decreasing
throughout the present century. Perhaps a portion of verminous mortality is
confounded with colick and gripes, or with hectic emaciation. Worms infest
most in infancy and childhood; but seldom until after ablactation; and then,
probably, more of the children of the necessitous than of the affluent. The
principal species of human worms are the rotunda, or lumbricalis, the tænia
or lata, the cucurbitina, and the ascarides: these are again, but with
superfluous subtility, subdivided by nosologists. The rotunda or lumbricalis,
has most resemblance to an earth-worm; it is forked at both ends, but paler:
in length various, from inches to feet: and often many are entangled
together in clusters. The tænia has some resemblance to tape, consisting of
numerous joints, or coherent links, about an inch or more distant, and often
many yards in length: this is most frequent in the adult age. The ascarides
are extremely numerous, active, and minute, like fine needles, or the
cuttings of white thread; and generally burrow in the lower extremity of the
intestinal tube of children: the former species wallow through all parts of
the alimentary canal.
Verminous symptoms are numerous, various, and all extremely ambiguous,
unless worms are discharged with the feces: feculence in the stomach and
intestines may occasion all the other symptoms: such as pale countenance;
fugaceous flushing of the face and cheeks, and circumscribed spots of
redness; itching of the nose; swelling of the upper lip and nose, and lower
eye-lids; dilatation of the pupil; grinding of the teeth; fetid breath, and
eructation; flow of saliva; irregular, impaired, or voracious appetite, nausea,
vomiting, colick, gripes and sudden screams from the violence of pain;
Page 165
tumid and enlarged belly; costiveness, or diarrhœa and fetid stools; the
urine sometimes like milk; sudden startings in sleep, frightful dreams;
palpitation of the heart; dry hectic cough, atrophy; various nervous
symptoms, epilepsy, tetanus, convulsions. The ascarides excite irritation
about the anus, tenesmus, and dysury. These intestinal insects are often
most tormenting when the stomach and intestines are empty. Sometimes
they excite a symptomatick and slow fever, with hot skin, quick pulse,
thirst; and the children are then confined to bed. But without fever, children
pursue their usual amusements. The causes, improper diet for these years,
as cheese, farinaceous, legumens, fruits, saccharine, putrid diet or
unwholesome aliment, hereditary weak constitution, moist air: the ova of
the insects swallowed with the air, food, or drink.
Hemorrhoides, piles. Is a frequent and very universal disease in both sexes,
and most so during the adult stages and decline of life; and by which the
lives of many are incommoded and harassed. They are distinguished into
the blind and open, the external and internal; and are temporary, periodical,
and chronic. The blind piles denote small imperforated lumps and tumors
about the margin of the anus. Sometimes the tumours and hemorrhage from
the anus ensue without any previous disease of the body; but generally
some antecedent or accompanying disorder is felt; such as vertigo, headach,
pain of the back and loins, oppression in the breast, colick, dysury, some
fever and heat. The approaching hemorrhage is with sense of fulness, heat,
itching, and pain about the anus, with tenesmus, costiveness, and
conglobated feces; and sometimes is preceded by a serous discharge, or this
sometimes is substituted for red blood. The quantity of sanguineous
extravasation is various in different persons, and in the same person at
different periods: from the internal vessels of the rectum it is more profuse
than from the external; and is generally during, or after the fecal discharge:
in other cases it is without fecal efforts, and then in larger debilitating
streams, but rarely immediately fatal. These tumors, or sanguinous torrents,
are almost always periodical, and at various intervals. They are often
salutary, if moderate, especially if bad health preceded; and also as
preservatives. In the decline of life, when the hemorrhoidal flux has been
frequent, but suddenly ceases, they are in danger of apoplexy or palsy. On
the other hand, in excess, it may exhaust the body, injure the health, and
terminate in dropsy or consumption. Or sometimes hemorrhoidal tumours
inflame, suppurate, and form fistulas in ano.
urine sometimes like milk; sudden startings in sleep, frightful dreams;
palpitation of the heart; dry hectic cough, atrophy; various nervous
symptoms, epilepsy, tetanus, convulsions. The ascarides excite irritation
about the anus, tenesmus, and dysury. These intestinal insects are often
most tormenting when the stomach and intestines are empty. Sometimes
they excite a symptomatick and slow fever, with hot skin, quick pulse,
thirst; and the children are then confined to bed. But without fever, children
pursue their usual amusements. The causes, improper diet for these years,
as cheese, farinaceous, legumens, fruits, saccharine, putrid diet or
unwholesome aliment, hereditary weak constitution, moist air: the ova of
the insects swallowed with the air, food, or drink.
Hemorrhoides, piles. Is a frequent and very universal disease in both sexes,
and most so during the adult stages and decline of life; and by which the
lives of many are incommoded and harassed. They are distinguished into
the blind and open, the external and internal; and are temporary, periodical,
and chronic. The blind piles denote small imperforated lumps and tumors
about the margin of the anus. Sometimes the tumours and hemorrhage from
the anus ensue without any previous disease of the body; but generally
some antecedent or accompanying disorder is felt; such as vertigo, headach,
pain of the back and loins, oppression in the breast, colick, dysury, some
fever and heat. The approaching hemorrhage is with sense of fulness, heat,
itching, and pain about the anus, with tenesmus, costiveness, and
conglobated feces; and sometimes is preceded by a serous discharge, or this
sometimes is substituted for red blood. The quantity of sanguineous
extravasation is various in different persons, and in the same person at
different periods: from the internal vessels of the rectum it is more profuse
than from the external; and is generally during, or after the fecal discharge:
in other cases it is without fecal efforts, and then in larger debilitating
streams, but rarely immediately fatal. These tumors, or sanguinous torrents,
are almost always periodical, and at various intervals. They are often
salutary, if moderate, especially if bad health preceded; and also as
preservatives. In the decline of life, when the hemorrhoidal flux has been
frequent, but suddenly ceases, they are in danger of apoplexy or palsy. On
the other hand, in excess, it may exhaust the body, injure the health, and
terminate in dropsy or consumption. Or sometimes hemorrhoidal tumours
inflame, suppurate, and form fistulas in ano.
Page 166
The predisposing and occasional causes hereditary; plethora, dense blood,
luxurious living, indolence and stimulating diet; intemperance, especially in
spirituous liquors; dried indigestible diet; suppression of the menses, and
their final cessation, and of other critical evacuations; obstructions of the
liver, spleen, of the mesenteric and hemorrhoidal veins; reiterated and
severe colick; abrasion of the intestinal mucus; acrid purges; acrimony of
the blood; costiveness, and hardened feces; worms; sitting too long on the
necessary, and over-warm steams, or stoves; long sitting, riding, and
compression of the hemorrhoidal veins; diseases of the vagina, womb, and
neck of the bladder; prolapsus ani; pregnancy; rupture of the extremities of
the iliac arteries; effusion of blood into the cellular texture of the intestines,
near its extremity.
Vomiting of Blood, hematomosis, vomitus cruentus, is a very rare disease. It
is said to be more frequent in females than males; and is an adult malady.
The symptoms, weight, straitness, and anxiety at the region of the stomach;
nausea, cardialgy, efforts to vomit, and discharge of blood without
coughing: the colour depends upon the time it has lain in the stomach, and
is with various intermixtures of food, bile, pituita: there is also great
prostration of strength, and proneness to faint. The quantity of this
extravasation is various, from ounces to pounds; and frequently some
portion descends by the anus. It is extremely dangerous, either immediately,
or in its consequences. If with fever and great force in the discharge, it may
destroy in a few paroxisms; or if chronic, may end in dropsy, consumption,
or diseases of the stomach and intestines. Slight eruptions have relieved
chronic maladies of the liver and spleen, hypochondriasm, hystericks, and
intermittents. From obstructed menses it is much less alarming. The causes,
obstructions of the liver, spleen, menses, hemorrhoids; scirrhus of the
stomach and liver, or spleen; suppression of habitual discharges or
evacuations, or old ulcers; dregs of intermittent fevers; scorbutick; acrids
and poisons swallowed, and violent efforts to vomit; worms; violent
passions; external injuries.
Poisons. By poisons conveyed through the mouth or wounds, very few of
the community are destroyed. The ancient Asiaticks, Greeks, and Romans,
were infected with the silly infatuation and apprehension of constantly
swallowing poison in their aliment. This was not an epidemical error of the
rabble, but had spread amongst their emperors and philosophers: hence the
luxurious living, indolence and stimulating diet; intemperance, especially in
spirituous liquors; dried indigestible diet; suppression of the menses, and
their final cessation, and of other critical evacuations; obstructions of the
liver, spleen, of the mesenteric and hemorrhoidal veins; reiterated and
severe colick; abrasion of the intestinal mucus; acrid purges; acrimony of
the blood; costiveness, and hardened feces; worms; sitting too long on the
necessary, and over-warm steams, or stoves; long sitting, riding, and
compression of the hemorrhoidal veins; diseases of the vagina, womb, and
neck of the bladder; prolapsus ani; pregnancy; rupture of the extremities of
the iliac arteries; effusion of blood into the cellular texture of the intestines,
near its extremity.
Vomiting of Blood, hematomosis, vomitus cruentus, is a very rare disease. It
is said to be more frequent in females than males; and is an adult malady.
The symptoms, weight, straitness, and anxiety at the region of the stomach;
nausea, cardialgy, efforts to vomit, and discharge of blood without
coughing: the colour depends upon the time it has lain in the stomach, and
is with various intermixtures of food, bile, pituita: there is also great
prostration of strength, and proneness to faint. The quantity of this
extravasation is various, from ounces to pounds; and frequently some
portion descends by the anus. It is extremely dangerous, either immediately,
or in its consequences. If with fever and great force in the discharge, it may
destroy in a few paroxisms; or if chronic, may end in dropsy, consumption,
or diseases of the stomach and intestines. Slight eruptions have relieved
chronic maladies of the liver and spleen, hypochondriasm, hystericks, and
intermittents. From obstructed menses it is much less alarming. The causes,
obstructions of the liver, spleen, menses, hemorrhoids; scirrhus of the
stomach and liver, or spleen; suppression of habitual discharges or
evacuations, or old ulcers; dregs of intermittent fevers; scorbutick; acrids
and poisons swallowed, and violent efforts to vomit; worms; violent
passions; external injuries.
Poisons. By poisons conveyed through the mouth or wounds, very few of
the community are destroyed. The ancient Asiaticks, Greeks, and Romans,
were infected with the silly infatuation and apprehension of constantly
swallowing poison in their aliment. This was not an epidemical error of the
rabble, but had spread amongst their emperors and philosophers: hence the
Page 167
pompous and absurd compositions of mithridate, theriac, and other
poisonous antidotes. None of the two hundred genera of the quadruped
creation, nor of birds, are poisonous; and very few of the fish, or of the
numerous insects and reptiles. Out of the many thousand genera of the
vegetable creation, the poisonous are comparatively trifling: such are the
napelli, apocyna, strammonium, solanum, laurus, aconitum, manchinel,
cicuta, opium, and a few others; some of which, however, are powerful
remedies. Of the mineral, the metals and semi-metals, arsenick excepted,
the preparations of lead, copper, and mercury, are also amongst the potent
remedies.
Of poisons, some corrode or burn, others are septic; and by far the greatest
number attack the vital principle, by either violent irritation or torpidity:
some have a more deadly malignity than others, and are more speedily
destructive. Most of the vegetable poisons excite narcotic, stupifying,
vertiginous, lethargic, convulsive, and emetic symptoms, affecting the
brain, external senses, heart, and stomach. The minerals, as arsenick and
corrosive sublimate, excite symptoms of inflammation in the stomach, in
the most violent degree; and both copper and lead of spasmodic colick also.
From their readier solution in the stomach, the vegetable poisons, except by
the symptoms, can rarely be subjected to ocular detection; but by certain
chymical analysis, when in any considerable quantity, the mineral may be
discovered. Arsenick has a milky whiteness, is gritty and insipid; part of it
swims in water, like a pale film, the greatest part sinking to the bottom
undissolved: thrown on a red-hot iron plate, it does not flame, but rises in
thick white fumes, which have an offensive smell of garlick, and cover cold
iron held over them with thick flowers: arsenick inclosed between two
plates of copper, then put into the fire and made red-hot, changes copper
white. Copper is soluble in all acids, and assumes a blue colour when
corroded by any acid or saline substance. Preparations of lead have a
peculiar sweet taste; and wine adulterated with lead is detected by any
alkali, which renders the mixture turbid, and precipitates the metal. These
observations are a part of medical jurisprudence; and we shall hereafter
touch upon it, under Female Abortion, and External Violence, especially
injuries of the head.
Hydrophobia. This disease may be classed with the mental, or with poisons,
and spasmodic affections of the superior part of the alimentary canal. There
poisonous antidotes. None of the two hundred genera of the quadruped
creation, nor of birds, are poisonous; and very few of the fish, or of the
numerous insects and reptiles. Out of the many thousand genera of the
vegetable creation, the poisonous are comparatively trifling: such are the
napelli, apocyna, strammonium, solanum, laurus, aconitum, manchinel,
cicuta, opium, and a few others; some of which, however, are powerful
remedies. Of the mineral, the metals and semi-metals, arsenick excepted,
the preparations of lead, copper, and mercury, are also amongst the potent
remedies.
Of poisons, some corrode or burn, others are septic; and by far the greatest
number attack the vital principle, by either violent irritation or torpidity:
some have a more deadly malignity than others, and are more speedily
destructive. Most of the vegetable poisons excite narcotic, stupifying,
vertiginous, lethargic, convulsive, and emetic symptoms, affecting the
brain, external senses, heart, and stomach. The minerals, as arsenick and
corrosive sublimate, excite symptoms of inflammation in the stomach, in
the most violent degree; and both copper and lead of spasmodic colick also.
From their readier solution in the stomach, the vegetable poisons, except by
the symptoms, can rarely be subjected to ocular detection; but by certain
chymical analysis, when in any considerable quantity, the mineral may be
discovered. Arsenick has a milky whiteness, is gritty and insipid; part of it
swims in water, like a pale film, the greatest part sinking to the bottom
undissolved: thrown on a red-hot iron plate, it does not flame, but rises in
thick white fumes, which have an offensive smell of garlick, and cover cold
iron held over them with thick flowers: arsenick inclosed between two
plates of copper, then put into the fire and made red-hot, changes copper
white. Copper is soluble in all acids, and assumes a blue colour when
corroded by any acid or saline substance. Preparations of lead have a
peculiar sweet taste; and wine adulterated with lead is detected by any
alkali, which renders the mixture turbid, and precipitates the metal. These
observations are a part of medical jurisprudence; and we shall hereafter
touch upon it, under Female Abortion, and External Violence, especially
injuries of the head.
Hydrophobia. This disease may be classed with the mental, or with poisons,
and spasmodic affections of the superior part of the alimentary canal. There
Page 168
are very few instances of this disease in Britain: it is, notwithstanding, one
of the modern hobgoblins, in which we rival the folly of the ancients
respecting alimentary poisons. It should first be indisputably ascertained
whether the dog, or other animal, was mad or not: we have a thousand false
alarms, forgeries, and falsehoods in this respect. Dogs, especially puppies,
are subject to periodical short fits, in which they run about as if mad,
barking incessantly, and with a querulous angry voice. The symptoms of a
mad dog, as described by authors, are, he suddenly becomes mopish,
peevish, and morose; has an aversion to food and drink; an unusual look
about his eyes; he runs about disorderly, forgets his master; his voice
changes to a shrill bark; he suffers no one to approach, or to handle him, but
bites at those who attempt it; he deserts his own habitation, running with his
head and tail drooping; the tongue hangs out of his mouth, covered with
foam and slaver; other dogs fly from him with horror; he attempts to bite all
who fall in his way; he flies from water and rivers, and at length falls down
exhausted, and dies on the third or fourth day after the first appearance of
the disease. It is also agreed, that canine madness is more general in hot
climates, and in the hottest summers of northern. But unfortunately hitherto,
in most cases, probably nineteen out of twenty, the mania of dogs has not
been incontrovertibly decided; as in cases even at the commencement, when
it is very dubious, dogs are very improperly and impolitickly destroyed,
instead of being confined in a place of security, to observe whether the
poison is fermenting in them. Hence, probably, much ideal terror and
horror; and boasted, though impotent, virtues of many vulgar nostrums,
panaceas, and antidotes.
In the human species, Hydrophobia, phrenitis latrans, rabies canina, aquæ
fugax, is described, for I never saw an instance of it, in the following
progressive train of symptoms; some days or weeks after the bite and
wound, heaviness, lassitude, disturbed sleep, frightful dreams, restlessness,
melancholy, pain in the wounded part; exacerbation during the phases and
changes of the moon; aversion to food and drink, pain in the throat,
difficulty or impracticability of swallowing, fluids especially; and horror, or
even convulsions, at the sight of any fluid; in some, delirium; in others, the
senses perfect. There are some instances of recovery in the stages of
hydrophobia. The diseases from other venomous bites and stings are
transferred to the future class of external accidents.
of the modern hobgoblins, in which we rival the folly of the ancients
respecting alimentary poisons. It should first be indisputably ascertained
whether the dog, or other animal, was mad or not: we have a thousand false
alarms, forgeries, and falsehoods in this respect. Dogs, especially puppies,
are subject to periodical short fits, in which they run about as if mad,
barking incessantly, and with a querulous angry voice. The symptoms of a
mad dog, as described by authors, are, he suddenly becomes mopish,
peevish, and morose; has an aversion to food and drink; an unusual look
about his eyes; he runs about disorderly, forgets his master; his voice
changes to a shrill bark; he suffers no one to approach, or to handle him, but
bites at those who attempt it; he deserts his own habitation, running with his
head and tail drooping; the tongue hangs out of his mouth, covered with
foam and slaver; other dogs fly from him with horror; he attempts to bite all
who fall in his way; he flies from water and rivers, and at length falls down
exhausted, and dies on the third or fourth day after the first appearance of
the disease. It is also agreed, that canine madness is more general in hot
climates, and in the hottest summers of northern. But unfortunately hitherto,
in most cases, probably nineteen out of twenty, the mania of dogs has not
been incontrovertibly decided; as in cases even at the commencement, when
it is very dubious, dogs are very improperly and impolitickly destroyed,
instead of being confined in a place of security, to observe whether the
poison is fermenting in them. Hence, probably, much ideal terror and
horror; and boasted, though impotent, virtues of many vulgar nostrums,
panaceas, and antidotes.
In the human species, Hydrophobia, phrenitis latrans, rabies canina, aquæ
fugax, is described, for I never saw an instance of it, in the following
progressive train of symptoms; some days or weeks after the bite and
wound, heaviness, lassitude, disturbed sleep, frightful dreams, restlessness,
melancholy, pain in the wounded part; exacerbation during the phases and
changes of the moon; aversion to food and drink, pain in the throat,
difficulty or impracticability of swallowing, fluids especially; and horror, or
even convulsions, at the sight of any fluid; in some, delirium; in others, the
senses perfect. There are some instances of recovery in the stages of
hydrophobia. The diseases from other venomous bites and stings are
transferred to the future class of external accidents.
Page 169
P. S. In the preceding group of diseases may be included two, which I had
no opportunity to introduce sooner: these are costiveness, and nasal
hemorrhage. Costiveness, it is true, is frequently symptomatic in many
diseases, but is also idiopathic; and the suppression of this excretory during
several days, occasions vertigo, headach, disturbed sleep, inappetency,
indigestion, flatulence, colick, &c. The causes, obstruction or constriction
of the intestinal tube; faults in its muscular fibres, diminution of irritability
by age or disease; defect of mucus, bile, especially cystic bile, its inertness;
costive food and drink, and medicines; too little drink; excessive discharge,
by perspiration or urine; indolence, and hard feces. Nasal hemorrhage
predominates principally in the adolescent age, and towards puberty and
manhood, and more amongst the male sex: the hemorrhage is generally
periodical at irregular intervals, usually from one nostril, and slight, or in
torrents: and there are instances on record of many quarts of blood being
discharged within a few days. After puberty it commonly abates, and some
years later ceases. The hemorrhage is very seldom immediately fatal; and
more dangerous diseases have followed its rash suppression. The causes
will be comprehended from those of hemorrhages in general.
DISEASES of the Urinary Organs. We shall begin with the diseases of the
first urinary strainer, the kidneys, descending progressively through the
conduits and reservoir, the ureters, bladder, and urethra. During the last 30
years of the preceding century, those marked in the mortal catalogue of
London as cut of the stone, gravel, and strangury, are only 1796; and at
present the mortality is more inconsiderable; and perhaps, in some degree,
maybe accounted for by modern improvements in the cure of the venereal
disease, and in the operation of lithotomy; for as to lithontripticks, we are as
yet as ignorant as of the philosopher’s stone. From Dr. Dobson’s Treatise it
appears, that out of 192,394 sick of various diseases, medical and surgical,
in different county hospitals, throughout England, 430 of these underwent
the operation of lithotomy. Some countries more than others, are obnoxious
to calculous concretions; which have been variously imputed to air, food,
drink, and water. Gravel and sand in the urinary organs is a frequent
complaint, to which infancy and childhood are by no means such martyrs as
no opportunity to introduce sooner: these are costiveness, and nasal
hemorrhage. Costiveness, it is true, is frequently symptomatic in many
diseases, but is also idiopathic; and the suppression of this excretory during
several days, occasions vertigo, headach, disturbed sleep, inappetency,
indigestion, flatulence, colick, &c. The causes, obstruction or constriction
of the intestinal tube; faults in its muscular fibres, diminution of irritability
by age or disease; defect of mucus, bile, especially cystic bile, its inertness;
costive food and drink, and medicines; too little drink; excessive discharge,
by perspiration or urine; indolence, and hard feces. Nasal hemorrhage
predominates principally in the adolescent age, and towards puberty and
manhood, and more amongst the male sex: the hemorrhage is generally
periodical at irregular intervals, usually from one nostril, and slight, or in
torrents: and there are instances on record of many quarts of blood being
discharged within a few days. After puberty it commonly abates, and some
years later ceases. The hemorrhage is very seldom immediately fatal; and
more dangerous diseases have followed its rash suppression. The causes
will be comprehended from those of hemorrhages in general.
DISEASES of the Urinary Organs. We shall begin with the diseases of the
first urinary strainer, the kidneys, descending progressively through the
conduits and reservoir, the ureters, bladder, and urethra. During the last 30
years of the preceding century, those marked in the mortal catalogue of
London as cut of the stone, gravel, and strangury, are only 1796; and at
present the mortality is more inconsiderable; and perhaps, in some degree,
maybe accounted for by modern improvements in the cure of the venereal
disease, and in the operation of lithotomy; for as to lithontripticks, we are as
yet as ignorant as of the philosopher’s stone. From Dr. Dobson’s Treatise it
appears, that out of 192,394 sick of various diseases, medical and surgical,
in different county hospitals, throughout England, 430 of these underwent
the operation of lithotomy. Some countries more than others, are obnoxious
to calculous concretions; which have been variously imputed to air, food,
drink, and water. Gravel and sand in the urinary organs is a frequent
complaint, to which infancy and childhood are by no means such martyrs as
Page 170
adults, those especially in the decline of life: but from the shortness and
width of the female urethra, they are preserved freer from calculi in the
bladder than the male sex. Diseases of the urinary organs have been often
described by authors under three general heads; Ischury, Dysury, and
Strangury. Ischuria means a total suppression of urine; and from the seat of
the disease is called renalis, uretoria, vesicalis: Dysury is only a slighter
degree of the former: Strangury, a constant irritation to urine, in small
quantity, and often with tenesmus.
width of the female urethra, they are preserved freer from calculi in the
bladder than the male sex. Diseases of the urinary organs have been often
described by authors under three general heads; Ischury, Dysury, and
Strangury. Ischuria means a total suppression of urine; and from the seat of
the disease is called renalis, uretoria, vesicalis: Dysury is only a slighter
degree of the former: Strangury, a constant irritation to urine, in small
quantity, and often with tenesmus.
Page 171
Inflammation and Calculi of the Kidneys, nephritis, nephralgia: and
generally confined to one kidney. The symptoms, shivering, fever, acute
pains and heat in the lumbar region, following the tract of the ureters, and
various in severity, from calculi excruciating; frequent efforts to
micturition; the urine in small quantity, red, bloody, hot, often intermixed
with sand, sometimes totally suppressed; with colick, flatulence, bilious
vomiting, costiveness. When the disease is severe, and from calculi, there is
stupor of the leg of the same side, and pains in the groin and male testicle,
and often retraction of the latter. There is also difficulty and pain in walking
or erecting the body; but the rheumatick lumbago, with which it may be
confounded, has no concomitant fever, nor disorder of the stomach; and has
more intense pain on bending or erecting the body. It is always dangerous
and precipitate, especially when the urine is suppressed, terminating within
seven, or, the utmost, fourteen days, by discussion, suppuration, gangrene,
scirrhus: discussion indicated by a copious flow of urine and sweats.
But the most frequent malady about the fountain of the urinary secretion, is
from calculi in the ureters. The kidneys have few nerves, and therefore not
very acute sensation. Calculi or gravel in the strainers of the kidneys,
seldom excite much uneasiness until they are forced into the ureters by the
current of urine, by exercise, exertions of the body, agitations of a coach,
passions of mind, stimulating diet and drink: then they excite atrocious
pain, like a stake driven into the back, which is exasperated by certain
postures, by every motion of the body, and by a full stomach; together with
all the other symptoms common to inflammation, except the fever; to
which, however, and to inflammation calculi, often give birth. At the
beginning the urine is limpid; afterwards it becomes turbid and fabulous.
This is a chronic periodical disease, with intermissions and nephritic
exacerbations at uncertain intervals. It is distinguishable from intestinal
colick by the pain fixed in the loins, the urinary obstruction, stupor of the
leg, and retraction of the testicle.
Inflammation and also Calculus of the Bladder. Of cystitis, the symptoms
are acute burning pain in the region of the bladder and perineum, and
extending to the loins; tumour, tension, and hardness of the abdomen from
the distended bladder, which may be felt between the pubis and navel; and
sometimes is turgid to an enormous magnitude; perpetual painful efforts to
urine and stool, and the urine either suppressed, or in small quantity; a
generally confined to one kidney. The symptoms, shivering, fever, acute
pains and heat in the lumbar region, following the tract of the ureters, and
various in severity, from calculi excruciating; frequent efforts to
micturition; the urine in small quantity, red, bloody, hot, often intermixed
with sand, sometimes totally suppressed; with colick, flatulence, bilious
vomiting, costiveness. When the disease is severe, and from calculi, there is
stupor of the leg of the same side, and pains in the groin and male testicle,
and often retraction of the latter. There is also difficulty and pain in walking
or erecting the body; but the rheumatick lumbago, with which it may be
confounded, has no concomitant fever, nor disorder of the stomach; and has
more intense pain on bending or erecting the body. It is always dangerous
and precipitate, especially when the urine is suppressed, terminating within
seven, or, the utmost, fourteen days, by discussion, suppuration, gangrene,
scirrhus: discussion indicated by a copious flow of urine and sweats.
But the most frequent malady about the fountain of the urinary secretion, is
from calculi in the ureters. The kidneys have few nerves, and therefore not
very acute sensation. Calculi or gravel in the strainers of the kidneys,
seldom excite much uneasiness until they are forced into the ureters by the
current of urine, by exercise, exertions of the body, agitations of a coach,
passions of mind, stimulating diet and drink: then they excite atrocious
pain, like a stake driven into the back, which is exasperated by certain
postures, by every motion of the body, and by a full stomach; together with
all the other symptoms common to inflammation, except the fever; to
which, however, and to inflammation calculi, often give birth. At the
beginning the urine is limpid; afterwards it becomes turbid and fabulous.
This is a chronic periodical disease, with intermissions and nephritic
exacerbations at uncertain intervals. It is distinguishable from intestinal
colick by the pain fixed in the loins, the urinary obstruction, stupor of the
leg, and retraction of the testicle.
Inflammation and also Calculus of the Bladder. Of cystitis, the symptoms
are acute burning pain in the region of the bladder and perineum, and
extending to the loins; tumour, tension, and hardness of the abdomen from
the distended bladder, which may be felt between the pubis and navel; and
sometimes is turgid to an enormous magnitude; perpetual painful efforts to
urine and stool, and the urine either suppressed, or in small quantity; a
Page 172
finger introduced into the anus, or into the female vagina, feels the vesical
tumour; or if the inflammation particularly fixes upon the neck of the
bladder, the surgical catheter cannot, without immense difficulty, be
introduced; and with all these symptoms, symptomatick fever, quick, hard,
phlogistic pulse. It is very rapid and dangerous: total suppression within a
very few days excites burning fever, lethargy, delirium, convulsions,
gangrene: or even after recovery from a violent disease, incontinence of
urine may remain for a considerable time.
Of calculus, or stone in the bladder, the symptoms are all dubious, without
sounding the bladder with the surgical instrument. It is a chronic disease,
slow in accumulation; and is frequently endured many years, without
having recourse to lithotomy. The symptoms vary in severity, and recur in
exacerbations at uncertain intervals; such are frequent irritation to urine,
and difficulty in the evacuation; strangury, tenesmus, pain, and titillation of
the glans of the penis, and the urethra, especially after making water;
itching of the genitals; sometimes bloody urine after riding, or exercise. If
the stone is large, there is a sensation of weight in the region of the pubis
and perineum; sudden stoppage of the urine during micturition; sometimes
necessity of kneeling, and of a prone posture in endeavouring to evacuate
the bladder. A finger introduced into the anus, will sometimes feel the stone;
but the sound is the only certain criterion. The size, shape, and number of
stones are various: often only one, but sometimes several are extracted by
lithotomy. Internal incrustations, and also scirrhus of the bladder, or even
internal hemorrhoides, have imposed on medical judgment as cystic calculi.
Inflammation and obstruction of the urethra cannot be thoroughly
investigated, without a description of the venereal disease, to which we
have not yet arrived; but which there could be no impropriety to introduce
amongst this group.
The predisposing and occasional causes of urinary suppression, obstruction,
and strangury, whether originating in the kidneys, ureters, bladder, or
urethra, are inflammation of the kidney or ureter, calculi or sand in the
kidneys or ureters; acrid diureticks; spirituous liquors; plethora, spasm,
poisons, severe riding, violent heat and muscular exercise; strains of the
lumbar and dorsal muscles; long continued posture in a bent position or
supine on the back; inactive sedentary life; wounds, contusions, abscess;
defecation and crisis of other diseases by the kidneys; scirrhous, incysted,
tumour; or if the inflammation particularly fixes upon the neck of the
bladder, the surgical catheter cannot, without immense difficulty, be
introduced; and with all these symptoms, symptomatick fever, quick, hard,
phlogistic pulse. It is very rapid and dangerous: total suppression within a
very few days excites burning fever, lethargy, delirium, convulsions,
gangrene: or even after recovery from a violent disease, incontinence of
urine may remain for a considerable time.
Of calculus, or stone in the bladder, the symptoms are all dubious, without
sounding the bladder with the surgical instrument. It is a chronic disease,
slow in accumulation; and is frequently endured many years, without
having recourse to lithotomy. The symptoms vary in severity, and recur in
exacerbations at uncertain intervals; such are frequent irritation to urine,
and difficulty in the evacuation; strangury, tenesmus, pain, and titillation of
the glans of the penis, and the urethra, especially after making water;
itching of the genitals; sometimes bloody urine after riding, or exercise. If
the stone is large, there is a sensation of weight in the region of the pubis
and perineum; sudden stoppage of the urine during micturition; sometimes
necessity of kneeling, and of a prone posture in endeavouring to evacuate
the bladder. A finger introduced into the anus, will sometimes feel the stone;
but the sound is the only certain criterion. The size, shape, and number of
stones are various: often only one, but sometimes several are extracted by
lithotomy. Internal incrustations, and also scirrhus of the bladder, or even
internal hemorrhoides, have imposed on medical judgment as cystic calculi.
Inflammation and obstruction of the urethra cannot be thoroughly
investigated, without a description of the venereal disease, to which we
have not yet arrived; but which there could be no impropriety to introduce
amongst this group.
The predisposing and occasional causes of urinary suppression, obstruction,
and strangury, whether originating in the kidneys, ureters, bladder, or
urethra, are inflammation of the kidney or ureter, calculi or sand in the
kidneys or ureters; acrid diureticks; spirituous liquors; plethora, spasm,
poisons, severe riding, violent heat and muscular exercise; strains of the
lumbar and dorsal muscles; long continued posture in a bent position or
supine on the back; inactive sedentary life; wounds, contusions, abscess;
defecation and crisis of other diseases by the kidneys; scirrhous, incysted,
Page 173
dropsical, paralytick kidney; gout; inflammation of the bladder or its
sphincter, stone in the bladder; the urine too long retained in the bladder, by
which it becomes violently stretched, and paralytic; hernia of the bladder;
obstructions in the neck of the bladder, or in the urethra; varicous blood
vessels; the prostrate glands or seminal vesicles scirrhous, or enlarged;
inflammation, caruncles, and stricture in the urethra; the corpus cavernosum
thickened; contiguous diseases of the anus, vagina, and womb; hardened
feces, hemorrhoides, wounds of the rectum, fistula; ulcers of the womb,
obstructed menses, or their retention in the vagina; pregnancy; ulcers and
worms in the kidneys, bladder, or urethra, and excretion of acrid pus or
membranes, by urine; grumous, extravasated blood in the bladder and
urethra; inspissated semen after coition; excess of venery; too acute
sensibility of the urethra, defect of mucus; acrid urine; tartarous and
astringent wine or drink, food, or medicines; stimulating food and drink;
frequent ebriety; terrestrious water; sudden refrigeration of the body;
contusion; old age; plethora; lunar, venereal, rheumatick, arthritick,
hysterick, scorbutick, dropsy, violent colick, retraction and shrinking of the
penis.
Incontinence of Urine, and also Diabetes. Of incontinence, or eneuresis,
authors make three species; one involuntary, without sense or effort; the
second involuntary, but with a knowledge of its excretion; the third
involuntary, during sleep. The Diabetes was unnoticed in the London bills
until the present century; and perhaps its trifling depredations were thrown
amongst consumptions. It denotes a chronic discharge of urine beyond the
natural quantity, and sometimes exceeding in weight all the fluids and
solids taken by aliment: it is generally clear and colourless, but sometimes
white and chylous, or unctuous, or, like honey dissolved in water, a
yellowish green, and tastes sweet like honey: there is unquenchable thirst,
intense heat, flow hectic and emaciation, pain in the loins; increased flow of
saliva, voraciousness, or inappetency. It often invades by slow and
imperceptible steps, and without any other disorder, until, by long
continuance, emaciation is visible, with debility and obscure fever. It is
sometimes periodical, and in hystericks symptomatic.
The predisposing and occasional causes of incontinence of urine are, palsy
of the sphincter of the bladder, from either too great dilatation and
accumulation of urine, or from violent efforts in parturition; debility, old
sphincter, stone in the bladder; the urine too long retained in the bladder, by
which it becomes violently stretched, and paralytic; hernia of the bladder;
obstructions in the neck of the bladder, or in the urethra; varicous blood
vessels; the prostrate glands or seminal vesicles scirrhous, or enlarged;
inflammation, caruncles, and stricture in the urethra; the corpus cavernosum
thickened; contiguous diseases of the anus, vagina, and womb; hardened
feces, hemorrhoides, wounds of the rectum, fistula; ulcers of the womb,
obstructed menses, or their retention in the vagina; pregnancy; ulcers and
worms in the kidneys, bladder, or urethra, and excretion of acrid pus or
membranes, by urine; grumous, extravasated blood in the bladder and
urethra; inspissated semen after coition; excess of venery; too acute
sensibility of the urethra, defect of mucus; acrid urine; tartarous and
astringent wine or drink, food, or medicines; stimulating food and drink;
frequent ebriety; terrestrious water; sudden refrigeration of the body;
contusion; old age; plethora; lunar, venereal, rheumatick, arthritick,
hysterick, scorbutick, dropsy, violent colick, retraction and shrinking of the
penis.
Incontinence of Urine, and also Diabetes. Of incontinence, or eneuresis,
authors make three species; one involuntary, without sense or effort; the
second involuntary, but with a knowledge of its excretion; the third
involuntary, during sleep. The Diabetes was unnoticed in the London bills
until the present century; and perhaps its trifling depredations were thrown
amongst consumptions. It denotes a chronic discharge of urine beyond the
natural quantity, and sometimes exceeding in weight all the fluids and
solids taken by aliment: it is generally clear and colourless, but sometimes
white and chylous, or unctuous, or, like honey dissolved in water, a
yellowish green, and tastes sweet like honey: there is unquenchable thirst,
intense heat, flow hectic and emaciation, pain in the loins; increased flow of
saliva, voraciousness, or inappetency. It often invades by slow and
imperceptible steps, and without any other disorder, until, by long
continuance, emaciation is visible, with debility and obscure fever. It is
sometimes periodical, and in hystericks symptomatic.
The predisposing and occasional causes of incontinence of urine are, palsy
of the sphincter of the bladder, from either too great dilatation and
accumulation of urine, or from violent efforts in parturition; debility, old
Page 174
age, excess of venery; fistula, abscess, ulcers, lithotomy, stone, spasm, gout,
apoplexy, palsy, external injuries. Also, copious, watery, acrid urine: the
bladder irritable from inflammation, ulcers, excoriation, defect of mucus;
spasm, relaxation of the sphincter; weakness of the sphincter ani, and
accelerator muscles; pregnancy, laborious parturition; compression and
irritation of the bladder; habit.—Of diabetes, aqueous tenuity, and also
acrimony of the blood; weakness, laxity of the kidneys and renal vessels;
the crassamentum of the blood not cohering with the serum; faults in the
assimilation of the nutriment, and sanguification; excess of watery drink
and ebriety; diureticks; sudden refrigeration of the body, and suppression of
perspiration; unusual determination of blood and serum to the kidneys;
excess of venery; increase of cutaneous absorption; obstructions of the
abdominal viscera; spasm; nervous; habit: often unknown.
Ulcers in the Kidneys and Bladder, and Bloody Urine. Of ulcers in the
kidneys, thick fetid urine, sometimes with mouldered fragments of the
kidneys; heat and weight in the loins; hectic emaciation, stupor of the leg,
and some other symptoms of nephritis. It is tedious and dangerous. Of ulcer
in the bladder, pain in the pelvis and perineum, exasperated at intervals;
heat, strangury, dysury; the urine fetid with intermixtures of pus, mucus,
and blood; sometimes the rectum also is eroded. Of bloody urine, or
hematuria from the kidneys, ureters, bladder, seminal vesicles, or urethra.
From the kidneys the hemorrhage is sometimes profuse, and the blood of
various colours, according to its solution and stagnation in the bladder; and
sometimes coagulated, takes the mould of the urethra: the urine tinges linen
dipped into it of a red colour, and the blood is coagulable by heat. There are
instances of its periodical flow, like the menses. The predisposing and
occasional causes of urinary hemorrhage are the general causes of
hemorrhages; calculi in the kidneys or bladder; falls, blows on the loins;
violent exertion of the lumbar muscles, riding, exercise; venery; plethora;
obstructed evacuations, hemorrhoids, menses; hemorrhoids of the bladder
and varicous veins; acrid diureticks; ulcers, symptomatick in scurvy; putrid
small pox, and malignant fever.
apoplexy, palsy, external injuries. Also, copious, watery, acrid urine: the
bladder irritable from inflammation, ulcers, excoriation, defect of mucus;
spasm, relaxation of the sphincter; weakness of the sphincter ani, and
accelerator muscles; pregnancy, laborious parturition; compression and
irritation of the bladder; habit.—Of diabetes, aqueous tenuity, and also
acrimony of the blood; weakness, laxity of the kidneys and renal vessels;
the crassamentum of the blood not cohering with the serum; faults in the
assimilation of the nutriment, and sanguification; excess of watery drink
and ebriety; diureticks; sudden refrigeration of the body, and suppression of
perspiration; unusual determination of blood and serum to the kidneys;
excess of venery; increase of cutaneous absorption; obstructions of the
abdominal viscera; spasm; nervous; habit: often unknown.
Ulcers in the Kidneys and Bladder, and Bloody Urine. Of ulcers in the
kidneys, thick fetid urine, sometimes with mouldered fragments of the
kidneys; heat and weight in the loins; hectic emaciation, stupor of the leg,
and some other symptoms of nephritis. It is tedious and dangerous. Of ulcer
in the bladder, pain in the pelvis and perineum, exasperated at intervals;
heat, strangury, dysury; the urine fetid with intermixtures of pus, mucus,
and blood; sometimes the rectum also is eroded. Of bloody urine, or
hematuria from the kidneys, ureters, bladder, seminal vesicles, or urethra.
From the kidneys the hemorrhage is sometimes profuse, and the blood of
various colours, according to its solution and stagnation in the bladder; and
sometimes coagulated, takes the mould of the urethra: the urine tinges linen
dipped into it of a red colour, and the blood is coagulable by heat. There are
instances of its periodical flow, like the menses. The predisposing and
occasional causes of urinary hemorrhage are the general causes of
hemorrhages; calculi in the kidneys or bladder; falls, blows on the loins;
violent exertion of the lumbar muscles, riding, exercise; venery; plethora;
obstructed evacuations, hemorrhoids, menses; hemorrhoids of the bladder
and varicous veins; acrid diureticks; ulcers, symptomatick in scurvy; putrid
small pox, and malignant fever.
Page 175
DROPSY. During the last thirty years of the preceding century, Dropsy and
Tympany amount to 23,366. In the present century, dropsy makes about one
twentieth share in the London funerals. It has been alledged, that more
women die of this internal deluge than men; and, according to Sydenham,
more of the former at the final menstrual ebb, than at any other period. But,
so far as my reading extends, neither the age, sex, mortality absolute or
comparative, have to this day been decided from facts or numbers; but
rather principally in the mode of tradition, and aphorisms of individual
oracles. I therefore, through my learned friend, Dr. Sims, procured the
registers of diseases in the Aldersgate Dispensary of London, which is
accessible to all ages and diseases, and to both sexes: the result of this
scrutiny is as follows:—Out of 70,000, during seventeen years, from 1770
to 1788, the dropsical amounted to rather more than one twentieth part of
the whole maladies; that is, to 1,188: of which number, I find there were of
males, 439; females, 749; cured, 674; relieved, 56; discharged or not
accounted for, 275; dead, 186. Of these their sundry ages were, from birth
to the 10th year, 106; from 10 to 20, 53; from 20 to 30, 112; from 30 to 40,
249; from 40 to 50, 321; from 50 to 60, 209; from 60 to 70, 110; from 70 to
80, 23; from 80 to 90, 9. Total, 1,188. These include every genus and
species of dropsy, the hydrocephalus and hydrocele; neither of which were
numerous: and the former principally fatal to children under ten years of
age. Anasarca was the most frequent genus; and next to that, Ascites.
Besides, all cases of anasarca and œdematous legs were ranged in this
dropsical group; nor was it possible to form an estimate of the genera
separately, as the word Hydrops was often indefinitely used.
From these data we may draw the following conclusions: That dropsy is
more inimical to the female than to the male sex: but at the same time it
must be recollected, that in London, and other cities, the women are
considerably more numerous; which somewhat detracts from the
comparative excess in them of dropsical mortality. For reasons, which
medical men of experience will anticipate, we may add to the dropsical
dead list some of the relieved, discharged, and not accounted for. It appears,
therefore, that, under skilful medical treatment, rather more than one half of
dropsies, promiscuously, were cured; that about one third or fourth died;
that dropsical ravages are principally amongst adults; for notwithstanding
that one half of the community are under twenty years of age, yet but a
Tympany amount to 23,366. In the present century, dropsy makes about one
twentieth share in the London funerals. It has been alledged, that more
women die of this internal deluge than men; and, according to Sydenham,
more of the former at the final menstrual ebb, than at any other period. But,
so far as my reading extends, neither the age, sex, mortality absolute or
comparative, have to this day been decided from facts or numbers; but
rather principally in the mode of tradition, and aphorisms of individual
oracles. I therefore, through my learned friend, Dr. Sims, procured the
registers of diseases in the Aldersgate Dispensary of London, which is
accessible to all ages and diseases, and to both sexes: the result of this
scrutiny is as follows:—Out of 70,000, during seventeen years, from 1770
to 1788, the dropsical amounted to rather more than one twentieth part of
the whole maladies; that is, to 1,188: of which number, I find there were of
males, 439; females, 749; cured, 674; relieved, 56; discharged or not
accounted for, 275; dead, 186. Of these their sundry ages were, from birth
to the 10th year, 106; from 10 to 20, 53; from 20 to 30, 112; from 30 to 40,
249; from 40 to 50, 321; from 50 to 60, 209; from 60 to 70, 110; from 70 to
80, 23; from 80 to 90, 9. Total, 1,188. These include every genus and
species of dropsy, the hydrocephalus and hydrocele; neither of which were
numerous: and the former principally fatal to children under ten years of
age. Anasarca was the most frequent genus; and next to that, Ascites.
Besides, all cases of anasarca and œdematous legs were ranged in this
dropsical group; nor was it possible to form an estimate of the genera
separately, as the word Hydrops was often indefinitely used.
From these data we may draw the following conclusions: That dropsy is
more inimical to the female than to the male sex: but at the same time it
must be recollected, that in London, and other cities, the women are
considerably more numerous; which somewhat detracts from the
comparative excess in them of dropsical mortality. For reasons, which
medical men of experience will anticipate, we may add to the dropsical
dead list some of the relieved, discharged, and not accounted for. It appears,
therefore, that, under skilful medical treatment, rather more than one half of
dropsies, promiscuously, were cured; that about one third or fourth died;
that dropsical ravages are principally amongst adults; for notwithstanding
that one half of the community are under twenty years of age, yet but a
Page 176
small portion of these are dropsical. It is chiefly against adults, and those in
the decline of life, that dropsy prowls with slow and sullen destruction; and
is, as 8 to 1, more fatal after twenty, than before that period. We may here
also observe, that, by retrospection to a former proposition, a sort of
medical geometry and trigonometry, a gross estimate may be formed from
the deaths, of the number of dropsical in a community.
Dropsy in the Brain and Spine, hydrocephalus, and spina bifida, is most
frequent in infancy and childhood; but is often very difficult to detect, and
the symptoms at the beginning are dubious. The most usual symptoms are
loss of appetite, strength, spirits, flesh; fixed pain in the head and eye-
brows, drowsiness or restlessness, heaviness, stupidity; pale countenance
and tongue; obscure or double vision, dilated pupil, insensibility of the
retina, even when exposed to the darting rays of the sun, or of a candle; the
hand often applied to the head; irregular pulse; vomiting. It is commonly
slow in increase; from months to a year, or more. It is seldom cured; and the
fatal termination frequently palsy and convulsions. The external
hydrocephalus, or local anasarca, is soft and elastic to the touch, and the
enlargement visible. The spinal dropsy is sometimes complicated with
hydrocephalus; in it a tumour turgid with fluid, the size of a chesnut, or
larger, is protruded from the opening in the lumbar vertebræ of infants.
Dropsy of the Thorax, hydrops pectoris, and pericardii: in one or both sacs
of the pleura, or in the pericardium; or in the pulmonic cellular texture. This
is much less frequent than the abdominal; and is often very difficult in the
early stages to be detected, as the same, or nearly similar symptoms, occur
in some other diseases of the breast: such are difficult and laborious
respiration, especially on any exercise or motion, or in a horizontal posture,
and gradually increasing; frequent cough, at first dry, but after some time,
with mucous expectoration; weight and oppression in the breast; disturbed
sleep, and sudden startings, with anxiety and dyspnœa; necessity of an erect
posture; palpitation of the heart, and irregular pulse: there is also commonly
scantiness of urine, œdematous tumour of the feet and ancles; a pasty
paleness of the face; and sometimes a fluctuation of water in the thorax is
perceptible to the patient.
Sometimes it is circumscribed and local; at other times, it begins by
anasarca, and is complicated with universal dropsy of the other cavities, or
with asthma; sometimes it consists of hydatides. It is distinguishable from
the decline of life, that dropsy prowls with slow and sullen destruction; and
is, as 8 to 1, more fatal after twenty, than before that period. We may here
also observe, that, by retrospection to a former proposition, a sort of
medical geometry and trigonometry, a gross estimate may be formed from
the deaths, of the number of dropsical in a community.
Dropsy in the Brain and Spine, hydrocephalus, and spina bifida, is most
frequent in infancy and childhood; but is often very difficult to detect, and
the symptoms at the beginning are dubious. The most usual symptoms are
loss of appetite, strength, spirits, flesh; fixed pain in the head and eye-
brows, drowsiness or restlessness, heaviness, stupidity; pale countenance
and tongue; obscure or double vision, dilated pupil, insensibility of the
retina, even when exposed to the darting rays of the sun, or of a candle; the
hand often applied to the head; irregular pulse; vomiting. It is commonly
slow in increase; from months to a year, or more. It is seldom cured; and the
fatal termination frequently palsy and convulsions. The external
hydrocephalus, or local anasarca, is soft and elastic to the touch, and the
enlargement visible. The spinal dropsy is sometimes complicated with
hydrocephalus; in it a tumour turgid with fluid, the size of a chesnut, or
larger, is protruded from the opening in the lumbar vertebræ of infants.
Dropsy of the Thorax, hydrops pectoris, and pericardii: in one or both sacs
of the pleura, or in the pericardium; or in the pulmonic cellular texture. This
is much less frequent than the abdominal; and is often very difficult in the
early stages to be detected, as the same, or nearly similar symptoms, occur
in some other diseases of the breast: such are difficult and laborious
respiration, especially on any exercise or motion, or in a horizontal posture,
and gradually increasing; frequent cough, at first dry, but after some time,
with mucous expectoration; weight and oppression in the breast; disturbed
sleep, and sudden startings, with anxiety and dyspnœa; necessity of an erect
posture; palpitation of the heart, and irregular pulse: there is also commonly
scantiness of urine, œdematous tumour of the feet and ancles; a pasty
paleness of the face; and sometimes a fluctuation of water in the thorax is
perceptible to the patient.
Sometimes it is circumscribed and local; at other times, it begins by
anasarca, and is complicated with universal dropsy of the other cavities, or
with asthma; sometimes it consists of hydatides. It is distinguishable from
Page 177
the empyema, and from the polypus and aneurism of the large vessels, by
the symptoms peculiar to each. After some fevers, thoracic dropsy has
formed with surprizing rapidity in one or two days. The fatal event is often
preceded by spitting of blood, anxiety, and accelerated respiration. In the
dropsy of the capsula of the heart, the pericardium, there is difficulty of
respiration, and of laying on the left side; quick, weak, intermittent pulse,
palpitation of the heart, syncope, dry cough; anasarcous ancles, scantiness
of urine: and sometimes a sensation of fluctuation during the motion of the
heart. In dropsy of the mediastinum, the symptoms are conjectural.
Abdominal Dropsy, including the ascites, the dropsy of the ovaria, fallopian
tubes, and womb. The ascites, or exudation between the peritoneum,
intestines, and viscera, is much more frequent than the hydrothorax. The
symptoms are enlargement and prominence of the belly; sense of
fluctuation to the fingers and ears on striking it with one hand, and applying
the other to the opposite side; the urine scanty, turbid, and high-coloured;
costiveness; the thirst at the beginning is inconsiderable, but generally
becomes irksome and insatiable; the skin dry; the body sluggish, and
increased in weight: the countenance becomes squalid, sallow, and
unwholesome; the upper part of the body and arms emaciated, and, sooner
or later, the ancles œdematous. Where there is a large accumulation of water
the diaphragm is impeded, with difficulty of respiration and dry cough,
particularly in a horizontal posture. The serous transudation is the general
form of ascites; but sometimes it is of a gelatinous consistence, and more of
coagulable lymph from the blood, and the fluctuation not perceptible: in
other cases it is inclosed in numerous morbid cysts, called hydatides; which
cannot be known to a certainty until after the experiment of tapping. It may,
however, be suspected, where there is no general cachexy, dropsy, thirst, or
scantiness of urine; where the appetite and sleep are natural, and the tumour
has begun in one part of the abdomen.
Some survive many years under ascites, and after reiterated evacuations by
tapping; on the whole, often amounting to several hogsheads of water. In
others, there are instances of accumulation so extraordinary, sudden, and
profuse, as to render it necessary to be drawn off repeatedly in the short
interval of a few weeks. It occurs either singly, or as a part of universal
dropsy. Ascites encysted; from broken constitutions; unsound viscera; the
consequence of other diseases; chronic; with decay of appetite; with urine
the symptoms peculiar to each. After some fevers, thoracic dropsy has
formed with surprizing rapidity in one or two days. The fatal event is often
preceded by spitting of blood, anxiety, and accelerated respiration. In the
dropsy of the capsula of the heart, the pericardium, there is difficulty of
respiration, and of laying on the left side; quick, weak, intermittent pulse,
palpitation of the heart, syncope, dry cough; anasarcous ancles, scantiness
of urine: and sometimes a sensation of fluctuation during the motion of the
heart. In dropsy of the mediastinum, the symptoms are conjectural.
Abdominal Dropsy, including the ascites, the dropsy of the ovaria, fallopian
tubes, and womb. The ascites, or exudation between the peritoneum,
intestines, and viscera, is much more frequent than the hydrothorax. The
symptoms are enlargement and prominence of the belly; sense of
fluctuation to the fingers and ears on striking it with one hand, and applying
the other to the opposite side; the urine scanty, turbid, and high-coloured;
costiveness; the thirst at the beginning is inconsiderable, but generally
becomes irksome and insatiable; the skin dry; the body sluggish, and
increased in weight: the countenance becomes squalid, sallow, and
unwholesome; the upper part of the body and arms emaciated, and, sooner
or later, the ancles œdematous. Where there is a large accumulation of water
the diaphragm is impeded, with difficulty of respiration and dry cough,
particularly in a horizontal posture. The serous transudation is the general
form of ascites; but sometimes it is of a gelatinous consistence, and more of
coagulable lymph from the blood, and the fluctuation not perceptible: in
other cases it is inclosed in numerous morbid cysts, called hydatides; which
cannot be known to a certainty until after the experiment of tapping. It may,
however, be suspected, where there is no general cachexy, dropsy, thirst, or
scantiness of urine; where the appetite and sleep are natural, and the tumour
has begun in one part of the abdomen.
Some survive many years under ascites, and after reiterated evacuations by
tapping; on the whole, often amounting to several hogsheads of water. In
others, there are instances of accumulation so extraordinary, sudden, and
profuse, as to render it necessary to be drawn off repeatedly in the short
interval of a few weeks. It occurs either singly, or as a part of universal
dropsy. Ascites encysted; from broken constitutions; unsound viscera; the
consequence of other diseases; chronic; with decay of appetite; with urine
Page 178
considerably disproportioned to the drink, are all species unfavourable,
some desperate. But in the most deplorable stages, patients entertain some
hopes of recovery.
Dropsy of the Ovaria, fallopian tubes, and womb, are female, and not
unfrequent maladies. It is rarely that both ovaria are affected. The disease
begins with a soft tumour at one side of the abdomen, generally increasing
by slow gradations, and at length sometimes to an enormous size and
weight, so as to distend the whole abdomen: it is accompanied with several
ascitic symptoms, and with pain about the pubis and loins; but the
fluctuation is imperceptible, or obscure; and the extravasation is often
encysted and gelatinous. That in the fallopian tubes requires no particular
description after the preceding, which it so nearly resembles. Both are often
incurable. Dropsy of the womb is a very rare disease: it has been described
as occurring either in the pregnant or unimpregnated state; and in the latter
case, as contained within the cavity of the womb, or between the fetal
membranes and the womb; or within the layers of the membranes. I cannot
find an author to satisfy my doubts respecting the accurate diagnostick of
this disease; and therefore shall not copy what I distrust.
Dropsy of the Cellular Membrane, externally, in the cellular texture under
the skin; the species anasarca, leucophlegmatia, œdema. It generally
appears first in the lower extremities, and there too only in the evening,
disappearing by a horizontal posture in the night: at length, it reaches up,
progressively, to the legs, thighs, trunk, and scrotum; and in some instances,
to the face, particularly in the mornings. The intumescence of the skin is
pale and soft, and, on pressure of the finger, indents; but is soon again filled
up with water. As it increases to a universal anasarca, there is difficulty of
breathing, particularly after exercise, scanty urine, thirst, decay of strength,
slow hectic diminution of the natural heat, and more or less insensibility of
the skin, which is dry. Sometimes the legs and thighs only are enlarged and
distended to a monstrous magnitude; their skin bursts, ulcerates, or is
irritated to erysipelatous inflammation. It is either complicated with ascites
or hydrothorax, or beginning as œdema, and increasing to anasarca, it oozes
through all the external cellular texture; and having inundated all the out-
works, proceeds in drowning the vital organs.
Dropsy of the Scrotum, hydrocele. This is a local disease, confined to the
male sex; and to which all ages are subject. There are two principal species;
some desperate. But in the most deplorable stages, patients entertain some
hopes of recovery.
Dropsy of the Ovaria, fallopian tubes, and womb, are female, and not
unfrequent maladies. It is rarely that both ovaria are affected. The disease
begins with a soft tumour at one side of the abdomen, generally increasing
by slow gradations, and at length sometimes to an enormous size and
weight, so as to distend the whole abdomen: it is accompanied with several
ascitic symptoms, and with pain about the pubis and loins; but the
fluctuation is imperceptible, or obscure; and the extravasation is often
encysted and gelatinous. That in the fallopian tubes requires no particular
description after the preceding, which it so nearly resembles. Both are often
incurable. Dropsy of the womb is a very rare disease: it has been described
as occurring either in the pregnant or unimpregnated state; and in the latter
case, as contained within the cavity of the womb, or between the fetal
membranes and the womb; or within the layers of the membranes. I cannot
find an author to satisfy my doubts respecting the accurate diagnostick of
this disease; and therefore shall not copy what I distrust.
Dropsy of the Cellular Membrane, externally, in the cellular texture under
the skin; the species anasarca, leucophlegmatia, œdema. It generally
appears first in the lower extremities, and there too only in the evening,
disappearing by a horizontal posture in the night: at length, it reaches up,
progressively, to the legs, thighs, trunk, and scrotum; and in some instances,
to the face, particularly in the mornings. The intumescence of the skin is
pale and soft, and, on pressure of the finger, indents; but is soon again filled
up with water. As it increases to a universal anasarca, there is difficulty of
breathing, particularly after exercise, scanty urine, thirst, decay of strength,
slow hectic diminution of the natural heat, and more or less insensibility of
the skin, which is dry. Sometimes the legs and thighs only are enlarged and
distended to a monstrous magnitude; their skin bursts, ulcerates, or is
irritated to erysipelatous inflammation. It is either complicated with ascites
or hydrothorax, or beginning as œdema, and increasing to anasarca, it oozes
through all the external cellular texture; and having inundated all the out-
works, proceeds in drowning the vital organs.
Dropsy of the Scrotum, hydrocele. This is a local disease, confined to the
male sex; and to which all ages are subject. There are two principal species;
Page 179
that between the vaginal coat and testicle, and that in the spermatic chord;
and either collected in cysts, or dispersed through all the cellular
membranes inclosing the spermatick vessels. In general, hydrocele is
confined to one testicle, at the beginning is not painful, and neither
diminishes nor disappears: it has usually a conical pyriform appearance, the
large end downwards: sometimes it is very hard and incompressible; and
when the membranes are much thickened, it is not transparent: there is slow
gradual accumulation of the fluid from below: it is incapable of reduction,
or return into the abdomen through the rings: it is not affected by posture,
cough, or sneezing of the patient: there is neither nausea, vomiting, quick
pulse, nor is the fecal discharge interrupted. If the quantity of water is
considerable, the testicle cannot be felt, at least not distinguished. In most
cases the spermatick vessels may be felt at their exit, through the abdominal
rings; but sometimes the hydrocele tumour reaches up to the rings, and
renders such cases puzzling to discriminate, as the spermatick chord is then
concealed. Again, hydrocele of the spermatick chord has been mistaken for
rupture, from its ascension to the rings: this species feels like a distended
bladder.
Hydrocele has not only been mistaken for rupture, but also for scirrhous
testicle, and venereal induration. Indurated and scirrhous testicle is rounder,
harder, painful, and the spermatic chord distinguishable at the rings: it has,
however, frequently a quantity of extravasated and surrounding fluid.
Besides, scrotal hydrocele and hernia, hydrocele and scirrhous testicle,
hydrocele and encysted dropsy of the spermatic chord, have been seen
combined. Some hydroceles are several years collecting: others are very
suddenly formed, especially from extravasated blood, external injuries,
violent muscular exertions; these likewise have been mistaken for ruptures.
Hydroceles vary in the quantity of fluid and magnitude, containing from
ounces to several quarts; some are enormous in size, reaching half-way
down to the knees, and occasioning great load, and pain in the back. The
colour of the extravasated fluid is also various; clear, limpid, pale, straw,
yellow, grumous, dark, bloody. Many, from choice or necessity, are
contented to drag on life, not chusing to risk what is termed the radical
operation and cure; but merely by frequent repetitions of the scrotal
puncture or palliative remedy. Sometimes the skin and cellular membrane
of the scrotum, in inveterate hydrocele, is prodigiously thickened.
and either collected in cysts, or dispersed through all the cellular
membranes inclosing the spermatick vessels. In general, hydrocele is
confined to one testicle, at the beginning is not painful, and neither
diminishes nor disappears: it has usually a conical pyriform appearance, the
large end downwards: sometimes it is very hard and incompressible; and
when the membranes are much thickened, it is not transparent: there is slow
gradual accumulation of the fluid from below: it is incapable of reduction,
or return into the abdomen through the rings: it is not affected by posture,
cough, or sneezing of the patient: there is neither nausea, vomiting, quick
pulse, nor is the fecal discharge interrupted. If the quantity of water is
considerable, the testicle cannot be felt, at least not distinguished. In most
cases the spermatick vessels may be felt at their exit, through the abdominal
rings; but sometimes the hydrocele tumour reaches up to the rings, and
renders such cases puzzling to discriminate, as the spermatick chord is then
concealed. Again, hydrocele of the spermatick chord has been mistaken for
rupture, from its ascension to the rings: this species feels like a distended
bladder.
Hydrocele has not only been mistaken for rupture, but also for scirrhous
testicle, and venereal induration. Indurated and scirrhous testicle is rounder,
harder, painful, and the spermatic chord distinguishable at the rings: it has,
however, frequently a quantity of extravasated and surrounding fluid.
Besides, scrotal hydrocele and hernia, hydrocele and scirrhous testicle,
hydrocele and encysted dropsy of the spermatic chord, have been seen
combined. Some hydroceles are several years collecting: others are very
suddenly formed, especially from extravasated blood, external injuries,
violent muscular exertions; these likewise have been mistaken for ruptures.
Hydroceles vary in the quantity of fluid and magnitude, containing from
ounces to several quarts; some are enormous in size, reaching half-way
down to the knees, and occasioning great load, and pain in the back. The
colour of the extravasated fluid is also various; clear, limpid, pale, straw,
yellow, grumous, dark, bloody. Many, from choice or necessity, are
contented to drag on life, not chusing to risk what is termed the radical
operation and cure; but merely by frequent repetitions of the scrotal
puncture or palliative remedy. Sometimes the skin and cellular membrane
of the scrotum, in inveterate hydrocele, is prodigiously thickened.
Page 180
The predisposing and occasional causes of Dropsies, comprehending all the
preceding genera, are in consequence of various acute and chronic
distempers; broken constitutions, cachexy; intermittent, remittent, and
scarlet fevers; repelled erysipelas; rickets; jaundice; biliary obstructions;
suppression or repulsion of habitual or wholesome evacuations, as menses,
hemorrhoides; general debility from various causes; atony of the
sanguinous vessels, and of the exhalents, and transudation of serum through
them; excessive evacuations by hemorrhage, diarrhœa, perspiration, or
other excretories; sudden and large draughts of cold water when the body is
much heated, especially if not discharged by urine or sweat; excess of
fluids, of spirituous liquors; languid circulation; sedentary life; watery
trades; moist air; suppressed perspiration, and watery excretions; tenuity or
impurity of the blood; tenacious adhesion and agglutination of the
coagulable lymph; increase of serous fluid in the blood; diseases and also
ruptures of the lacteals and lymphaticks, and of the kidneys, ureters, and
bladder; defect of lymphatic absorption; obstructed and scirrhous viscera,
mesentery and lungs; asthma, polypi, ossified arteries, excessive fatness,
and other causes intercepting the circulation of the blood: diseases of the
stomach and digestive organs, and those of sanguification; laxity of the
external subcutaneous cellular membrane; debility of the muscular solids
and fibres, and of the tela cellulosa; hereditary; hydatides; violent muscular
exertions, external injuries.
Tympany. There are two species; that where air is confined within the
intestinal tube; the other, where it is extravasated between the intestines and
peritoneum: this last species very rarely occurs, and only from an erosion or
hole of the intestines. The symptoms of Tympanites are, tumour and tension
of the abdomen, and compared to the stretched head of a drum, without
fluctuation or thirst; and not altered by a change of posture, nor is the body
increased in weight: there is inappetency, indigestion, colick pains,
eructation, and explosion of fetid air by the mouth and anus; costiveness,
sallow complexion; and, from the distension of the abdomen, difficulty in
breathing: in the inveterate stages of the disease, ischury, dysury,
emaciation, hectic, and atrophy. Its increase is generally quicker than
ascites; it is also chronic, and contumacious to medicine. Tympany of the
womb is also mentioned by authors; but is a very unusual occurrence: it is
described by local heat, pain, tenesmus, tumour, discharge of fetid air. The
causes of Tympanites are, atony and palsy of the intestinal tube; excessive
preceding genera, are in consequence of various acute and chronic
distempers; broken constitutions, cachexy; intermittent, remittent, and
scarlet fevers; repelled erysipelas; rickets; jaundice; biliary obstructions;
suppression or repulsion of habitual or wholesome evacuations, as menses,
hemorrhoides; general debility from various causes; atony of the
sanguinous vessels, and of the exhalents, and transudation of serum through
them; excessive evacuations by hemorrhage, diarrhœa, perspiration, or
other excretories; sudden and large draughts of cold water when the body is
much heated, especially if not discharged by urine or sweat; excess of
fluids, of spirituous liquors; languid circulation; sedentary life; watery
trades; moist air; suppressed perspiration, and watery excretions; tenuity or
impurity of the blood; tenacious adhesion and agglutination of the
coagulable lymph; increase of serous fluid in the blood; diseases and also
ruptures of the lacteals and lymphaticks, and of the kidneys, ureters, and
bladder; defect of lymphatic absorption; obstructed and scirrhous viscera,
mesentery and lungs; asthma, polypi, ossified arteries, excessive fatness,
and other causes intercepting the circulation of the blood: diseases of the
stomach and digestive organs, and those of sanguification; laxity of the
external subcutaneous cellular membrane; debility of the muscular solids
and fibres, and of the tela cellulosa; hereditary; hydatides; violent muscular
exertions, external injuries.
Tympany. There are two species; that where air is confined within the
intestinal tube; the other, where it is extravasated between the intestines and
peritoneum: this last species very rarely occurs, and only from an erosion or
hole of the intestines. The symptoms of Tympanites are, tumour and tension
of the abdomen, and compared to the stretched head of a drum, without
fluctuation or thirst; and not altered by a change of posture, nor is the body
increased in weight: there is inappetency, indigestion, colick pains,
eructation, and explosion of fetid air by the mouth and anus; costiveness,
sallow complexion; and, from the distension of the abdomen, difficulty in
breathing: in the inveterate stages of the disease, ischury, dysury,
emaciation, hectic, and atrophy. Its increase is generally quicker than
ascites; it is also chronic, and contumacious to medicine. Tympany of the
womb is also mentioned by authors; but is a very unusual occurrence: it is
described by local heat, pain, tenesmus, tumour, discharge of fetid air. The
causes of Tympanites are, atony and palsy of the intestinal tube; excessive
Page 181
purging; chronic colick, dysentery and diarrhœa, or their premature
suppression; suppression of the lochia or menses; the consequence of
rickets, intermittent fevers, asthma, hypochondriasis; diseased abdominal
viscera; excess of pituita, or bile; complicated with ascites, and the
intestinal tube debilitated by soaking in water.
Excess of Fat, obesitas, polysarcia; including anasarcous obesity, abdominal
corpulency, and their complication. This is a frequent malady of adult age in
this island. Those, unfortunately for themselves, thus stuffed and loaded
with grease, are clumsy, unwieldy, inactive, lethargic; on any exercise or
motion, they are panting for breath; and may be compared to cumbrous
hulks. The causes hereditary; laxity of the cellular membrane, or tela
cellulosa; esculent luxuries, sensual living, epicurism, malt liquors, excess
of oleaginous secretion from the blood.
My original intention was to have proceeded to the next group, as arranged
in the medical catalogue: but whether we enter upon their discussion now or
hereafter, is a matter of no moment. However modern nosologists may
plume themselves on classification, it appears to me as attended with no
difficulty, nor requiring any exertion of genius: we may with as much
facility as shuffling a pack of cards, throw diseases into endless
arrangments and associations.
FEMALE Diseases, including obstructio-mensium, chlorosis, profluvium
mensium, fluor albus, hystericks. These derangements of the human
machinery, which, from the days of Hippocrates, have been discriminated
by specifick morbid names, are notwithstanding unnoticed in the London
registers; unless perhaps rising of the lights, spleen, and vapours are
substituted as a portion of hysterick mortality. This formidable phalanx,
whose frequency and fatality are of universal notoriety, must be mustered
amongst the chronic host of diseases. From about the period of puberty,
seldom earlier, they begin to infest numbers of the female sex. On a careful
perusal of nearly one half of the books of the Aldersgate Dispensary in
London, and before mentioned, during six years, I found the total sick and
diseased amounted to 29,511: by far the greater proportion of which were
suppression; suppression of the lochia or menses; the consequence of
rickets, intermittent fevers, asthma, hypochondriasis; diseased abdominal
viscera; excess of pituita, or bile; complicated with ascites, and the
intestinal tube debilitated by soaking in water.
Excess of Fat, obesitas, polysarcia; including anasarcous obesity, abdominal
corpulency, and their complication. This is a frequent malady of adult age in
this island. Those, unfortunately for themselves, thus stuffed and loaded
with grease, are clumsy, unwieldy, inactive, lethargic; on any exercise or
motion, they are panting for breath; and may be compared to cumbrous
hulks. The causes hereditary; laxity of the cellular membrane, or tela
cellulosa; esculent luxuries, sensual living, epicurism, malt liquors, excess
of oleaginous secretion from the blood.
My original intention was to have proceeded to the next group, as arranged
in the medical catalogue: but whether we enter upon their discussion now or
hereafter, is a matter of no moment. However modern nosologists may
plume themselves on classification, it appears to me as attended with no
difficulty, nor requiring any exertion of genius: we may with as much
facility as shuffling a pack of cards, throw diseases into endless
arrangments and associations.
FEMALE Diseases, including obstructio-mensium, chlorosis, profluvium
mensium, fluor albus, hystericks. These derangements of the human
machinery, which, from the days of Hippocrates, have been discriminated
by specifick morbid names, are notwithstanding unnoticed in the London
registers; unless perhaps rising of the lights, spleen, and vapours are
substituted as a portion of hysterick mortality. This formidable phalanx,
whose frequency and fatality are of universal notoriety, must be mustered
amongst the chronic host of diseases. From about the period of puberty,
seldom earlier, they begin to infest numbers of the female sex. On a careful
perusal of nearly one half of the books of the Aldersgate Dispensary in
London, and before mentioned, during six years, I found the total sick and
diseased amounted to 29,511: by far the greater proportion of which were
Page 182
adults, and more females than males. Of this twenty-nine thousand, the
numbers afflicted with different female complaints were as follow:
Obstruct. mens. and chlorosis, 254; profluvium mens. 270; fluor albus, 446;
hysteria, 1104; total, 2074. Here it is worthy of observation, that four only
of the principal female infirmities constituted nearly one fourteenth part of
all the diseases in that dispensary, which is open to afflicted patients of
every description and age. I should, however, not omit to add, from the
information of one of the learned physicians of that charity, that under Fluor
Albus, a few cases of venereal gonorrhœa were concealed; and that under
Hysteriæ, were arranged all female and nervous complaints, without strictly
attending to its generick symptoms. We have here likewise, one proof that
uterine relaxation is a more frequent female malady than obstruction in
London: it is more so in warm than in cold climates: and probably, all these
four female diseases are more prevalent amongst the higher and luxurious
ranks; and in city than in country.
Hippocrates has truly said, “Uterus sexcentarum œrumnarum mulieri auctor
merito dicatur.” Great and important changes ensue at puberty amongst the
two sexes, especially the female, affecting their future health. In both, the
organs of generation are then evolved, and the sexes first capable of
procreation. The semen in males about this period, begins to be strained
through the generative organs, the beard to sprout, and the countenance to
assume a more masculine appearance. That periodical discharge of red
blood from the female womb, called Menses, the index of womanhood,
begins in this island to gleet monthly, about the age of 14, 15, or 16: but its
first eruption and final cessation, as well as its periodical returns, are
sometimes extremely variable; from 11 to 20 years of age; and its final ebb
between 30 and 50; generally, however, between 40 and 50. In warm
climates, the menstrual commencement is earlier, and more profuse. This
discharge is not suddenly in a full stream, but continues oozing from 3 to 5
days, and even longer; the whole quantity in healthy women amounting to 4
or 6, and in others, to even 12 ounces: but the first efforts to menstruation
are commonly scanty and irregular. The quantity of blood evacuated, the
duration, the intervals, periodical returns and effects, are various; and are
diversified by climates, seasons, constitutions, mode of life, habit, and by
numerous other accidental circumstances. In different women the menstrual
intervals are from 2 to 6 weeks, or longer; but when strictly regular, or the
woman not pregnant, every lunar month. The first periods of menstruation,
numbers afflicted with different female complaints were as follow:
Obstruct. mens. and chlorosis, 254; profluvium mens. 270; fluor albus, 446;
hysteria, 1104; total, 2074. Here it is worthy of observation, that four only
of the principal female infirmities constituted nearly one fourteenth part of
all the diseases in that dispensary, which is open to afflicted patients of
every description and age. I should, however, not omit to add, from the
information of one of the learned physicians of that charity, that under Fluor
Albus, a few cases of venereal gonorrhœa were concealed; and that under
Hysteriæ, were arranged all female and nervous complaints, without strictly
attending to its generick symptoms. We have here likewise, one proof that
uterine relaxation is a more frequent female malady than obstruction in
London: it is more so in warm than in cold climates: and probably, all these
four female diseases are more prevalent amongst the higher and luxurious
ranks; and in city than in country.
Hippocrates has truly said, “Uterus sexcentarum œrumnarum mulieri auctor
merito dicatur.” Great and important changes ensue at puberty amongst the
two sexes, especially the female, affecting their future health. In both, the
organs of generation are then evolved, and the sexes first capable of
procreation. The semen in males about this period, begins to be strained
through the generative organs, the beard to sprout, and the countenance to
assume a more masculine appearance. That periodical discharge of red
blood from the female womb, called Menses, the index of womanhood,
begins in this island to gleet monthly, about the age of 14, 15, or 16: but its
first eruption and final cessation, as well as its periodical returns, are
sometimes extremely variable; from 11 to 20 years of age; and its final ebb
between 30 and 50; generally, however, between 40 and 50. In warm
climates, the menstrual commencement is earlier, and more profuse. This
discharge is not suddenly in a full stream, but continues oozing from 3 to 5
days, and even longer; the whole quantity in healthy women amounting to 4
or 6, and in others, to even 12 ounces: but the first efforts to menstruation
are commonly scanty and irregular. The quantity of blood evacuated, the
duration, the intervals, periodical returns and effects, are various; and are
diversified by climates, seasons, constitutions, mode of life, habit, and by
numerous other accidental circumstances. In different women the menstrual
intervals are from 2 to 6 weeks, or longer; but when strictly regular, or the
woman not pregnant, every lunar month. The first periods of menstruation,
Page 183
and the final cessation by age, are two very important epochs in female life,
on which much of their succeeding health and longevity will hinge. But,
without entailing diseases, many women are liable to some menstrual
irregularity, with respect to the periods, duration, and quantity.
Morbid and Irregular Menstruation, under the different heads of scantiness,
chlorosis, or morbus virginius, retention, partial obstruction, and total
suppression. The menstrual eruption is generally and naturally preceded by
heat of the loins, and weight about the uterine region, frequently with pain
and cholick, lassitude, headach, dulness of vision, disturbed sleep,
inappetency, and nausea, pain and load about the breast: all which, with
many other troublesome symptoms, usually disappear on the establishment
of this salutary and critical evacuation. But where the menses do not flow at
puberty, or afterwards become obstructed or suppressed, a numerous train
of morbid symptoms and fatal diseases often ensue; such as inappetency,
indigestion, colick, palpitation of the heart, difficulty and labour in
respiration, pulmonary consumption, hectic, dropsy, fluor albus, low spirits,
fainting, hystericks, insanity, apoplexy, general bad health, barrenness.
Indeed, those women who have passed the stage of puberty some years
without menstruation, are generally barren.—The Chlorosis appears about
puberty, sometimes indeed earlier; and is more frequent amongst indolent
and luxurious females. The complexion is pale, sallow, of a green sickly
tinge; the lips pale, with aversion to motion, with debility, muscular
flaccidity, inappetency, indigestion, craving for unusual and unnatural food,
flatulence, palpitation of the heart, laborious and quick respiration on
exercise or ascending any eminence; pain and weight about the loins, night
sweats, hectic and emaciation, œdematous ancles, crude urine, usually
obstructed menses, unusual bad health, and derangement of the animal,
vital, and natural functions. It is seldom immediately dangerous to life, but
often lays the foundation of some of those diseases above enumerated.
The predisposing and occasional causes of scanty menstruation,
obstruction, and suppression, and of chlorosis, may be comprehended under
the following: general bad health, debility, and unsound constitutions;
partial weakness of the uterine vessels; too great resistance and rigidity of
the uterine vessels; want of sufficient momentum in the sanguineous
circulation; scarcity of florid blood; not sufficient motion nor exercise of
the body; sanguine plethora; sizy blood; spasmodic constriction of the
on which much of their succeeding health and longevity will hinge. But,
without entailing diseases, many women are liable to some menstrual
irregularity, with respect to the periods, duration, and quantity.
Morbid and Irregular Menstruation, under the different heads of scantiness,
chlorosis, or morbus virginius, retention, partial obstruction, and total
suppression. The menstrual eruption is generally and naturally preceded by
heat of the loins, and weight about the uterine region, frequently with pain
and cholick, lassitude, headach, dulness of vision, disturbed sleep,
inappetency, and nausea, pain and load about the breast: all which, with
many other troublesome symptoms, usually disappear on the establishment
of this salutary and critical evacuation. But where the menses do not flow at
puberty, or afterwards become obstructed or suppressed, a numerous train
of morbid symptoms and fatal diseases often ensue; such as inappetency,
indigestion, colick, palpitation of the heart, difficulty and labour in
respiration, pulmonary consumption, hectic, dropsy, fluor albus, low spirits,
fainting, hystericks, insanity, apoplexy, general bad health, barrenness.
Indeed, those women who have passed the stage of puberty some years
without menstruation, are generally barren.—The Chlorosis appears about
puberty, sometimes indeed earlier; and is more frequent amongst indolent
and luxurious females. The complexion is pale, sallow, of a green sickly
tinge; the lips pale, with aversion to motion, with debility, muscular
flaccidity, inappetency, indigestion, craving for unusual and unnatural food,
flatulence, palpitation of the heart, laborious and quick respiration on
exercise or ascending any eminence; pain and weight about the loins, night
sweats, hectic and emaciation, œdematous ancles, crude urine, usually
obstructed menses, unusual bad health, and derangement of the animal,
vital, and natural functions. It is seldom immediately dangerous to life, but
often lays the foundation of some of those diseases above enumerated.
The predisposing and occasional causes of scanty menstruation,
obstruction, and suppression, and of chlorosis, may be comprehended under
the following: general bad health, debility, and unsound constitutions;
partial weakness of the uterine vessels; too great resistance and rigidity of
the uterine vessels; want of sufficient momentum in the sanguineous
circulation; scarcity of florid blood; not sufficient motion nor exercise of
the body; sanguine plethora; sizy blood; spasmodic constriction of the
Page 184
uterine vessels; sudden passions of mind, especially the depressing
passions; cold wet feet; cold liquors and various cooling luxuries drank or
eat at the menstrual period; crude watery diet; worms; celibacy; love;
salacity stifled; lax fibre; severe parturition, and local diseases inherent in
the womb and vagina.
Uterine Relaxation, including excessive menstruation, fluor albus,
leucorrhœa. There is a great similarity in all their causes. We here treat of
menstrual excess in the unimpregnated state; reserving for pregnancy that
uterine hemorrhage, vulgarly denominated Flooding. Menstruation may be
morbid from frequency in the returns, from duration, and from quantity. It
has already been said, that the quantity of the menstrual flux, the
recurrence, and the duration, vary in different women: the immoderate
discharge is determined not altogether by the absolute quantity, but by the
effects: such as languor, debility, pale countenance, weak pulse, palpitation
of the heart; depression of spirits, pain in the back and loins, inappetency,
coldness of the skin and of the lower extremities; in the evening œdematous
ancles. Excessive menstruation may either be sudden and within a few days,
or chronic and persevering a long time beyond the natural period. There is
also erroneous menstruation from various parts of the body; of which many
extraordinary and monstrous examples may be seen in the records of
medicine. Menstruation in excess, especially if chronic, is often
accompanied with fluor albus; and may terminate in consumption and
dropsy, and in many of the diseases enumerated, under obstruction and
suppression.
The Fluor Albus often succeeds or accompanies excessive menstruation. It
is a dripping discharge from the womb and vagina, and from the same
vessels which exude the menses, sometimes pale and serous, or often
variously intermixed with yellow, green, and red tinges; sometimes fetid
and acrid, and either constant or irregularly intermittent. At the
commencement, the usual concomitant symptoms ascribed to this disease,
such as pain and weakness in the back and loins, indigestion, &c. only
occur when the discharge is excessive, or long continued. It is then attended
with a pale sickly colour and countenance, dejection of spirits, palpitation
of the heart, lassitude and debility, pain in the stomach, loss of appetite,
indigestion, flatulence, acrid and turbid urine, hectic. But notwithstanding
the heat and acrimony of the excretion in many instances, especially when
passions; cold wet feet; cold liquors and various cooling luxuries drank or
eat at the menstrual period; crude watery diet; worms; celibacy; love;
salacity stifled; lax fibre; severe parturition, and local diseases inherent in
the womb and vagina.
Uterine Relaxation, including excessive menstruation, fluor albus,
leucorrhœa. There is a great similarity in all their causes. We here treat of
menstrual excess in the unimpregnated state; reserving for pregnancy that
uterine hemorrhage, vulgarly denominated Flooding. Menstruation may be
morbid from frequency in the returns, from duration, and from quantity. It
has already been said, that the quantity of the menstrual flux, the
recurrence, and the duration, vary in different women: the immoderate
discharge is determined not altogether by the absolute quantity, but by the
effects: such as languor, debility, pale countenance, weak pulse, palpitation
of the heart; depression of spirits, pain in the back and loins, inappetency,
coldness of the skin and of the lower extremities; in the evening œdematous
ancles. Excessive menstruation may either be sudden and within a few days,
or chronic and persevering a long time beyond the natural period. There is
also erroneous menstruation from various parts of the body; of which many
extraordinary and monstrous examples may be seen in the records of
medicine. Menstruation in excess, especially if chronic, is often
accompanied with fluor albus; and may terminate in consumption and
dropsy, and in many of the diseases enumerated, under obstruction and
suppression.
The Fluor Albus often succeeds or accompanies excessive menstruation. It
is a dripping discharge from the womb and vagina, and from the same
vessels which exude the menses, sometimes pale and serous, or often
variously intermixed with yellow, green, and red tinges; sometimes fetid
and acrid, and either constant or irregularly intermittent. At the
commencement, the usual concomitant symptoms ascribed to this disease,
such as pain and weakness in the back and loins, indigestion, &c. only
occur when the discharge is excessive, or long continued. It is then attended
with a pale sickly colour and countenance, dejection of spirits, palpitation
of the heart, lassitude and debility, pain in the stomach, loss of appetite,
indigestion, flatulence, acrid and turbid urine, hectic. But notwithstanding
the heat and acrimony of the excretion in many instances, especially when
Page 185
chronic and inveterate, yet it may easily be distinguished from venereal
gonorrhœa. Women of various ages after puberty, married and unmarried,
some even after the final menstrual cessation, are obnoxious to this gleet,
which is not infectious. The fatal termination may be in some of the
different diseases consequent of obstructed and excessive menstruation;
such as barrenness, diseases of the womb; colick, piles, strangury,
hystericks, low spirits, consumption, dropsy.
The predisposing and occasional causes of excessive menstruation and of
fluor albus, are, many of the general causes of hemorrhages, already
enumerated; plethora, sedentary, luxurious life, stimulating and nutritious
diet; too long indulgence in warm soft beds; warm chambers; suppression
of usual and habitual evacuations; weakness and laxity of the uterine
vessels from abortion, violent evulsion of the placenta, or other injuries
during parturition; difficult and lingering, and also frequent parturition;
general relaxation, and delicate constitution; weak nerves; violent exercise,
especially in hot climates and weather; excessive heat of the season or
climate; moist watery climate; violent efforts of the body or muscles, or
straining of the body and loins; external injuries, or falls near the uterine
region; excess of venery and salacity, manustupration; spirituous liquors
and drunkenness, intemperance, immoderate use of tea, and other warm
fluids; immoderate use of warm baths or stoves; neglect of cleanliness and
abstersion; passions of mind, frights; impeded perspiration; excess of serum
in the blood; scorbutic habit and acrimony: purulent translation to and
deposition upon the womb from other parts of the body; polypi, fungus,
scirrhus, cancer, ulcers in the womb or vagina; procidentia uteri et vaginæ,
emmenagogue medicines.
Final Cessation of Menstruation from years. This is a dangerous period to
women; more so, perhaps, than any other stage of maturity. In this island
the menses usually cease about 48, 45, or sometimes at 41, and earlier;
especially after frequent parturition. The springs of life, or generative
powers, then become effete; but in the male sex, the faculty of procreation
continues ten, twenty, and in some thirty years later. In most cases, women
do not conceive before menstruation, nor after its cessation. Towards the
final drain, women commonly are irregular in the recurrence, duration, or
quantity of the discharge; which is often excessive. The longer or shorter
duration of menstruation depends, in some degree, on its earlier or later
gonorrhœa. Women of various ages after puberty, married and unmarried,
some even after the final menstrual cessation, are obnoxious to this gleet,
which is not infectious. The fatal termination may be in some of the
different diseases consequent of obstructed and excessive menstruation;
such as barrenness, diseases of the womb; colick, piles, strangury,
hystericks, low spirits, consumption, dropsy.
The predisposing and occasional causes of excessive menstruation and of
fluor albus, are, many of the general causes of hemorrhages, already
enumerated; plethora, sedentary, luxurious life, stimulating and nutritious
diet; too long indulgence in warm soft beds; warm chambers; suppression
of usual and habitual evacuations; weakness and laxity of the uterine
vessels from abortion, violent evulsion of the placenta, or other injuries
during parturition; difficult and lingering, and also frequent parturition;
general relaxation, and delicate constitution; weak nerves; violent exercise,
especially in hot climates and weather; excessive heat of the season or
climate; moist watery climate; violent efforts of the body or muscles, or
straining of the body and loins; external injuries, or falls near the uterine
region; excess of venery and salacity, manustupration; spirituous liquors
and drunkenness, intemperance, immoderate use of tea, and other warm
fluids; immoderate use of warm baths or stoves; neglect of cleanliness and
abstersion; passions of mind, frights; impeded perspiration; excess of serum
in the blood; scorbutic habit and acrimony: purulent translation to and
deposition upon the womb from other parts of the body; polypi, fungus,
scirrhus, cancer, ulcers in the womb or vagina; procidentia uteri et vaginæ,
emmenagogue medicines.
Final Cessation of Menstruation from years. This is a dangerous period to
women; more so, perhaps, than any other stage of maturity. In this island
the menses usually cease about 48, 45, or sometimes at 41, and earlier;
especially after frequent parturition. The springs of life, or generative
powers, then become effete; but in the male sex, the faculty of procreation
continues ten, twenty, and in some thirty years later. In most cases, women
do not conceive before menstruation, nor after its cessation. Towards the
final drain, women commonly are irregular in the recurrence, duration, or
quantity of the discharge; which is often excessive. The longer or shorter
duration of menstruation depends, in some degree, on its earlier or later
Page 186
commencement. Women who never had children, nor enjoyed sound health;
those whose constitutions have been impaired by frequent parturition and
miscarriages, and others of delicate nerves and structure, all these are
frequently obnoxious to complaints and diseases at the final uterine ebb. As
infirmities and bad health are frequently removed on the first flow of the
menses, such are also again prone to relapse in this autumn of life, into
nervous complaints, hystericks, consumption, dropsy.
Hystericks, uterine suffocation, and female nervous diseases. This morbid
Proteus rarely attacks before puberty, most frequently between puberty and
middle age. Married and single women are obnoxious to it; but more so the
latter and widows, and those barren, or irregular in menstruation. It is not so
frequent amongst the laborious class, or those of clumsy organs, as in the
higher ranks, and particularly in those constitutions strung to a morbid
extreme of nervous and muscular sensibility and irritability. It may also
affect females of robust muscular constitutions. It very rarely attacks the
male sex; the only disease in them, somewhat analogous to it, is
hypochondriasm. The regular hysterick paroxism generally attacks by
surprize, with a sensation of some pain and fulness, and of a convoluted ball
or lump, rising up from the lower part of the belly to the stomach and
throat, where it seems to stick, and excites efforts to cough it up, or to gulp
it down; with difficulty of swallowing and sense of strangulation, and often
suspension of the functions of voice and speech. In others, the ball, without
ascending, rolls tumultuously and convulsively round the abdomen. The
paroxisms are preceded and accompanied with palpitation of the heart: the
patient often falls down in a fainting fit, turns cold and pale, and the breath
and pulse are scarce perceptible. Sometimes the paroxism deviates into
immoderate laughter or tears; sometimes into muscular convulsions and
distortions, resembling epilepsy; or into stupor and insensibility; and there
is usually a profuse secretion of limpid urine; sometimes there is vomiting.
After some remission and exacerbation, the paroxisms cease, the patient
recovers, stupid, and seemingly dozing, with repeated sighing and sobbing;
and generally with some remembrance of the paroxism. The form, duration,
violence, recurrence, and repetition of the hysterick paroxisms are various,
not only in different women, but even in the same at different times; and,
however alarming in appearance, are seldom immediately dangerous to life:
but by continuance, may derange the machine, and lay the foundation of
those whose constitutions have been impaired by frequent parturition and
miscarriages, and others of delicate nerves and structure, all these are
frequently obnoxious to complaints and diseases at the final uterine ebb. As
infirmities and bad health are frequently removed on the first flow of the
menses, such are also again prone to relapse in this autumn of life, into
nervous complaints, hystericks, consumption, dropsy.
Hystericks, uterine suffocation, and female nervous diseases. This morbid
Proteus rarely attacks before puberty, most frequently between puberty and
middle age. Married and single women are obnoxious to it; but more so the
latter and widows, and those barren, or irregular in menstruation. It is not so
frequent amongst the laborious class, or those of clumsy organs, as in the
higher ranks, and particularly in those constitutions strung to a morbid
extreme of nervous and muscular sensibility and irritability. It may also
affect females of robust muscular constitutions. It very rarely attacks the
male sex; the only disease in them, somewhat analogous to it, is
hypochondriasm. The regular hysterick paroxism generally attacks by
surprize, with a sensation of some pain and fulness, and of a convoluted ball
or lump, rising up from the lower part of the belly to the stomach and
throat, where it seems to stick, and excites efforts to cough it up, or to gulp
it down; with difficulty of swallowing and sense of strangulation, and often
suspension of the functions of voice and speech. In others, the ball, without
ascending, rolls tumultuously and convulsively round the abdomen. The
paroxisms are preceded and accompanied with palpitation of the heart: the
patient often falls down in a fainting fit, turns cold and pale, and the breath
and pulse are scarce perceptible. Sometimes the paroxism deviates into
immoderate laughter or tears; sometimes into muscular convulsions and
distortions, resembling epilepsy; or into stupor and insensibility; and there
is usually a profuse secretion of limpid urine; sometimes there is vomiting.
After some remission and exacerbation, the paroxisms cease, the patient
recovers, stupid, and seemingly dozing, with repeated sighing and sobbing;
and generally with some remembrance of the paroxism. The form, duration,
violence, recurrence, and repetition of the hysterick paroxisms are various,
not only in different women, but even in the same at different times; and,
however alarming in appearance, are seldom immediately dangerous to life:
but by continuance, may derange the machine, and lay the foundation of
Page 187
diseases. They sometimes occasion, symptoms of dyspepsy; but oftener the
appetite and digestion are unimpaired.
The prolifick brood of what may be termed Nervous symptoms, or irregular
hysterick paroxisms, in their turn interrupt and disturb most of the
important functions and organs of the human body; the brain and nerves;
the heart, blood vessels, circulation, and respiration; the stomach and
intestines. Amongst this medley of afflictions are nausea and vomiting,
flatulence, coldness of the stomach, depraved appetite, indigestion, unusual
cravings, colick pains, sudden flushes of heat and cold, formication,
transient fugacious pains, fixed spasms, fainting, convulsions, headach,
general or partial, and fixed like a nail in a small compass; vertigo,
drowsiness, lethargy; alarm, trembling and starting at the least noise or
surprize; the spirits sometimes exhilarated to excess, at other times plunged
into despair: to these may be added timidity, capricious temper, palpitation
of the heart, resemblance of spasmodic asthma, flow of limpid urine, or of
saliva, difficulty of urine, night sweats; “cum multis aliis.” If the symptoms
of each are properly understood, hystericks cannot be confounded with
syncope, epilepsy, and apoplexy; to all which it has some resemblance.
The predisposing and occasional causes of hystericks are, excessive
delicacy, sensibility, and irritability of the nervous and muscular fibres, and
laxity of the muscular solids; retention and suppression of usual
evacuations, especially the menses; scantiness and also excess in
menstruation; fluor albus; profuse hemorrhages, and other evacuations by
stool and urine; sanguineous plethora; hereditary; obstructions in some of
the abdominal viscera, or in the circulation of the vena porta; scirrhous
abdominal viscera; flatulence in the stomach and intestines; tough phlegm
and sordes in the stomach and intestines; weak stomach; worms; improper
food; drunkenness; indolent, luxurious, voluptuous, sedentary life;
valetudinarian regimen; irritability of mind; passions of mind, particularly
the disagreeable and depressing, as cares, grief, disappointed love, jealousy,
frights, intense fixed mental application to one object, religion, envy, anger,
grievous misfortunes, joy, concealed uneasiness of mind; celibacy; salacity;
sudden and great changes in the constitution from menstruation, generation,
pregnancy, and parturition; impure blood, its acrid tenuity; repulsion of
cutaneous eruptions; general bad health, and diseased state of the fluids or
appetite and digestion are unimpaired.
The prolifick brood of what may be termed Nervous symptoms, or irregular
hysterick paroxisms, in their turn interrupt and disturb most of the
important functions and organs of the human body; the brain and nerves;
the heart, blood vessels, circulation, and respiration; the stomach and
intestines. Amongst this medley of afflictions are nausea and vomiting,
flatulence, coldness of the stomach, depraved appetite, indigestion, unusual
cravings, colick pains, sudden flushes of heat and cold, formication,
transient fugacious pains, fixed spasms, fainting, convulsions, headach,
general or partial, and fixed like a nail in a small compass; vertigo,
drowsiness, lethargy; alarm, trembling and starting at the least noise or
surprize; the spirits sometimes exhilarated to excess, at other times plunged
into despair: to these may be added timidity, capricious temper, palpitation
of the heart, resemblance of spasmodic asthma, flow of limpid urine, or of
saliva, difficulty of urine, night sweats; “cum multis aliis.” If the symptoms
of each are properly understood, hystericks cannot be confounded with
syncope, epilepsy, and apoplexy; to all which it has some resemblance.
The predisposing and occasional causes of hystericks are, excessive
delicacy, sensibility, and irritability of the nervous and muscular fibres, and
laxity of the muscular solids; retention and suppression of usual
evacuations, especially the menses; scantiness and also excess in
menstruation; fluor albus; profuse hemorrhages, and other evacuations by
stool and urine; sanguineous plethora; hereditary; obstructions in some of
the abdominal viscera, or in the circulation of the vena porta; scirrhous
abdominal viscera; flatulence in the stomach and intestines; tough phlegm
and sordes in the stomach and intestines; weak stomach; worms; improper
food; drunkenness; indolent, luxurious, voluptuous, sedentary life;
valetudinarian regimen; irritability of mind; passions of mind, particularly
the disagreeable and depressing, as cares, grief, disappointed love, jealousy,
frights, intense fixed mental application to one object, religion, envy, anger,
grievous misfortunes, joy, concealed uneasiness of mind; celibacy; salacity;
sudden and great changes in the constitution from menstruation, generation,
pregnancy, and parturition; impure blood, its acrid tenuity; repulsion of
cutaneous eruptions; general bad health, and diseased state of the fluids or
Page 188
solids; irregular gout. It is often difficult and impracticable to dive into the
real efficient causes.
Childbed Mortality in London is nearly one eightieth part of the whole
funeral catalogue. It is in storms and hurricanes; or within a very short
space of time. The mortality of this group must occur between the two
extremes of 16 and 50 years of age. Or, as marriages in this island, one with
another, are computed to commence on the side of the woman at 25, we
may, with safety, rate the principal mortality in the stage of life between 20
and 50. On this interesting subject there are several curious and useful
propositions, which I have attempted to establish by demonstrative proof.
These are, 1st, The number of women who, on an average, die in childbed:
2dly, The proportion between natural, laborious, preternatural, and complex
labours: 3dly, The number of abortive and stillborn infants to those brought
forth alive: 4thly, The proportion of twins and tergemini to single births:
5thly, The diseases principally fatal to women during pregnancy and
parturition, and afterwards, with the arithmetical ratio and fatality of each,
and also of labours. To the investigation of these corollaries I proceed in a
regular order.
From twenty-four years of the London, and from several country registers
in England and Germany, Dr. Short calculates, that on an average, 1 of
every 60 women die in childbed: others rate the decrement at 1 of 66, or 3
in 200. Upon a much broader basis I formed a puerperal estimate. From the
year 1700 to 1776, the christenings in the London registers amount to
1,220,656; and the abortives and stillborn in the same interval, to 46,831.
The sum total therefore of the births, including the christenings and
abortives, amounts to 1,267,487. During the above period of 76 years, the
deaths in childbed are 17,057; which number employed as a dividend to the
former, makes about 1 of 74 pregnant women to perish in childbed. But as a
considerable number of infants, after being brought into the world alive, die
before baptism or christening, and consequently are excluded from the
publick enrolment of births and christenings, this is an additional reason for
believing that the perils of childbed are not rated by us too low.
Respecting the proportion of natural, laborious, and preternatural
parturition, Dr. Smellie says, “That of 1000 women in childbed, 920 of
them will be delivered in the ordinary way, with little or no accocheur
trouble, skill, or assistance: 70 more of the thousand will be difficult
real efficient causes.
Childbed Mortality in London is nearly one eightieth part of the whole
funeral catalogue. It is in storms and hurricanes; or within a very short
space of time. The mortality of this group must occur between the two
extremes of 16 and 50 years of age. Or, as marriages in this island, one with
another, are computed to commence on the side of the woman at 25, we
may, with safety, rate the principal mortality in the stage of life between 20
and 50. On this interesting subject there are several curious and useful
propositions, which I have attempted to establish by demonstrative proof.
These are, 1st, The number of women who, on an average, die in childbed:
2dly, The proportion between natural, laborious, preternatural, and complex
labours: 3dly, The number of abortive and stillborn infants to those brought
forth alive: 4thly, The proportion of twins and tergemini to single births:
5thly, The diseases principally fatal to women during pregnancy and
parturition, and afterwards, with the arithmetical ratio and fatality of each,
and also of labours. To the investigation of these corollaries I proceed in a
regular order.
From twenty-four years of the London, and from several country registers
in England and Germany, Dr. Short calculates, that on an average, 1 of
every 60 women die in childbed: others rate the decrement at 1 of 66, or 3
in 200. Upon a much broader basis I formed a puerperal estimate. From the
year 1700 to 1776, the christenings in the London registers amount to
1,220,656; and the abortives and stillborn in the same interval, to 46,831.
The sum total therefore of the births, including the christenings and
abortives, amounts to 1,267,487. During the above period of 76 years, the
deaths in childbed are 17,057; which number employed as a dividend to the
former, makes about 1 of 74 pregnant women to perish in childbed. But as a
considerable number of infants, after being brought into the world alive, die
before baptism or christening, and consequently are excluded from the
publick enrolment of births and christenings, this is an additional reason for
believing that the perils of childbed are not rated by us too low.
Respecting the proportion of natural, laborious, and preternatural
parturition, Dr. Smellie says, “That of 1000 women in childbed, 920 of
them will be delivered in the ordinary way, with little or no accocheur
trouble, skill, or assistance: 70 more of the thousand will be difficult
Page 189
labours, or slow and tedious, when often some skill and aid of the
accocheur will be necessary; and the remaining ten of the thousand will be
preternatural labours.” There will, therefore, according to this author, be
about 8 per cent. of slow, laborious, preternatural, and anomalous labours,
which, in different gradations, will be more tedious, difficult, and dangerous
than in the usual process of nature.
It is a proposition not uninteresting in Obstetricks, and in medical
jurisprudence, and in many instances it is material to the medical character,
to observe that, in the preceding list, during seventy-five years in London,
there were brought forth alive and christened, 1,220,656; that the abortives
and stillborn in the same period were, 46831, or as 1 of 26. But, as we just
now remarked, that the chrisoms and infants who die in the threshold of
life, and previous to baptism, are excluded from the registered births and
christenings; on that account we may venture to calculate the abortive list to
those who are ushered alive into the world, as 1 of 27 or 28; perhaps more,
or about 3 per cent. Were we, however, to add the abortions and
miscarriages of diminutive embryos, in the early months of pregnancy, and
which are much more frequent than in the latter months, the abortive
catalogue would be prodigiously swelled.
Dr. Short attempted to ascertain the proportion between single births, twins,
and tergemini, from a register of three large parishes, during a series of
years, in which the single births amounted to 11,415; the twins and
tergemini to 311, or about one of thirty-five.
Lastly, Let us examine what were the several diseases during pregnancy and
parturition, and afterwards which occasioned this childbed mortality, and in
what arithmetical ratio were the fatality of those respective puerperal
diseases and casualties. This inquiry demands a previous analysis of
pregnancy and parturition.
Conception and Pregnancy. In some instances, there is not a more puzzling
problem in midwifery, than to decide the simple question, whether or not a
woman is pregnant? The symptoms in the beginning are various and
obscure, not only in different women, but even in the same woman at
different times, and are fallible until the end of the fourth month of
gestation. In the beginning, one or more of the following indications sway
our decision: a slight titillating pain, or unusual disturbance about the womb
accocheur will be necessary; and the remaining ten of the thousand will be
preternatural labours.” There will, therefore, according to this author, be
about 8 per cent. of slow, laborious, preternatural, and anomalous labours,
which, in different gradations, will be more tedious, difficult, and dangerous
than in the usual process of nature.
It is a proposition not uninteresting in Obstetricks, and in medical
jurisprudence, and in many instances it is material to the medical character,
to observe that, in the preceding list, during seventy-five years in London,
there were brought forth alive and christened, 1,220,656; that the abortives
and stillborn in the same period were, 46831, or as 1 of 26. But, as we just
now remarked, that the chrisoms and infants who die in the threshold of
life, and previous to baptism, are excluded from the registered births and
christenings; on that account we may venture to calculate the abortive list to
those who are ushered alive into the world, as 1 of 27 or 28; perhaps more,
or about 3 per cent. Were we, however, to add the abortions and
miscarriages of diminutive embryos, in the early months of pregnancy, and
which are much more frequent than in the latter months, the abortive
catalogue would be prodigiously swelled.
Dr. Short attempted to ascertain the proportion between single births, twins,
and tergemini, from a register of three large parishes, during a series of
years, in which the single births amounted to 11,415; the twins and
tergemini to 311, or about one of thirty-five.
Lastly, Let us examine what were the several diseases during pregnancy and
parturition, and afterwards which occasioned this childbed mortality, and in
what arithmetical ratio were the fatality of those respective puerperal
diseases and casualties. This inquiry demands a previous analysis of
pregnancy and parturition.
Conception and Pregnancy. In some instances, there is not a more puzzling
problem in midwifery, than to decide the simple question, whether or not a
woman is pregnant? The symptoms in the beginning are various and
obscure, not only in different women, but even in the same woman at
different times, and are fallible until the end of the fourth month of
gestation. In the beginning, one or more of the following indications sway
our decision: a slight titillating pain, or unusual disturbance about the womb
Page 190
and navel; nausea and reaching to vomit in the mornings, loss of appetite,
sudden unnatural cravings and longings of the stomach, heartburn,
drowsiness, slothfulness, chagrin, capriciousness, dislike, moroseness,
aversion to venereal dalliance, headach, tooth-ach, increased secretion of
saliva, tawny circle round the eyes, and some perceptible alteration of
countenance. But the most unerring signs of pregnancy are by the touch and
feel of the accocheur’s finger introduced into the vagina, or rectum.
The womb, a small bag, in shape and size like a pear, situated within the
pelvis, between the bladder and rectum, and terminated at its lower part by
a soft tube, from three to six inches in length, called the Vagina, begins in
pregnancy to be enlarged. About the third month of gestation, the womb is
closely locked up, and the menses cease to flow: but in some very rare
cases, there is a serous gleet during pregnancy, and in others plethoric, a
small sanguineous discharge at the usual menstrual periods. About the
fourth or fifth month, the womb is considerably distended, and its upper
part ascends above the brim of the pelvis; by the finger it is felt weighty and
enlarged, its neck shorter, and raised higher up in the pelvis; and the
abdomen begins to be distended above the pubis. About this period also, the
mother begins to be sensible of the infant’s motion. For although the heart
and arteries of the embryo, from its earliest, rudiments, are in action, yet the
other muscular efforts of the fœtus are seldom perceptible by the mother
until the third or fourth month, increasing in strength and frequency to the
end of pregnancy. Before the end of the fifth month, the womb reaches up
half-way between the pubis and navel; in the sixth month, to the navel; in
the eighth month, half-way between the navel and stomach; in the ninth and
last month, to near the lower part of the stomach, filling up the whole
anterior part of the abdomen. The uterine enlargement is then not only
perceptible to the hand pressed on the abdomen, but is also obvious to the
eye of the spectator. In different women, however, the size of this
protuberance is various. Towards the latter stages of pregnancy, the
mother’s breasts begin to enlarge, and the circle or areola round the nipples,
is of a brown colour.
Nine solar months, or thirty-nine weeks, or 273 days, reckoning from the
time of conception, is the usual period of uterine gestation in the human
species. But, as conception is often obscure, unless the limited congress of
the sexes can be ascertained, we must be guided by probable conjectures
sudden unnatural cravings and longings of the stomach, heartburn,
drowsiness, slothfulness, chagrin, capriciousness, dislike, moroseness,
aversion to venereal dalliance, headach, tooth-ach, increased secretion of
saliva, tawny circle round the eyes, and some perceptible alteration of
countenance. But the most unerring signs of pregnancy are by the touch and
feel of the accocheur’s finger introduced into the vagina, or rectum.
The womb, a small bag, in shape and size like a pear, situated within the
pelvis, between the bladder and rectum, and terminated at its lower part by
a soft tube, from three to six inches in length, called the Vagina, begins in
pregnancy to be enlarged. About the third month of gestation, the womb is
closely locked up, and the menses cease to flow: but in some very rare
cases, there is a serous gleet during pregnancy, and in others plethoric, a
small sanguineous discharge at the usual menstrual periods. About the
fourth or fifth month, the womb is considerably distended, and its upper
part ascends above the brim of the pelvis; by the finger it is felt weighty and
enlarged, its neck shorter, and raised higher up in the pelvis; and the
abdomen begins to be distended above the pubis. About this period also, the
mother begins to be sensible of the infant’s motion. For although the heart
and arteries of the embryo, from its earliest, rudiments, are in action, yet the
other muscular efforts of the fœtus are seldom perceptible by the mother
until the third or fourth month, increasing in strength and frequency to the
end of pregnancy. Before the end of the fifth month, the womb reaches up
half-way between the pubis and navel; in the sixth month, to the navel; in
the eighth month, half-way between the navel and stomach; in the ninth and
last month, to near the lower part of the stomach, filling up the whole
anterior part of the abdomen. The uterine enlargement is then not only
perceptible to the hand pressed on the abdomen, but is also obvious to the
eye of the spectator. In different women, however, the size of this
protuberance is various. Towards the latter stages of pregnancy, the
mother’s breasts begin to enlarge, and the circle or areola round the nipples,
is of a brown colour.
Nine solar months, or thirty-nine weeks, or 273 days, reckoning from the
time of conception, is the usual period of uterine gestation in the human
species. But, as conception is often obscure, unless the limited congress of
the sexes can be ascertained, we must be guided by probable conjectures
Page 191
respecting the ultimate completion of uterine gestation; in which women
themselves often err days and weeks. The usual way of regulating puerperal
books, or reckonings, is by going backwards, and computing from the
middle space between the last menstruation, and the immediately
succeeding menstrual period which should appear, but is interrupted to
support the fœtus. Some women are delivered of living children
considerably earlier than the end of the ninth month; and others, probably, a
little later.
The comparative growth of the fœtus infinitely surpasses that of its whole
future existence. But the exact age of uterine embryos, and of abortives, is,
in some degree, conjectural. Before the seventeenth day after conception, its
rudiments are not even visible to the naked eye: the glary ovum has then
slidden down from the ovarium, through one of the lateral tubes into the
womb. The size of an abortion, comprehending the fœtus, its membranes,
waters, and placenta, at the end of six weeks, does not exceed in size that of
a pigeon’s or hen’s, and in three months, a goose’s egg. About the end of the
fourth month, its different viscera are formed; and its length between four
and five inches. At the end of the ninth month, the homunculus length, from
head to foot, is from sixteen to twenty-one, and in some even twenty-six
inches: its weight, from six to ten pounds. Some extraordinary fœtal giants,
however, have been seen, from ten to twenty pounds in gravity. Its usual
dimensions, so necessary to obstetrical knowledge, is, from the forehead to
the hindhead, four inches and a half; from each temple the lateral
dimensions three inches and a half; the circumference of the head from
twelve to fourteen or fifteen inches; the breadth of the shoulders five or six
inches, and of the breech nearly the same; the circumference of the
shoulders and of the breech, from fifteen to eighteen inches. We might also
have observed, that in gravity, exclusive of placenta, membranes, and
waters, the mature fœtus exceeds considerably that of the whole menstrual
blood, were it to be accumulated throughout pregnancy.
In the womb, the fœtus is folded together into a round oval form; and its
usual position is with the head downwards, presenting at the upper brim of
the pelvis, and at the mouth of the womb; the chin resting on its breast; one
ear turned to the back part of the mother, the other forwards; the face and
hindhead to the mother’s sides; the thighs bent up along the belly; the legs
again bent backwards, with the heels to the buttocks; the arms laid along the
themselves often err days and weeks. The usual way of regulating puerperal
books, or reckonings, is by going backwards, and computing from the
middle space between the last menstruation, and the immediately
succeeding menstrual period which should appear, but is interrupted to
support the fœtus. Some women are delivered of living children
considerably earlier than the end of the ninth month; and others, probably, a
little later.
The comparative growth of the fœtus infinitely surpasses that of its whole
future existence. But the exact age of uterine embryos, and of abortives, is,
in some degree, conjectural. Before the seventeenth day after conception, its
rudiments are not even visible to the naked eye: the glary ovum has then
slidden down from the ovarium, through one of the lateral tubes into the
womb. The size of an abortion, comprehending the fœtus, its membranes,
waters, and placenta, at the end of six weeks, does not exceed in size that of
a pigeon’s or hen’s, and in three months, a goose’s egg. About the end of the
fourth month, its different viscera are formed; and its length between four
and five inches. At the end of the ninth month, the homunculus length, from
head to foot, is from sixteen to twenty-one, and in some even twenty-six
inches: its weight, from six to ten pounds. Some extraordinary fœtal giants,
however, have been seen, from ten to twenty pounds in gravity. Its usual
dimensions, so necessary to obstetrical knowledge, is, from the forehead to
the hindhead, four inches and a half; from each temple the lateral
dimensions three inches and a half; the circumference of the head from
twelve to fourteen or fifteen inches; the breadth of the shoulders five or six
inches, and of the breech nearly the same; the circumference of the
shoulders and of the breech, from fifteen to eighteen inches. We might also
have observed, that in gravity, exclusive of placenta, membranes, and
waters, the mature fœtus exceeds considerably that of the whole menstrual
blood, were it to be accumulated throughout pregnancy.
In the womb, the fœtus is folded together into a round oval form; and its
usual position is with the head downwards, presenting at the upper brim of
the pelvis, and at the mouth of the womb; the chin resting on its breast; one
ear turned to the back part of the mother, the other forwards; the face and
hindhead to the mother’s sides; the thighs bent up along the belly; the legs
again bent backwards, with the heels to the buttocks; the arms laid along the
Page 192
infant’s sides, or before its breast. Thus folded together in a globular heap, it
is wrapped up in four delicate transparent membranes, and is immerged in
water, which continues decreasing throughout pregnancy, and at parturition
is various in quantity, from one to six pints. By its blood vessels united into
what is termed the navel-string, the fœtus is attached to a flat round cake,
resembling a firm coagulum of blood, called the placenta, and which is
closely cemented with the mother’s womb. In this natural posture the
mature fœtus lays above the pelvis, and totally within the abdomen.
Previous to parturition, the fœtus must descend “inter scyllam et
charybdin,” through that ossious circumvallation, or bony cavity of the
mother, called Pelvis. This cavity is open, both above and below, and is
inclosed between the hips, groin, and lower part of the spine. The female
pelvis, for obvious reasons, is more capacious than in males. In a well
formed and proportioned woman, the common standard is at the upper part
of the brim, from the back part of the spine, or sacrum, four inches and a
half; laterally, or from side to side, five inches and a half; below, at the
lower opening of the pelvis, these dimensions are exactly reversed. But as
in parturition, the os coxcygis, or lower bone of the spine, is elastic and
moveable, on pressure backwards by the infant’s head, the diameter of the
pelvis below is thereby enlarged in all its dimensions. The ossious depth of
the pelvis, from the top of the os sacrum to the extremity of the os coxcygis,
is five, or five inches and a half; at the sides four; before, or in the interval
between the groins, two inches. In some deformed and ricketty women, the
dimensions of the pelvis are either throughout, or in particular parts, greatly
contracted, and most commonly at the upper part.
Of Parturition natural, laborious, preternatural, complex, or anomalous.
Natural labours are all those in which the infant’s head presents at the
orifice of the womb; which are probably ninety-nine out of every hundred
labours. But in this presentation of the infant, some are natural and easy,
and a small number lingering and difficult labours. Preternatural labours are
either all those wherein any other part of the fœtus spontaneously presents
at the orifice of the womb, or where, notwithstanding the natural
presentation of the head, yet it is necessary to turn the infant by force, and
to deliver it by the feet foremost. Complex and anomalous labours are
those, whether natural or preternatural, accompanied with extraordinary
symptoms and danger, such as floodings, convulsions, &c.
is wrapped up in four delicate transparent membranes, and is immerged in
water, which continues decreasing throughout pregnancy, and at parturition
is various in quantity, from one to six pints. By its blood vessels united into
what is termed the navel-string, the fœtus is attached to a flat round cake,
resembling a firm coagulum of blood, called the placenta, and which is
closely cemented with the mother’s womb. In this natural posture the
mature fœtus lays above the pelvis, and totally within the abdomen.
Previous to parturition, the fœtus must descend “inter scyllam et
charybdin,” through that ossious circumvallation, or bony cavity of the
mother, called Pelvis. This cavity is open, both above and below, and is
inclosed between the hips, groin, and lower part of the spine. The female
pelvis, for obvious reasons, is more capacious than in males. In a well
formed and proportioned woman, the common standard is at the upper part
of the brim, from the back part of the spine, or sacrum, four inches and a
half; laterally, or from side to side, five inches and a half; below, at the
lower opening of the pelvis, these dimensions are exactly reversed. But as
in parturition, the os coxcygis, or lower bone of the spine, is elastic and
moveable, on pressure backwards by the infant’s head, the diameter of the
pelvis below is thereby enlarged in all its dimensions. The ossious depth of
the pelvis, from the top of the os sacrum to the extremity of the os coxcygis,
is five, or five inches and a half; at the sides four; before, or in the interval
between the groins, two inches. In some deformed and ricketty women, the
dimensions of the pelvis are either throughout, or in particular parts, greatly
contracted, and most commonly at the upper part.
Of Parturition natural, laborious, preternatural, complex, or anomalous.
Natural labours are all those in which the infant’s head presents at the
orifice of the womb; which are probably ninety-nine out of every hundred
labours. But in this presentation of the infant, some are natural and easy,
and a small number lingering and difficult labours. Preternatural labours are
either all those wherein any other part of the fœtus spontaneously presents
at the orifice of the womb, or where, notwithstanding the natural
presentation of the head, yet it is necessary to turn the infant by force, and
to deliver it by the feet foremost. Complex and anomalous labours are
those, whether natural or preternatural, accompanied with extraordinary
symptoms and danger, such as floodings, convulsions, &c.
Page 193
Labour or parturition is a salutary effort of nature, to expel the contents of
the womb by its own muscular contraction, and the collateral assistance of
the muscles of the abdomen, diaphragm, thorax, back, and extremities.
These exertions commence at intervals, called Paroxisms, or Labour Pains,
which are various in strength and duration, from one to several minutes, and
recurring at irregular intervals of one minute, an hour, or more. The
symptoms naturally preceding and accompanying real parturition are,
anxiety, shivering, violent pains, shooting from the loins to the lower part of
the abdomen or womb, and extending down to the thighs; trembling of the
thighs and legs; frequent micturition, tenesmus, diarrhœa, and involuntary
stools, colick; the countenance and visage florid and red from the violence
of the muscular efforts, with profuse perspiration and sweats; softness of the
breasts, sinking of the abdomen in size, gradual dilatation of the orifice of
the womb, protrusion of the membranes through its orifice in the form of a
soft gut or bladder: in the absence of the labour pains the membranes and
waters are retracted, at length are ruptured, when the fœtus may be felt with
the finger introduced: next ensue the spiral descent of the infant’s head
through the pelvis, dilatation of the external parts round the orifice of the
vagina, expulsion of the infant, its membranes and waters; separation of the
placenta, exclusion and extraction, together with some sanguineous
discharge. Natural labours are generally terminated within a few hours,
from 2 to 12 of real labour efforts; sometimes in a few minutes, and with a
trifling exertion or pain. In some warm climates labours are alledged to be
particularly easy.
But there are specious, or False labour pains, which are vague and irregular
in frequency and force, and do not produce any sensible enlargement of the
uterine orifice, and are not attended with any mucous discharge: they are
generally confined to the lumbar region and abdomen, without extending
down the thighs; they are most troublesome towards night, and are relieved
by clysters and opiates. They generally are excited by one of the following
causes, stretching of the womb, erect posture, spasm in the intestinal canal,
colick, costiveness, distention of the bladder with urine, &c.
Of laborious, lingering, tedious, or difficult parturition. Every labour in
which the process is prolonged beyond 24 hours, may be classed under this
head, notwithstanding the natural presentation of the infant. Sometimes the
labour may continue several days, either from the head not entering the
the womb by its own muscular contraction, and the collateral assistance of
the muscles of the abdomen, diaphragm, thorax, back, and extremities.
These exertions commence at intervals, called Paroxisms, or Labour Pains,
which are various in strength and duration, from one to several minutes, and
recurring at irregular intervals of one minute, an hour, or more. The
symptoms naturally preceding and accompanying real parturition are,
anxiety, shivering, violent pains, shooting from the loins to the lower part of
the abdomen or womb, and extending down to the thighs; trembling of the
thighs and legs; frequent micturition, tenesmus, diarrhœa, and involuntary
stools, colick; the countenance and visage florid and red from the violence
of the muscular efforts, with profuse perspiration and sweats; softness of the
breasts, sinking of the abdomen in size, gradual dilatation of the orifice of
the womb, protrusion of the membranes through its orifice in the form of a
soft gut or bladder: in the absence of the labour pains the membranes and
waters are retracted, at length are ruptured, when the fœtus may be felt with
the finger introduced: next ensue the spiral descent of the infant’s head
through the pelvis, dilatation of the external parts round the orifice of the
vagina, expulsion of the infant, its membranes and waters; separation of the
placenta, exclusion and extraction, together with some sanguineous
discharge. Natural labours are generally terminated within a few hours,
from 2 to 12 of real labour efforts; sometimes in a few minutes, and with a
trifling exertion or pain. In some warm climates labours are alledged to be
particularly easy.
But there are specious, or False labour pains, which are vague and irregular
in frequency and force, and do not produce any sensible enlargement of the
uterine orifice, and are not attended with any mucous discharge: they are
generally confined to the lumbar region and abdomen, without extending
down the thighs; they are most troublesome towards night, and are relieved
by clysters and opiates. They generally are excited by one of the following
causes, stretching of the womb, erect posture, spasm in the intestinal canal,
colick, costiveness, distention of the bladder with urine, &c.
Of laborious, lingering, tedious, or difficult parturition. Every labour in
which the process is prolonged beyond 24 hours, may be classed under this
head, notwithstanding the natural presentation of the infant. Sometimes the
labour may continue several days, either from the head not entering the
Page 194
pelvis, or, which is much more frequent, from some impediment during its
descent through that ossious cavity. In these cases the woman becomes hot,
thirsty, anxious, restless, low-spirited; is afflicted with headach, nausea,
sickness, vomiting, incontinence, and difficulty of urine; she tosses
incessantly, and finds no comfort in any posture. During this struggle, the
infant’s head advances slowly, or stops at various parts in its descent; and
the intervals of labour paroxisms are various. It is by no means necessary
that childbirth pains should be incessant, or without intervals of respite and
rest. In some cases, tedious and difficult labours may continue two, three,
and even four days and nights, when, after reiterated paroxisms, the infant
may at length be excluded by the efforts of nature alone: in some of these
cases also, the mother’s recovery is surprisingly expeditious, as if she had
been delivered in half the time; and unless some dangerous symptoms
indicate, no manual assistance will be necessary. It is an obstetrical axiom,
that in labours with the head presenting, the labour pains continuing strong,
the woman not deformed, the pelvis sufficiently capacious, the constitution
sound, not exhausted by labour pains nor weak, there is the strongest reason
to expect that nature will be adequate to the task of delivery.
Indeed, the obstetrical cases, where instruments are required, are very rare;
and in such emergencies there is often much greater difficulty to determine
the ultimate propriety of employing instrumental aid, than in the mode of
using the few implements peculiar to the obstetrick art; consisting
principally of forceps, crotchet, and scissars. The danger of the mother,
from tedious and difficult parturition, is discernible from her natural
constitution, her debility, pulse, respiration, voice, countenance, the
duration of the labour, the weakness of the pains, or their perseverance and
severity, the space elapsed from the entrance of the head into the pelvis, and
from the rupture of the membranes. The danger of the fœtus may be
predicted from the time its head has been pressed into the pelvis, and the
violence of that pressure, especially on the yielding cranial bones.
Preternatural labours are these wherein any other parts but the infant’s head
present at the orifice of the womb; such as the feet, breech, shoulders, arms,
and so on; besides those other cases in which, although the fœtal
presentation may be natural, yet, for variety of reasons, and in dangerous
emergencies, it is necessary to turn the infant in utero, and to extract it by
the feet. The signs of the preternatural position of the fœtus are uncertain,
descent through that ossious cavity. In these cases the woman becomes hot,
thirsty, anxious, restless, low-spirited; is afflicted with headach, nausea,
sickness, vomiting, incontinence, and difficulty of urine; she tosses
incessantly, and finds no comfort in any posture. During this struggle, the
infant’s head advances slowly, or stops at various parts in its descent; and
the intervals of labour paroxisms are various. It is by no means necessary
that childbirth pains should be incessant, or without intervals of respite and
rest. In some cases, tedious and difficult labours may continue two, three,
and even four days and nights, when, after reiterated paroxisms, the infant
may at length be excluded by the efforts of nature alone: in some of these
cases also, the mother’s recovery is surprisingly expeditious, as if she had
been delivered in half the time; and unless some dangerous symptoms
indicate, no manual assistance will be necessary. It is an obstetrical axiom,
that in labours with the head presenting, the labour pains continuing strong,
the woman not deformed, the pelvis sufficiently capacious, the constitution
sound, not exhausted by labour pains nor weak, there is the strongest reason
to expect that nature will be adequate to the task of delivery.
Indeed, the obstetrical cases, where instruments are required, are very rare;
and in such emergencies there is often much greater difficulty to determine
the ultimate propriety of employing instrumental aid, than in the mode of
using the few implements peculiar to the obstetrick art; consisting
principally of forceps, crotchet, and scissars. The danger of the mother,
from tedious and difficult parturition, is discernible from her natural
constitution, her debility, pulse, respiration, voice, countenance, the
duration of the labour, the weakness of the pains, or their perseverance and
severity, the space elapsed from the entrance of the head into the pelvis, and
from the rupture of the membranes. The danger of the fœtus may be
predicted from the time its head has been pressed into the pelvis, and the
violence of that pressure, especially on the yielding cranial bones.
Preternatural labours are these wherein any other parts but the infant’s head
present at the orifice of the womb; such as the feet, breech, shoulders, arms,
and so on; besides those other cases in which, although the fœtal
presentation may be natural, yet, for variety of reasons, and in dangerous
emergencies, it is necessary to turn the infant in utero, and to extract it by
the feet. The signs of the preternatural position of the fœtus are uncertain,
Page 195
until the accocheur can touch the presenting part. But in all cases, natural
and preternatural, before the rupture of the membranes and evacuation of
the waters, it is often extremely difficult to distinguish by the finger what
part is felt. Preternatural postures of the infant may be suspected, if the
pains from the beginning are lingering, tardy, weak, making little
impression on the orifice of the womb, consequently tedious labours; if the
membranes are either soon ruptured, or are pinched up into a conical form,
like the finger of a glove; if no part of the infant can even be touched until
the uterine orifice is moderately dilated, which remains high up in the
pelvis, and when any part of the fœtus can be reached, it is indistinct and
irregular, and generally small.
In some preternatural presentations delivery may be easy; but in general,
they are always precarious, often difficult and troublesome to the mother
and accocheur. After some continuance of labour the membranes break; but
still no bulky part descends, nor is the mouth of the womb sufficiently
dilated: at length the labour pains abate in strength and frequency;
sometimes they intermit during a few hours, and, in some instances, a day
or more. When we compare the size of the fœtus and of the pelvis, the
reason is obvious why in cross postures, where the infant descends double,
and is expelled by the natural efforts of the mother, such cases will be
difficult, especially in first labours; and unless the child is very small, it will
often be born dead. It is true, Providence has wisely provided, as far as
possible, against puerperal compression, by the softness of the buttocks,
belly, and shoulders, and by the over-lapping of the parietal bones of the
infant’s head. Infants in the womb, we may presume, are subject to diseases
as well as casualties; but probably the most frequent causes of mature
abortives and stillborn, originate from laborious, preternatural, and complex
parturition; which cases, as we observed, may be estimated at about eight
per cent.; but the abortives and stillborn are not altogether three per cent.
In a pelvis not two inches wide at the brim, it is impossible for the fœtus to
descend alive through such a narrow passage. Deformity at the brim of the
pelvis is more difficult to detect than at the lower part. Some pelvises have
been seen not altogether one inch in diameter either above or below: but,
happily, such instances of deformity very rarely occur. We have but eight
examples on record during the last hundred years in this island, three of
them in London, and five in Edinburgh, wherein it was thought necessary to
and preternatural, before the rupture of the membranes and evacuation of
the waters, it is often extremely difficult to distinguish by the finger what
part is felt. Preternatural postures of the infant may be suspected, if the
pains from the beginning are lingering, tardy, weak, making little
impression on the orifice of the womb, consequently tedious labours; if the
membranes are either soon ruptured, or are pinched up into a conical form,
like the finger of a glove; if no part of the infant can even be touched until
the uterine orifice is moderately dilated, which remains high up in the
pelvis, and when any part of the fœtus can be reached, it is indistinct and
irregular, and generally small.
In some preternatural presentations delivery may be easy; but in general,
they are always precarious, often difficult and troublesome to the mother
and accocheur. After some continuance of labour the membranes break; but
still no bulky part descends, nor is the mouth of the womb sufficiently
dilated: at length the labour pains abate in strength and frequency;
sometimes they intermit during a few hours, and, in some instances, a day
or more. When we compare the size of the fœtus and of the pelvis, the
reason is obvious why in cross postures, where the infant descends double,
and is expelled by the natural efforts of the mother, such cases will be
difficult, especially in first labours; and unless the child is very small, it will
often be born dead. It is true, Providence has wisely provided, as far as
possible, against puerperal compression, by the softness of the buttocks,
belly, and shoulders, and by the over-lapping of the parietal bones of the
infant’s head. Infants in the womb, we may presume, are subject to diseases
as well as casualties; but probably the most frequent causes of mature
abortives and stillborn, originate from laborious, preternatural, and complex
parturition; which cases, as we observed, may be estimated at about eight
per cent.; but the abortives and stillborn are not altogether three per cent.
In a pelvis not two inches wide at the brim, it is impossible for the fœtus to
descend alive through such a narrow passage. Deformity at the brim of the
pelvis is more difficult to detect than at the lower part. Some pelvises have
been seen not altogether one inch in diameter either above or below: but,
happily, such instances of deformity very rarely occur. We have but eight
examples on record during the last hundred years in this island, three of
them in London, and five in Edinburgh, wherein it was thought necessary to
Page 196
have recourse to the dreadful alternative of the Cesarian operation; that is,
of cutting out the infant by an incision made through the mother’s abdomen
and womb; and all these women died. During the above long interval of
time, including three generations, of fifty or sixty puerperal women in
London, whose pelvises were remarkably small and deformed,
notwithstanding the unavoidable necessity of recurring to obstetrical
instruments, in order to diminish and tear away the infant, yet not above
five or six died. We have instances, almost miraculous, where, after five
days strong labour, and a pelvis deformed and contracted in all dimensions,
yet, by obstetrical perseverance and skill, the woman has been delivered,
and has recovered. Instructed by these precedents, we may reasonably
expect, that two barbarous and ineffectual operations, the Cesarian, and the
modern attempt at improvement, by severing the anterior cartilaginous
juncture of the bones of the pelvis, will both hereafter be for ever exploded,
at least in this enlightened island.
Anomalous, or complex labours, are either natural or preternatural: but at
the same time are accompanied with uterine hemorrhage, with convulsions,
or with two or more fœtuses; and to these some add the cases of
instrumental delivery. It is natural and usual for the human species, and for
all large animals, to bring forth one at a birth: twins often occur; tergemini
are rare: four, or at least five, are not perhaps seen in some millions of
births. Plurality of fœtuses are seldom attended with peculiar circumstances
of danger. Twins do not occasion much difficulty: they are generally small;
and the remaining fœtus is seldom discovered before the exclusion of the
first, by which the passage is stretched. Neither the number nor size, and
much less the sex of fœtuses, can be predicted: a large quantity of uterine
waters will sometimes produce a more prominent belly than twins,
especially if the infant is at the same time large.
The predisponent and occasional causes of difficult, laborious, lingering,
preternatural, and complex parturition, are, on the part of the mother,
ricketty formation, and deformity of the pelvis; this narrowness generally
begins in infancy, and the common obstruction or protuberance is at the
jetting forward of the lower lumbar vertibra, or of the os sacrum; the pelvis
may also be too small, without any deformity or projection; it may be too
narrow from the fore to the back part, above and below, and at the sides: the
os coxcygis rigid; too great resistance and rigidity of the uterine orifice,
of cutting out the infant by an incision made through the mother’s abdomen
and womb; and all these women died. During the above long interval of
time, including three generations, of fifty or sixty puerperal women in
London, whose pelvises were remarkably small and deformed,
notwithstanding the unavoidable necessity of recurring to obstetrical
instruments, in order to diminish and tear away the infant, yet not above
five or six died. We have instances, almost miraculous, where, after five
days strong labour, and a pelvis deformed and contracted in all dimensions,
yet, by obstetrical perseverance and skill, the woman has been delivered,
and has recovered. Instructed by these precedents, we may reasonably
expect, that two barbarous and ineffectual operations, the Cesarian, and the
modern attempt at improvement, by severing the anterior cartilaginous
juncture of the bones of the pelvis, will both hereafter be for ever exploded,
at least in this enlightened island.
Anomalous, or complex labours, are either natural or preternatural: but at
the same time are accompanied with uterine hemorrhage, with convulsions,
or with two or more fœtuses; and to these some add the cases of
instrumental delivery. It is natural and usual for the human species, and for
all large animals, to bring forth one at a birth: twins often occur; tergemini
are rare: four, or at least five, are not perhaps seen in some millions of
births. Plurality of fœtuses are seldom attended with peculiar circumstances
of danger. Twins do not occasion much difficulty: they are generally small;
and the remaining fœtus is seldom discovered before the exclusion of the
first, by which the passage is stretched. Neither the number nor size, and
much less the sex of fœtuses, can be predicted: a large quantity of uterine
waters will sometimes produce a more prominent belly than twins,
especially if the infant is at the same time large.
The predisponent and occasional causes of difficult, laborious, lingering,
preternatural, and complex parturition, are, on the part of the mother,
ricketty formation, and deformity of the pelvis; this narrowness generally
begins in infancy, and the common obstruction or protuberance is at the
jetting forward of the lower lumbar vertibra, or of the os sacrum; the pelvis
may also be too small, without any deformity or projection; it may be too
narrow from the fore to the back part, above and below, and at the sides: the
os coxcygis rigid; too great resistance and rigidity of the uterine orifice,
Page 197
which is a frequent cause; rigidity of the vagina and surrounding soft parts;
first child; the mother in years, or long intervals between parturition; the
womb too much distended and stretched, its irregular contraction, oblique
position; the membranes too soon ruptured by nature or art, and the womb
contracting closely before the infant’s shoulders; the membranes rigid; the
mouth of the womb strait, callous, inert, irritable; its spasmodic
constriction; the bladder distended with urine; hardened feces collected in
the rectum; piles; weakness of the mother; tedious labour and fatigue;
passions of mind; terror and fear of the event; the mind and spirits broken,
irritable; the mother delicate, fat, torpid, plethoric; diarrhœa, profuse
evacuations, floodings, convulsions; heat, cordials, strong liquors; improper
fatigue and torment during labour, with fruitless and officious endeavours in
the accocheur to dilate the parts, and to expedite delivery: the mother’s
belly pendulous; tumours and cicatrices blocking up the vagina; rupture of
the womb; stone in the bladder. From the fœtus erroneous in position, and
different to the natural; in laborious cases with the head detained at the
brim, or after its descent into the pelvis: such postures are vertebral,
occipital, auricular, mental, oral, facial. Of the preternatural and cross
positions authors enumerate; the neck, breast, shoulders, arms, hands, back,
loins, buttocks, breech, sides, belly, knees, feet. The fœtus may also be
detained by the whole being monstrous in size, or only in particular parts;
such as the head, shoulders, belly; the head dropsical; the cranial bones
ossified, and not yielding in its descent: the fœtus dead, emphysematous,
and blown up with putrid air: the navel string twisted round its neck; two or
more fœtuses entangled; twins growing together; deformed monsters.
Having now finished the various processes of parturition, with the perils
and difficulties that encompass our immediate exit from the shell, I shall
return back to pregnancy, to explore the different inconveniences and
maladies that ensue in consequence of that state, both before and after
parturition: many of these are merely temporary morbid symptoms; some of
them rarely occur; others are attended with trifling danger; and a few only
with imminent hazard. We may include all these troublesome symptoms,
accidents, and diseases, under the following heads; proceeding
progressively from the beginning of conception to the end of parturition,
with all its train of evils. These are nausea, indigestion, vomiting, pains in
the stomach, acidity, unusual cravings, headach, vertigo, costiveness,
difficulty and incontinence of urine, piles, varix, pains in the back and loins,
first child; the mother in years, or long intervals between parturition; the
womb too much distended and stretched, its irregular contraction, oblique
position; the membranes too soon ruptured by nature or art, and the womb
contracting closely before the infant’s shoulders; the membranes rigid; the
mouth of the womb strait, callous, inert, irritable; its spasmodic
constriction; the bladder distended with urine; hardened feces collected in
the rectum; piles; weakness of the mother; tedious labour and fatigue;
passions of mind; terror and fear of the event; the mind and spirits broken,
irritable; the mother delicate, fat, torpid, plethoric; diarrhœa, profuse
evacuations, floodings, convulsions; heat, cordials, strong liquors; improper
fatigue and torment during labour, with fruitless and officious endeavours in
the accocheur to dilate the parts, and to expedite delivery: the mother’s
belly pendulous; tumours and cicatrices blocking up the vagina; rupture of
the womb; stone in the bladder. From the fœtus erroneous in position, and
different to the natural; in laborious cases with the head detained at the
brim, or after its descent into the pelvis: such postures are vertebral,
occipital, auricular, mental, oral, facial. Of the preternatural and cross
positions authors enumerate; the neck, breast, shoulders, arms, hands, back,
loins, buttocks, breech, sides, belly, knees, feet. The fœtus may also be
detained by the whole being monstrous in size, or only in particular parts;
such as the head, shoulders, belly; the head dropsical; the cranial bones
ossified, and not yielding in its descent: the fœtus dead, emphysematous,
and blown up with putrid air: the navel string twisted round its neck; two or
more fœtuses entangled; twins growing together; deformed monsters.
Having now finished the various processes of parturition, with the perils
and difficulties that encompass our immediate exit from the shell, I shall
return back to pregnancy, to explore the different inconveniences and
maladies that ensue in consequence of that state, both before and after
parturition: many of these are merely temporary morbid symptoms; some of
them rarely occur; others are attended with trifling danger; and a few only
with imminent hazard. We may include all these troublesome symptoms,
accidents, and diseases, under the following heads; proceeding
progressively from the beginning of conception to the end of parturition,
with all its train of evils. These are nausea, indigestion, vomiting, pains in
the stomach, acidity, unusual cravings, headach, vertigo, costiveness,
difficulty and incontinence of urine, piles, varix, pains in the back and loins,
Page 198
cramp, colick, fainting, œdematous legs and thighs, difficulty and labour in
breathing, retroverted womb, extra uterine conception, superfœtation,
graviditas perennis, moles and false conceptions, rupture of the womb,
protrusion or too low descent of the womb or vagina, miscarriage and
abortion, dead fœtus, uterine hemorrhage, convulsions, irregularity of the
lochia, including obstruction, suppression or excess, inflammation of the
womb, puerperal fever, milk fever, weed, inflammation of the breasts,
excess and defect of milk, insanity.
The causes of many of these complaints during the early and latter months
of pregnancy, and affecting the head, thorax, stomach, intestines, rectum,
bladder, and circulation, originate from sympathetic effects of conception
and pregnancy; from plethora, from the bulk, weight, pressure, and
irritation of the enlarged womb, and from its stretching, &c.; and either
spontaneously, or by proper advice, cease before or after delivery. Several
of the puerperal diseases and accidents to be immediately described rarely
occur; and some of them are without danger.
Retroverted womb is a very rare accident; where it does occur, it is from the
third to the sixth month after conception, when the impregnated womb is
thereby prevented from rising above the brim of the pelvis; hence it falls
back, and descends into the interior and posterior part of that cavity; its
fundus becoming the lower part, and its mouth drawn upwards. The woman
feels weight and pressure about that region; is afflicted with tenesmus and
colick pains resembling labour; the feces and urine are excreted with
difficulty; the finger introduced into the rectum, feels the womb, where, by
crowding the whole lower part of the pelvis, it compresses and irritates the
organs in that vicinity. Its general causes are imputed to violent muscular
exertions, fatigue, distended bladder, obstinate costiveness, capacious
pelvis.
Extra uterine conception in the ovarium or fallopian tubes, where the
fecundated ovum is stopped in its descent to the womb. Some have burst
into the cavity of the abdomen, and formed abscesses in its depending parts;
and others have been gradually, and in fragments, discharged by the anus.
Superfœtation is a miracle in medicine, and commonly happens where there
is a double womb. Of graviditas perennis, there are some extraordinary
instances, or of pregnant women advancing to the full period of uterine
gestation, about which time the fœtus has died, the womb has not emptied
breathing, retroverted womb, extra uterine conception, superfœtation,
graviditas perennis, moles and false conceptions, rupture of the womb,
protrusion or too low descent of the womb or vagina, miscarriage and
abortion, dead fœtus, uterine hemorrhage, convulsions, irregularity of the
lochia, including obstruction, suppression or excess, inflammation of the
womb, puerperal fever, milk fever, weed, inflammation of the breasts,
excess and defect of milk, insanity.
The causes of many of these complaints during the early and latter months
of pregnancy, and affecting the head, thorax, stomach, intestines, rectum,
bladder, and circulation, originate from sympathetic effects of conception
and pregnancy; from plethora, from the bulk, weight, pressure, and
irritation of the enlarged womb, and from its stretching, &c.; and either
spontaneously, or by proper advice, cease before or after delivery. Several
of the puerperal diseases and accidents to be immediately described rarely
occur; and some of them are without danger.
Retroverted womb is a very rare accident; where it does occur, it is from the
third to the sixth month after conception, when the impregnated womb is
thereby prevented from rising above the brim of the pelvis; hence it falls
back, and descends into the interior and posterior part of that cavity; its
fundus becoming the lower part, and its mouth drawn upwards. The woman
feels weight and pressure about that region; is afflicted with tenesmus and
colick pains resembling labour; the feces and urine are excreted with
difficulty; the finger introduced into the rectum, feels the womb, where, by
crowding the whole lower part of the pelvis, it compresses and irritates the
organs in that vicinity. Its general causes are imputed to violent muscular
exertions, fatigue, distended bladder, obstinate costiveness, capacious
pelvis.
Extra uterine conception in the ovarium or fallopian tubes, where the
fecundated ovum is stopped in its descent to the womb. Some have burst
into the cavity of the abdomen, and formed abscesses in its depending parts;
and others have been gradually, and in fragments, discharged by the anus.
Superfœtation is a miracle in medicine, and commonly happens where there
is a double womb. Of graviditas perennis, there are some extraordinary
instances, or of pregnant women advancing to the full period of uterine
gestation, about which time the fœtus has died, the womb has not emptied
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any of its contents, and they have not been excluded until some years after.
Moles and false conceptions often assume the semblance of pregnancy, and
are generally void of danger. When the fœtus is deprived of life, and
dissolved in the early months of pregnancy into a gelatinous state, the
placenta and membranes remaining some time in the womb, acquire
additional bulk, and are called Moles. Others again are formed merely of
inorganic coagulated blood, after menstruation or flooding, and, by
stagnation, assume that fibrous compact substance. Moles in general are
excluded in a few months: some have grown to an enormous size, to double
the weight of the natural fœtus, and remained for years incarcerated in the
womb.
Rupture of the womb during parturition, is also a very rare accident, and
generally fatal; it occasions severe pains, sudden cessation of the efforts of
labour, and of the descent of the fœtus, which, if the laceration is large, by
degrees is retracted, and cannot be felt; a considerable change and irregular
protuberance is perceivable in the abdomen; the pulse and spirits soon sink,
with vomiting, hiccup, convulsions. Inversion of the womb is a very
dangerous but uncommon accident, and cannot happen but from gross
obstetrical ignorance or rashness. Descent of the womb and vagina may be
thrown into the general group of ruptures; of which hereafter. The following
comprehend most of the fatal diseases and accidents during the puerperal
state.
Abortion and Miscarriage; Uterine Hemorrhage, or Flooding. Abortion or
miscarriage, or premature exclusion of the fœtus, may happen through
every month of pregnancy. Early miscarriages between the third and fifth
month, though not recorded in the burials, are notwithstanding far more
numerous than in the latter months; but are infinitely less hazardous to
women. The mature abortives and stillborn, are alone thought deserving of
formal interment, and of notice in the registers. To carry a diminutive
embryo, a Lilliputian in miniature, to a church-yard, and to bury it with
funeral pomp and obsequies, would be ridiculous. In all probability, a very
great majority of the registered abortives and stillborn in London, had
arrived at or near the full period of uterine maturity. Some miscarriages are
sudden, with little or no warning, and with ease; others again are slow. In
early gestation, the gelatinous ovum is sometimes excluded several days
before the membranes; in other cases, there is a discharge of serum days
Moles and false conceptions often assume the semblance of pregnancy, and
are generally void of danger. When the fœtus is deprived of life, and
dissolved in the early months of pregnancy into a gelatinous state, the
placenta and membranes remaining some time in the womb, acquire
additional bulk, and are called Moles. Others again are formed merely of
inorganic coagulated blood, after menstruation or flooding, and, by
stagnation, assume that fibrous compact substance. Moles in general are
excluded in a few months: some have grown to an enormous size, to double
the weight of the natural fœtus, and remained for years incarcerated in the
womb.
Rupture of the womb during parturition, is also a very rare accident, and
generally fatal; it occasions severe pains, sudden cessation of the efforts of
labour, and of the descent of the fœtus, which, if the laceration is large, by
degrees is retracted, and cannot be felt; a considerable change and irregular
protuberance is perceivable in the abdomen; the pulse and spirits soon sink,
with vomiting, hiccup, convulsions. Inversion of the womb is a very
dangerous but uncommon accident, and cannot happen but from gross
obstetrical ignorance or rashness. Descent of the womb and vagina may be
thrown into the general group of ruptures; of which hereafter. The following
comprehend most of the fatal diseases and accidents during the puerperal
state.
Abortion and Miscarriage; Uterine Hemorrhage, or Flooding. Abortion or
miscarriage, or premature exclusion of the fœtus, may happen through
every month of pregnancy. Early miscarriages between the third and fifth
month, though not recorded in the burials, are notwithstanding far more
numerous than in the latter months; but are infinitely less hazardous to
women. The mature abortives and stillborn, are alone thought deserving of
formal interment, and of notice in the registers. To carry a diminutive
embryo, a Lilliputian in miniature, to a church-yard, and to bury it with
funeral pomp and obsequies, would be ridiculous. In all probability, a very
great majority of the registered abortives and stillborn in London, had
arrived at or near the full period of uterine maturity. Some miscarriages are
sudden, with little or no warning, and with ease; others again are slow. In
early gestation, the gelatinous ovum is sometimes excluded several days
before the membranes; in other cases, there is a discharge of serum days
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and weeks before miscarriage. Abortion is usually preceded by nausea, pain
in the back and loins, frequent micturition, tenesmus, discharge from the
womb of water or of blood. If not in their immediate, yet in their future
consequences, miscarriages are much more fatal to puerperal women than
appears in the registers.
Floodings are seldom fatal to women before the two or three last months of
pregnancy; the gradations of danger increasing to the end of the ninth
month, at which period the uterine blood vessels are enlarged, and the
hemorrhagick torrent is in proportion. The mouth of the womb also being
then less distended than in ordinary parturition, is more difficultly forced
open to expedite delivery. Floodings may at intervals, and some weeks
precede natural parturition or miscarriage; and after a temporary cessation,
are prone to return on the slighted irregularity. Their danger is estimated
from the quantity of blood, the suddenness of the torrent, and the effects on
the mother; such as paleness, weakness, coldness of the extremities, quick
fluttering pulse and respiration, fainting, dejected countenance, weak voice,
convulsions: these portend imminent danger to the mother and infant, as do
floodings near the full period of gestation, and not accompanied with labour
pains. Uterine hemorrhages may occur not only in abortion and natural
parturition, but also immediately, or soon after the birth of the infant, and
extraction of the placenta. Sometimes also during parturition, when the
child’s head blocks up the pelvis, the hemorrhage has been unperceived,
and often unsuspected, until after the exclusion of the infant: but the
uncommon weakness and faintness of the mother, without any evident
causes, might have given the alarm.
The predisposing and occasional causes of abortions and floodings are,
frights, terror, anger, violent agitation of mind or body; strong muscular
exertions and efforts; external injuries, blows, falls, running, leaping,
coughing, crying, fainting, hystericks; plethora; errors in the non-naturals;
impetuous flow of blood to the womb, salacity; too much amorous
dalliance; too strait lacing and dress; hot close rooms; foul air; disagreeable
smells; cravings not gratified; spirituous liquors; abuse of emmenagogue,
cathartick, and diuretick medicines; hardened feces and costiveness; piles;
extreme irritability of the body and womb; weak hysterical constitution;
weak diseased small, contracted, not sufficiently dilatable womb; weakness
of the uterine vessels from preceding abortion, irregular menstruation; poor
in the back and loins, frequent micturition, tenesmus, discharge from the
womb of water or of blood. If not in their immediate, yet in their future
consequences, miscarriages are much more fatal to puerperal women than
appears in the registers.
Floodings are seldom fatal to women before the two or three last months of
pregnancy; the gradations of danger increasing to the end of the ninth
month, at which period the uterine blood vessels are enlarged, and the
hemorrhagick torrent is in proportion. The mouth of the womb also being
then less distended than in ordinary parturition, is more difficultly forced
open to expedite delivery. Floodings may at intervals, and some weeks
precede natural parturition or miscarriage; and after a temporary cessation,
are prone to return on the slighted irregularity. Their danger is estimated
from the quantity of blood, the suddenness of the torrent, and the effects on
the mother; such as paleness, weakness, coldness of the extremities, quick
fluttering pulse and respiration, fainting, dejected countenance, weak voice,
convulsions: these portend imminent danger to the mother and infant, as do
floodings near the full period of gestation, and not accompanied with labour
pains. Uterine hemorrhages may occur not only in abortion and natural
parturition, but also immediately, or soon after the birth of the infant, and
extraction of the placenta. Sometimes also during parturition, when the
child’s head blocks up the pelvis, the hemorrhage has been unperceived,
and often unsuspected, until after the exclusion of the infant: but the
uncommon weakness and faintness of the mother, without any evident
causes, might have given the alarm.
The predisposing and occasional causes of abortions and floodings are,
frights, terror, anger, violent agitation of mind or body; strong muscular
exertions and efforts; external injuries, blows, falls, running, leaping,
coughing, crying, fainting, hystericks; plethora; errors in the non-naturals;
impetuous flow of blood to the womb, salacity; too much amorous
dalliance; too strait lacing and dress; hot close rooms; foul air; disagreeable
smells; cravings not gratified; spirituous liquors; abuse of emmenagogue,
cathartick, and diuretick medicines; hardened feces and costiveness; piles;
extreme irritability of the body and womb; weak hysterical constitution;
weak diseased small, contracted, not sufficiently dilatable womb; weakness
of the uterine vessels from preceding abortion, irregular menstruation; poor
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blood; fluor albus; previous injuries during parturition; repetition from
habit; the habitual tendency towards menstruation every month; hereditary;
acute or chronic diseases; morbid adhesion of the placenta, and also
coalescence with the womb from previous inflammation; partial separation
of the placenta; rupture of the vessels on the surface of the placenta;
separation of the false chorion from the womb; adhesion of the ovum or
placenta to the neck of the womb; blights of the fœtus, scarcity of
nourishment in the womb, its violent efforts, monstrous size, its diseases in
the womb; rupture of the navel string, a noose formed upon it; long
compression of the infant’s head or navel string during parturition; injuries
by the hands or instruments of the accocheur; a dead fœtus.
The signs of a dead fœtus are in the mother subsidence, softness, and
coldness of the abdomen and breasts, sickness, faintness, shiverings, cold
sweats, sensation of a heavy tumour within the belly, cessation of the
motion of the fœtus after quickening, putrid discharge from the vagina,
evacuation of the waters, dejected languid countenance: if, during actual
labour, the mother perceives no motion of the infant, and is cold; no
pulsation can be felt between the interstices of the infant’s parietal bones,
nor at its wrist, nor navel string; its outer skin easily peels off; it has a
lifeless coldness; and there is a cadaverous smell and fetid discharge from
the vagina.
Convulsions may happen before, during, and after delivery. They resemble
epilepsy, with froth at the mouth, distortion of the countenance and body;
and are a much more terrific and frightful spectacle than hysterical and
nervous spasms. In the advanced state of pregnancy, convulsions are still
more dangerous, and, like the sudden impetuosity of a whirlwind,
sometimes close the fatal scene; especially if at the same time a violent pain
is felt at the stomach. The plethoric and robust are not exempt from this
tremendous assailant; but the hysterical and delicate are the most frequent
victims. The predisposing and occasional causes are morbid sensibility;
profuse uterine hemorrhage; want of due quantity of blood; plethora;
frights; low spirits; fear, dread, surprize, and sudden emotion and agitation
of mind at this critical period; dead fœtus.
Irregularity of the Lochia, comprehending excess, obstruction, and
suppression. After delivery, there is generally a gush of red blood, from
about a half to two pounds. The mother is then weak and infirm, from the
habit; the habitual tendency towards menstruation every month; hereditary;
acute or chronic diseases; morbid adhesion of the placenta, and also
coalescence with the womb from previous inflammation; partial separation
of the placenta; rupture of the vessels on the surface of the placenta;
separation of the false chorion from the womb; adhesion of the ovum or
placenta to the neck of the womb; blights of the fœtus, scarcity of
nourishment in the womb, its violent efforts, monstrous size, its diseases in
the womb; rupture of the navel string, a noose formed upon it; long
compression of the infant’s head or navel string during parturition; injuries
by the hands or instruments of the accocheur; a dead fœtus.
The signs of a dead fœtus are in the mother subsidence, softness, and
coldness of the abdomen and breasts, sickness, faintness, shiverings, cold
sweats, sensation of a heavy tumour within the belly, cessation of the
motion of the fœtus after quickening, putrid discharge from the vagina,
evacuation of the waters, dejected languid countenance: if, during actual
labour, the mother perceives no motion of the infant, and is cold; no
pulsation can be felt between the interstices of the infant’s parietal bones,
nor at its wrist, nor navel string; its outer skin easily peels off; it has a
lifeless coldness; and there is a cadaverous smell and fetid discharge from
the vagina.
Convulsions may happen before, during, and after delivery. They resemble
epilepsy, with froth at the mouth, distortion of the countenance and body;
and are a much more terrific and frightful spectacle than hysterical and
nervous spasms. In the advanced state of pregnancy, convulsions are still
more dangerous, and, like the sudden impetuosity of a whirlwind,
sometimes close the fatal scene; especially if at the same time a violent pain
is felt at the stomach. The plethoric and robust are not exempt from this
tremendous assailant; but the hysterical and delicate are the most frequent
victims. The predisposing and occasional causes are morbid sensibility;
profuse uterine hemorrhage; want of due quantity of blood; plethora;
frights; low spirits; fear, dread, surprize, and sudden emotion and agitation
of mind at this critical period; dead fœtus.
Irregularity of the Lochia, comprehending excess, obstruction, and
suppression. After delivery, there is generally a gush of red blood, from
about a half to two pounds. The mother is then weak and infirm, from the
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fatigue and efforts of parturition; from the great evacuation and diminution
of the womb and abdomen; from the loss of blood; from the agitation and
anxiety of mind; and from the increased irritability: and, according to
certain states of the air and seasons not yet explained, women are then more
than at any other time prone to fevers. In most cases the placenta is expelled
in ten, twenty, or thirty minutes after the infant. Afterwards, the orifices of
the uterine vessels continue to discharge red blood, which gradually
becomes thin and serous, and even in some degree purulent. This discharge
named Lochia, is various in duration and quantity, from two to ten ounces
daily, and, gradually decreasing, in about ten or twenty days is dried up;
nature having then restored the womb to its natural size: and at this stage all
immediate puerperal danger is escaped. Sometimes there are great
variations in the lochial duration in different women: in some, they cease
after a few days; in most, after two or three weeks; and in a few others, not
until after one or two months: the duration and quantity being varied by
climate, season, constitution, mode of life, and state of the breasts. Lochial
excess is determined more by the morbid effects than the absolute quantity;
such as weakness, paleness, dejected countenance, feeble voice and pulse,
fainting, convulsions. Or in its consequences it may more slowly sap the
pillars of health, and occasion consumption or dropsy. Obstruction and
suppression of the lochia is much more frequent and dangerous than excess.
Most of the usual complaints after delivery, says Smellie, originate from
obstruction of the lochia, or of milk: the former is accompanied with pain of
the back and loins, pudenda, and groins; heat, shivering, hard quick pulse,
restlessness; sometimes colick and diarrhœa, and difficult oppressed
perspiration.
Inflammation of the Womb begins generally between the fourth and ninth
day after delivery, and commonly with retention of the lochia: with fever,
heat, and pain about the uterine region, elevation and hardness of the
abdomen below, with tenderness and acute sensibility on pressure, irritation
to urine and stools, colick, intense headach, strong full pulse. The whole, or
different parts only, of the womb may be inflamed, whence the contiguous
viscera of the pelvis will be differently affected. Where the inflammation is
not violent, the crisis is about the fourth or seventh day from the attack; but
if severe, may be protracted to the ninth, eleventh, and fourteenth, and be
then discussed with some sensible evacuation, by perspiration and sweat,
of the womb and abdomen; from the loss of blood; from the agitation and
anxiety of mind; and from the increased irritability: and, according to
certain states of the air and seasons not yet explained, women are then more
than at any other time prone to fevers. In most cases the placenta is expelled
in ten, twenty, or thirty minutes after the infant. Afterwards, the orifices of
the uterine vessels continue to discharge red blood, which gradually
becomes thin and serous, and even in some degree purulent. This discharge
named Lochia, is various in duration and quantity, from two to ten ounces
daily, and, gradually decreasing, in about ten or twenty days is dried up;
nature having then restored the womb to its natural size: and at this stage all
immediate puerperal danger is escaped. Sometimes there are great
variations in the lochial duration in different women: in some, they cease
after a few days; in most, after two or three weeks; and in a few others, not
until after one or two months: the duration and quantity being varied by
climate, season, constitution, mode of life, and state of the breasts. Lochial
excess is determined more by the morbid effects than the absolute quantity;
such as weakness, paleness, dejected countenance, feeble voice and pulse,
fainting, convulsions. Or in its consequences it may more slowly sap the
pillars of health, and occasion consumption or dropsy. Obstruction and
suppression of the lochia is much more frequent and dangerous than excess.
Most of the usual complaints after delivery, says Smellie, originate from
obstruction of the lochia, or of milk: the former is accompanied with pain of
the back and loins, pudenda, and groins; heat, shivering, hard quick pulse,
restlessness; sometimes colick and diarrhœa, and difficult oppressed
perspiration.
Inflammation of the Womb begins generally between the fourth and ninth
day after delivery, and commonly with retention of the lochia: with fever,
heat, and pain about the uterine region, elevation and hardness of the
abdomen below, with tenderness and acute sensibility on pressure, irritation
to urine and stools, colick, intense headach, strong full pulse. The whole, or
different parts only, of the womb may be inflamed, whence the contiguous
viscera of the pelvis will be differently affected. Where the inflammation is
not violent, the crisis is about the fourth or seventh day from the attack; but
if severe, may be protracted to the ninth, eleventh, and fourteenth, and be
then discussed with some sensible evacuation, by perspiration and sweat,
Page 203
urine, diarrhœa, lochial discharge, or current of milk from the breasts; or
may terminate fatally in gangrene, delirium, and convulsions.
The predisposing and occasional causes of irregularity of the lochia, and of
uterine inflammation, are, of Excess, grumous clots of blood in the womb;
violence done to the womb during parturition; retention of the placenta, or
part of it; great weakness; passions of mind; a second child; spasm;
repulsion of milk from the breasts; too early and violent motion or walking
about; diseased state of the womb; inverted womb; errors in food, drink,
passions of mind, excretions, &c. Of Obstruction and Suppression; clots of
blood in the vagina; cold admitted to the naked body, either externally or
internally; cold rooms, cloaths, and drink; obstructed perspiration; impure
air and close heated rooms; passions of mind; hystericks; errors in the non-
naturals, diarrhœa. Of inflammation of the womb, suppression of the lochia;
external violence; falls; rude extraction of the placenta; morbid adhesion of
the placenta; miscarriage; too tight bandages round the belly: its termination
is by discussion or gangrene.
Puerperal Fever, or Peritonitis, commonly alledged to be peculiar to
women after delivery, has been dignified by the moderns, from its danger
and fatality, with a generic name: happily for the fair sex, it does not often
occur: sometimes it is epidemic, from some unknown quality of the
atmosphere; and in such circumstances a considerable number of puerperal
women are afflicted at the same time. It generally attacks one or two days,
but sometimes a few hours after delivery; and rarely later than the sixth day.
The assault is sudden and violent, with shivering, headach, especially in the
temples and eyes, giddiness, nausea, sickness of the stomach, and vomiting
of bile in large quantity, pains darting through the lower region of the
abdomen, and reaching up to the stomach, with extreme sensibility and
tenderness, on being pressed with the hand, or by coughing or vomiting: the
pain is felt between the stomach and navel, and is higher than in the
inflammation of the womb; there is unusual languor and weakness, anxiety,
oppression, and load of the spirits, impaired strength, so as not to be able to
render themselves any assistance in bed; no refreshing sleep, sometimes
delirium; the pulse is always extremely rapid, but various in strength during
the revolution of the febrile paroxisms, that is, of the cold and hot fit. When
the vomiting abates, it is succeeded by a profuse diarrhœa, accompanied
with colick, tormenting gripes, tenesmus. In some, the abdomen begins to
may terminate fatally in gangrene, delirium, and convulsions.
The predisposing and occasional causes of irregularity of the lochia, and of
uterine inflammation, are, of Excess, grumous clots of blood in the womb;
violence done to the womb during parturition; retention of the placenta, or
part of it; great weakness; passions of mind; a second child; spasm;
repulsion of milk from the breasts; too early and violent motion or walking
about; diseased state of the womb; inverted womb; errors in food, drink,
passions of mind, excretions, &c. Of Obstruction and Suppression; clots of
blood in the vagina; cold admitted to the naked body, either externally or
internally; cold rooms, cloaths, and drink; obstructed perspiration; impure
air and close heated rooms; passions of mind; hystericks; errors in the non-
naturals, diarrhœa. Of inflammation of the womb, suppression of the lochia;
external violence; falls; rude extraction of the placenta; morbid adhesion of
the placenta; miscarriage; too tight bandages round the belly: its termination
is by discussion or gangrene.
Puerperal Fever, or Peritonitis, commonly alledged to be peculiar to
women after delivery, has been dignified by the moderns, from its danger
and fatality, with a generic name: happily for the fair sex, it does not often
occur: sometimes it is epidemic, from some unknown quality of the
atmosphere; and in such circumstances a considerable number of puerperal
women are afflicted at the same time. It generally attacks one or two days,
but sometimes a few hours after delivery; and rarely later than the sixth day.
The assault is sudden and violent, with shivering, headach, especially in the
temples and eyes, giddiness, nausea, sickness of the stomach, and vomiting
of bile in large quantity, pains darting through the lower region of the
abdomen, and reaching up to the stomach, with extreme sensibility and
tenderness, on being pressed with the hand, or by coughing or vomiting: the
pain is felt between the stomach and navel, and is higher than in the
inflammation of the womb; there is unusual languor and weakness, anxiety,
oppression, and load of the spirits, impaired strength, so as not to be able to
render themselves any assistance in bed; no refreshing sleep, sometimes
delirium; the pulse is always extremely rapid, but various in strength during
the revolution of the febrile paroxisms, that is, of the cold and hot fit. When
the vomiting abates, it is succeeded by a profuse diarrhœa, accompanied
with colick, tormenting gripes, tenesmus. In some, the abdomen begins to
Page 204
swell early. At the beginning the symptoms have an inflammatory
appearance; but after a very few days change undisguisedly into the nervous
and putrid type, and sometimes with miliary eruption. Often neither the
lochial discharge, nor the milk, are interrupted; and it has been observed to
ensue even after easy labours.
The puerperal Fever will be affected and diversified by different
constitutions and temperaments, whether robust, plethoric, or delicate; by
the quantity of the lochial discharge, the putrid atmosphere in the sick room,
the medical treatment, the state of the atmosphere and seasons, and morbid
quality of the prevailing febrile epidemick. Between five and fifteen days
terminates the event in recovery or death. It is always most fatal when most
epidemick, and the sooner it attacks after delivery. In some of our London
hospitals, one half of the women ill of this fever have died; in others, one of
seven. The crisis by discussion is followed by diarrhœa, by a serous or
purulent transudation from the omentum or mesentery, into the abdomen;
and from this cause sometimes consumption and dropsy. Some, even after a
favourable crisis, have recovered slowly. When gangrene is the direful
event, it is commonly within four or six days from the attack, and is known
by the usual symptoms.
The predisposing and occasional causes are, a peculiar noxious constitution
of the atmosphere; errors in the non-naturals; anxiety of mind; hot cordial
regimen; heated unventilated rooms after delivery, and impure air; hence
miliary eruptions and profuse sweats. The immediate cause is generally
ascribed to inflammation of the omentum, mesentery, or peritoneum, and
the sudden contraction of the womb after delivery, dragging and tearing
down with it these membranes. But it merits the most serious and mature
investigation, whether to employ the remedies accommodated to
inflammatory, or to nervous and putrid fever. We know that purulency in the
abdomen and thorax is likewise found in the putrid fever of the West Indies.
After-Pains; Weed, Milk-Fever; Inflammation of the Breasts, are far less
formidable foes than the preceding. After parturition, women are sometimes
afflicted for some days with pains resembling colick; both in torture and
severity extremely harassing. The causes are, the continued and sudden
contraction of the womb towards its natural dimensions; fragments of the
placenta or membranes, or of clotted blood in the womb; injuries done to
the fibres of the womb during parturition; violent extension of the
appearance; but after a very few days change undisguisedly into the nervous
and putrid type, and sometimes with miliary eruption. Often neither the
lochial discharge, nor the milk, are interrupted; and it has been observed to
ensue even after easy labours.
The puerperal Fever will be affected and diversified by different
constitutions and temperaments, whether robust, plethoric, or delicate; by
the quantity of the lochial discharge, the putrid atmosphere in the sick room,
the medical treatment, the state of the atmosphere and seasons, and morbid
quality of the prevailing febrile epidemick. Between five and fifteen days
terminates the event in recovery or death. It is always most fatal when most
epidemick, and the sooner it attacks after delivery. In some of our London
hospitals, one half of the women ill of this fever have died; in others, one of
seven. The crisis by discussion is followed by diarrhœa, by a serous or
purulent transudation from the omentum or mesentery, into the abdomen;
and from this cause sometimes consumption and dropsy. Some, even after a
favourable crisis, have recovered slowly. When gangrene is the direful
event, it is commonly within four or six days from the attack, and is known
by the usual symptoms.
The predisposing and occasional causes are, a peculiar noxious constitution
of the atmosphere; errors in the non-naturals; anxiety of mind; hot cordial
regimen; heated unventilated rooms after delivery, and impure air; hence
miliary eruptions and profuse sweats. The immediate cause is generally
ascribed to inflammation of the omentum, mesentery, or peritoneum, and
the sudden contraction of the womb after delivery, dragging and tearing
down with it these membranes. But it merits the most serious and mature
investigation, whether to employ the remedies accommodated to
inflammatory, or to nervous and putrid fever. We know that purulency in the
abdomen and thorax is likewise found in the putrid fever of the West Indies.
After-Pains; Weed, Milk-Fever; Inflammation of the Breasts, are far less
formidable foes than the preceding. After parturition, women are sometimes
afflicted for some days with pains resembling colick; both in torture and
severity extremely harassing. The causes are, the continued and sudden
contraction of the womb towards its natural dimensions; fragments of the
placenta or membranes, or of clotted blood in the womb; injuries done to
the fibres of the womb during parturition; violent extension of the
Page 205
suspensory ligaments; inflammation and irritation of the womb, or its neck:
tender state of the intestines; flatulence; flatulent food; suppression of the
lochia; errors in the non-naturals; a second child. Weed, or ephemera,
sometimes occurs, and is the most simple and innocent species of fever; it is
preceded by lassitude, slight wandering pains; a succession of shivering,
heat and sweat, resembling an intermittent paroxism; and in the space of a
few hours, or at the utmost days, the fever disappears. The causes are some
errors in the non-naturals. Milk fever: during pregnancy and parturition the
breasts sympathize greatly with the womb. This natural fever begins three
or four days after delivery, with shivering and heat, pain, distention and
throbbing of the breasts, shooting to the armpits, restlessness; after twenty-
four hours, commonly terminating by sweat, diarrhœa, eruption of milk: the
usual quantity of this nutritive fluid is from two to three pints daily. In the
preceding puerperal stage, inflammation of one, but rarely of both breasts,
is a frequent affliction, varying in degree and severity: its symptoms are
local redness and swelling, burning heat, extreme tenderness, throbbing;
and is terminated by discussion, frequently by suppuration; sometimes by
scirrhus. The causes are impetuous rush of milk to the breasts; excess of
milk; not suckling; milk obstructed in the breasts or lactiferous tubes;
suckling too soon; obstructed lochia; cold and obstructed perspiration.
INFANT DISEASES every where furnish a vast supply to the gloomy
realms of Pluto; and this calamity is infinitely aggravated by the noxious
atmosphere of cities and towns. At birth, an infant is not only ushered into a
new world, but every function of its frail body undergoes new and sudden
changes. From the human oven of 96 degrees of heat, it is launched into a
variable climate of heat and cold. A new element of many thousand pounds
weight then presses upon the surface of its body. This atmospherick fluid,
adulterated in cities with innumerable impurities and feculencies is drawn
into its lungs: its diaphragm and muscles of respiration then begin to act,
the lungs expand, and the respiration commences. The passage between the
auricles of its heart and arterial duct are gradually closed up; the sphere of
the circulation is extended; the whole current of blood in its frequent
revolution hourly, passes through the lungs; the circulation through the
navel-string, and through which it had till then drawn its principal
nourishment, instantly ceases: food, for the first time, begins to be taken in
tender state of the intestines; flatulence; flatulent food; suppression of the
lochia; errors in the non-naturals; a second child. Weed, or ephemera,
sometimes occurs, and is the most simple and innocent species of fever; it is
preceded by lassitude, slight wandering pains; a succession of shivering,
heat and sweat, resembling an intermittent paroxism; and in the space of a
few hours, or at the utmost days, the fever disappears. The causes are some
errors in the non-naturals. Milk fever: during pregnancy and parturition the
breasts sympathize greatly with the womb. This natural fever begins three
or four days after delivery, with shivering and heat, pain, distention and
throbbing of the breasts, shooting to the armpits, restlessness; after twenty-
four hours, commonly terminating by sweat, diarrhœa, eruption of milk: the
usual quantity of this nutritive fluid is from two to three pints daily. In the
preceding puerperal stage, inflammation of one, but rarely of both breasts,
is a frequent affliction, varying in degree and severity: its symptoms are
local redness and swelling, burning heat, extreme tenderness, throbbing;
and is terminated by discussion, frequently by suppuration; sometimes by
scirrhus. The causes are impetuous rush of milk to the breasts; excess of
milk; not suckling; milk obstructed in the breasts or lactiferous tubes;
suckling too soon; obstructed lochia; cold and obstructed perspiration.
INFANT DISEASES every where furnish a vast supply to the gloomy
realms of Pluto; and this calamity is infinitely aggravated by the noxious
atmosphere of cities and towns. At birth, an infant is not only ushered into a
new world, but every function of its frail body undergoes new and sudden
changes. From the human oven of 96 degrees of heat, it is launched into a
variable climate of heat and cold. A new element of many thousand pounds
weight then presses upon the surface of its body. This atmospherick fluid,
adulterated in cities with innumerable impurities and feculencies is drawn
into its lungs: its diaphragm and muscles of respiration then begin to act,
the lungs expand, and the respiration commences. The passage between the
auricles of its heart and arterial duct are gradually closed up; the sphere of
the circulation is extended; the whole current of blood in its frequent
revolution hourly, passes through the lungs; the circulation through the
navel-string, and through which it had till then drawn its principal
nourishment, instantly ceases: food, for the first time, begins to be taken in
Page 206
by its mouth; the digestive, with all the numerous secretory and excretory
organs, then begin to perform their different offices; the tender creature is
exposed to sounds, in a few days to light; the bones at the superior part of
its head gape, and the brain is there defended by skin only; its head, belly,
liver, and lymphatic glands, are large, and its extremities slender; the fetal
brain is destitute of ideas; its bones are little more than gristles and
cartilages; its muscles are soft, flabby, and without swell or expression; the
greatest part of its time is spent in a state of inactive vegetation; it is unable
for several months to support its own weight, or to take nourishment, and is
then the most feeble and helpless of all the animal creation. With such
delicate machinery, it has soon to encounter pain and disease; the assaults of
internal and external enemies; when its crazy beams and bolts are easily
shook asunder in the first storm.
The acute diseases of early infancy; that is, under two years of age (small
pox, measles, and a few others excepted) are in the London registers,
principally accumulated into two aggregate heaps, Convulsions and
Teething: the former of which forms a dreary catalogue of astonishing
magnitude in London funerals; amounting to nearly one third of the whole
mortality in the metropolis. But convulsions and teething are terms too
indefinite. Every infant disease, not immediately obvious to the senses, is
thrust into these two articles by the ignorant reporters. If we consider the
term scientifically, convulsions, in multitudes of cases, convey no more
intelligence of the nature of the disease, than if they had said the child died
from want of breath. Let us therefore examine, whether the collected
observations of medical authors will not illuminate many dark and defective
parts of the publick registers, respecting infant mortality. Infants are exempt
from a multitude of the acute and chronic diseases of adults: they rarely
suffer so early in life from hereditary diseases, cares, passions of mind,
painful impulses of retentive memory, severe study, intemperance, hard
labour, the inclemency and vicissitudes of the seasons, and so on. The
principal diseases of infancy may be comprehended under the following:
convulsions, inward spasms and tetanus, colick, vomiting, acidity,
indigestion, flatulence, diarrhœa and gripes, thrush, dentition, hectic fever
and atrophy, rickets, scald head, rash, dropsy of the head and spine, inguinal
ruptures; together with small pox, measles, hooping cough, worms, and a
few others already described.
organs, then begin to perform their different offices; the tender creature is
exposed to sounds, in a few days to light; the bones at the superior part of
its head gape, and the brain is there defended by skin only; its head, belly,
liver, and lymphatic glands, are large, and its extremities slender; the fetal
brain is destitute of ideas; its bones are little more than gristles and
cartilages; its muscles are soft, flabby, and without swell or expression; the
greatest part of its time is spent in a state of inactive vegetation; it is unable
for several months to support its own weight, or to take nourishment, and is
then the most feeble and helpless of all the animal creation. With such
delicate machinery, it has soon to encounter pain and disease; the assaults of
internal and external enemies; when its crazy beams and bolts are easily
shook asunder in the first storm.
The acute diseases of early infancy; that is, under two years of age (small
pox, measles, and a few others excepted) are in the London registers,
principally accumulated into two aggregate heaps, Convulsions and
Teething: the former of which forms a dreary catalogue of astonishing
magnitude in London funerals; amounting to nearly one third of the whole
mortality in the metropolis. But convulsions and teething are terms too
indefinite. Every infant disease, not immediately obvious to the senses, is
thrust into these two articles by the ignorant reporters. If we consider the
term scientifically, convulsions, in multitudes of cases, convey no more
intelligence of the nature of the disease, than if they had said the child died
from want of breath. Let us therefore examine, whether the collected
observations of medical authors will not illuminate many dark and defective
parts of the publick registers, respecting infant mortality. Infants are exempt
from a multitude of the acute and chronic diseases of adults: they rarely
suffer so early in life from hereditary diseases, cares, passions of mind,
painful impulses of retentive memory, severe study, intemperance, hard
labour, the inclemency and vicissitudes of the seasons, and so on. The
principal diseases of infancy may be comprehended under the following:
convulsions, inward spasms and tetanus, colick, vomiting, acidity,
indigestion, flatulence, diarrhœa and gripes, thrush, dentition, hectic fever
and atrophy, rickets, scald head, rash, dropsy of the head and spine, inguinal
ruptures; together with small pox, measles, hooping cough, worms, and a
few others already described.
Page 207
As infants cannot by speech express their pain, we are too often under the
necessity to guess at their complaints by physiognomy, gestures, and dumb
signs: these are principally manifested by nausea, indigestion, vomiting,
flatulence, refusal of food, or the breast, diarrhœa and its different colour
and consistence, restlessness, cries, shrieks, agitation and contraction of the
lower extremities, disturbed sleep, injured respiration, cuticular eruptions,
pustules, and ulcers. In infancy the pulse and urine are precarious
symptoms: their arterial pulsations in fevers are sometimes so rapid, that the
most minute divisions of time in horological instruments, cannot keep pace
with them.
The general causes of Infant Diseases and mortality may be referred to the
sudden and violent changes after birth in its tender machinery; to weakness
and injuries from tedious and laborious parturition; delivery before the end
of the ninth month; hereditary debility; diseased parents; foul air of cities;
improper food and drink; scarcity of food and milk; ill formed nipples; the
tongue tied or retracted; errors in quantity or quality of nutriment; too long
continuance of vegetable and acescent food; foul stomach and intestines;
acidity in its stomach; errors of the mother or nurse in food, drink, rest,
exercise, excretions, passions of mind, ill temper, passionate, hysterical,
addicted to raw spirituous liquors and drunkenness; diseased; fasting too
long before the infant sucks; unwholesome milk; adulterated milk and
bread; neglect of cleanliness, and suffering the infant to lay too long in wet
cloaths; insufficient exercise, and also too violent agitation of the infant; the
ligatures, bandages, and pins too tight, and tormenting the infant; improper
positions and postures; cold cloathing and habitations, beds, and scarcity of
fuel, especially in northern regions, and in winter; infants excretions, and
especially by the anus, defective or excessive; improper treatment and
quackery of old women and nurses, and other such medicasters, during its
illness. It is but candid also to confess, that, in numerous instances, the
causes of infantile maladies are not yet sufficiently established nor
explained.
Convulsions, Inward Spasms, and Tetanus. From the exquisite tenderness
and irritability of its frame, most diseases of infants, when fatal, seem to
terminate in spasms, epilepsy, and convulsions; with which they are
infinitely more afflicted than adults, and often endure better. Inward spasms
are amongst the first of infantile maladies: it appears as if slumbering; the
necessity to guess at their complaints by physiognomy, gestures, and dumb
signs: these are principally manifested by nausea, indigestion, vomiting,
flatulence, refusal of food, or the breast, diarrhœa and its different colour
and consistence, restlessness, cries, shrieks, agitation and contraction of the
lower extremities, disturbed sleep, injured respiration, cuticular eruptions,
pustules, and ulcers. In infancy the pulse and urine are precarious
symptoms: their arterial pulsations in fevers are sometimes so rapid, that the
most minute divisions of time in horological instruments, cannot keep pace
with them.
The general causes of Infant Diseases and mortality may be referred to the
sudden and violent changes after birth in its tender machinery; to weakness
and injuries from tedious and laborious parturition; delivery before the end
of the ninth month; hereditary debility; diseased parents; foul air of cities;
improper food and drink; scarcity of food and milk; ill formed nipples; the
tongue tied or retracted; errors in quantity or quality of nutriment; too long
continuance of vegetable and acescent food; foul stomach and intestines;
acidity in its stomach; errors of the mother or nurse in food, drink, rest,
exercise, excretions, passions of mind, ill temper, passionate, hysterical,
addicted to raw spirituous liquors and drunkenness; diseased; fasting too
long before the infant sucks; unwholesome milk; adulterated milk and
bread; neglect of cleanliness, and suffering the infant to lay too long in wet
cloaths; insufficient exercise, and also too violent agitation of the infant; the
ligatures, bandages, and pins too tight, and tormenting the infant; improper
positions and postures; cold cloathing and habitations, beds, and scarcity of
fuel, especially in northern regions, and in winter; infants excretions, and
especially by the anus, defective or excessive; improper treatment and
quackery of old women and nurses, and other such medicasters, during its
illness. It is but candid also to confess, that, in numerous instances, the
causes of infantile maladies are not yet sufficiently established nor
explained.
Convulsions, Inward Spasms, and Tetanus. From the exquisite tenderness
and irritability of its frame, most diseases of infants, when fatal, seem to
terminate in spasms, epilepsy, and convulsions; with which they are
infinitely more afflicted than adults, and often endure better. Inward spasms
are amongst the first of infantile maladies: it appears as if slumbering; the
Page 208
eyelids are not perfectly closed, and the white bulb of the eye is partly
turned upwards, and exposed to view; the eye-lashes twinkle; there is a
tremulous motion of the muscles of the face and lips, sometimes resembling
a smile or laugh: as the disease increases, the breath seems frequently to
stop; the tip of the nose is then contracted, with a pale, sometimes ghastly
and livid circle around the eyes and mouth; it starts on any motion or noise;
sometimes it seems falling into convulsions, but on discharging flatulent air
upwards and downwards, it recovers, and relapses again into a lethargic
state. By continuance, these spasms often terminate in some of the
following diseases; hectic fever, thrush, vomiting, diarrhœa and green feces,
watery gripes, convulsions. Infants also are sometimes subject to a locked
jaw; which we have already noticed under Tetanus.
The predisposing and occasional causes of convulsions and inward spasms
are, acrid stimulus of food, acidity, or bile, or inflammation in its stomach
or intestines; general debility; the brain compressed during parturition,
hence mould shot, horseshoe head; water in the brain; teeth cutting the
gums; passions and frights of the nurse affecting her milk, or drinking raw
spirituous liquors; improper food of the nurse or infant; scald head,
excretion behind its ears, and cutaneous rash repelled; they are usually
imputed to fulness and foulness of the stomach and intestines. Lastly,
Derangements in its yet crude machinery.
Some adult mortality, but in all probability a very inconsiderable portion, is
included in convulsions: infants are the principal victims. The convulsive
list diminishes during the latter half of the present century: but to unravel
the problem respecting convulsive increase or decrease, requires more
elaborate investigation than preceding calculators and criticks seem to have
suspected. It is necessary to contrast the deaths by convulsions and teething
with the christenings; for if more are born, more should be expected to die
in infancy. We must also take cognizance of some other titles of London
diseases, particularly stoppage of the stomach, colick and gripes of the guts;
both which have already been under review. Besides, chrysoms and infants,
an obsolete term, denoting the deaths in the first month after birth, is long
exploded from the bills, and probably ingulfed in convulsions.
Dentition. It is probable that the mortality under this head is exaggerated
enormously in the London registers, amounting to one fifteenth part of the
annual burials. Dentition usually commences about six or seven months
turned upwards, and exposed to view; the eye-lashes twinkle; there is a
tremulous motion of the muscles of the face and lips, sometimes resembling
a smile or laugh: as the disease increases, the breath seems frequently to
stop; the tip of the nose is then contracted, with a pale, sometimes ghastly
and livid circle around the eyes and mouth; it starts on any motion or noise;
sometimes it seems falling into convulsions, but on discharging flatulent air
upwards and downwards, it recovers, and relapses again into a lethargic
state. By continuance, these spasms often terminate in some of the
following diseases; hectic fever, thrush, vomiting, diarrhœa and green feces,
watery gripes, convulsions. Infants also are sometimes subject to a locked
jaw; which we have already noticed under Tetanus.
The predisposing and occasional causes of convulsions and inward spasms
are, acrid stimulus of food, acidity, or bile, or inflammation in its stomach
or intestines; general debility; the brain compressed during parturition,
hence mould shot, horseshoe head; water in the brain; teeth cutting the
gums; passions and frights of the nurse affecting her milk, or drinking raw
spirituous liquors; improper food of the nurse or infant; scald head,
excretion behind its ears, and cutaneous rash repelled; they are usually
imputed to fulness and foulness of the stomach and intestines. Lastly,
Derangements in its yet crude machinery.
Some adult mortality, but in all probability a very inconsiderable portion, is
included in convulsions: infants are the principal victims. The convulsive
list diminishes during the latter half of the present century: but to unravel
the problem respecting convulsive increase or decrease, requires more
elaborate investigation than preceding calculators and criticks seem to have
suspected. It is necessary to contrast the deaths by convulsions and teething
with the christenings; for if more are born, more should be expected to die
in infancy. We must also take cognizance of some other titles of London
diseases, particularly stoppage of the stomach, colick and gripes of the guts;
both which have already been under review. Besides, chrysoms and infants,
an obsolete term, denoting the deaths in the first month after birth, is long
exploded from the bills, and probably ingulfed in convulsions.
Dentition. It is probable that the mortality under this head is exaggerated
enormously in the London registers, amounting to one fifteenth part of the
annual burials. Dentition usually commences about six or seven months
Page 209
after birth; sometimes not before ten, twelve, or eighteen months, and, in
some extraordinary instances, not before two years of age. These sharp
bones, in piercing the tender gums, often excite exquisite pain, restlessness,
fever, flow of saliva; the infant’s hand is frequently thrust into its mouth; it
bites the nipple; sometimes the gum is swelled at the jutting of the tooth,
and a pale spot appears at the part where it endeavours to protrude. When
dentition is out of the natural order, it is generally painful: in the natural
progress, the two foreteeth of the lower, then those of the upper jaw; next,
the two adjacent of the upper, and afterwards of the lower jaw, cut their
way. After the eye-teeth, or canine, in the upper, and those two opposite to
them in the lower jaw are protruded, the danger of teething is generally
escaped. It is only in the first dentition, that is, under two years of age, that
mortality ensues from this source: the fatal and most frequent transition is
into convulsions. About two years of age, infants are generally provided
with twenty teeth for the purposes of mastication: and this number remains
stationary until after seven years from birth, when all the first set are
gradually and successively thrust out by others deeper seated in the jaw
bones; about the age of fourteen all are excluded; and in adults the number
is increased to thirty-two.
Rickets. Notwithstanding the omission of ancient authors to discriminate
this disease, we cannot believe but that, in this instance, the same causes
would in all ages have produced the same effects. Rickets would seem by
the London registers to decrease; for in our last group of fifteen years they
shrink to 104; whereas in the thirty last years of the preceding century,
ricketty deaths are numbered at 11,415. To what cause is this decrease to be
ascribed? Does it indicate more maternal attention, and also more propriety
in suckling and rearing of infants? Is implicit faith to be placed in the
London registers, and crimination of diseases?
Rickets, one of the chronic diseases, seldom commence before three, six, or
nine months after birth, generally between nine months and two or three
years of age, and seldom or ever after five. The progressive symptoms are
aversion to motion, and to put the feet to the ground, decrease of strength,
paleness and flaccidity of the muscles, wasting of flesh, although in many
the appetite is voracious; enlarged belly, liver, spleen, head, and joints;
tumid and tympanitick abdomen; laborious respiration; dentition later or
slower than usual; carious teeth; fetid breath; premature acuteness of genius
some extraordinary instances, not before two years of age. These sharp
bones, in piercing the tender gums, often excite exquisite pain, restlessness,
fever, flow of saliva; the infant’s hand is frequently thrust into its mouth; it
bites the nipple; sometimes the gum is swelled at the jutting of the tooth,
and a pale spot appears at the part where it endeavours to protrude. When
dentition is out of the natural order, it is generally painful: in the natural
progress, the two foreteeth of the lower, then those of the upper jaw; next,
the two adjacent of the upper, and afterwards of the lower jaw, cut their
way. After the eye-teeth, or canine, in the upper, and those two opposite to
them in the lower jaw are protruded, the danger of teething is generally
escaped. It is only in the first dentition, that is, under two years of age, that
mortality ensues from this source: the fatal and most frequent transition is
into convulsions. About two years of age, infants are generally provided
with twenty teeth for the purposes of mastication: and this number remains
stationary until after seven years from birth, when all the first set are
gradually and successively thrust out by others deeper seated in the jaw
bones; about the age of fourteen all are excluded; and in adults the number
is increased to thirty-two.
Rickets. Notwithstanding the omission of ancient authors to discriminate
this disease, we cannot believe but that, in this instance, the same causes
would in all ages have produced the same effects. Rickets would seem by
the London registers to decrease; for in our last group of fifteen years they
shrink to 104; whereas in the thirty last years of the preceding century,
ricketty deaths are numbered at 11,415. To what cause is this decrease to be
ascribed? Does it indicate more maternal attention, and also more propriety
in suckling and rearing of infants? Is implicit faith to be placed in the
London registers, and crimination of diseases?
Rickets, one of the chronic diseases, seldom commence before three, six, or
nine months after birth, generally between nine months and two or three
years of age, and seldom or ever after five. The progressive symptoms are
aversion to motion, and to put the feet to the ground, decrease of strength,
paleness and flaccidity of the muscles, wasting of flesh, although in many
the appetite is voracious; enlarged belly, liver, spleen, head, and joints;
tumid and tympanitick abdomen; laborious respiration; dentition later or
slower than usual; carious teeth; fetid breath; premature acuteness of genius
Page 210
and reason than is natural to the years; the countenance serious and ancient;
the infant waddles in its gait, the spine and bones of the lower extremities
become crooked and deformed, the breast prominent. The earlier rickets
commence, they are more contumacious; and when chronic or fatal, are
frequently accompanied with hectic fever: they may continue several years,
and at length terminate in general bad health, atrophy, dropsy. Should they
not be checked before the fifth, or at the utmost, the eighth year,
irremediable deformity must ensue, which in females is often the cause of
distorted pelvis, and difficult labours. The predisponent and occasional
causes are hereditary; weak diseased parents or nurses; negligent nursing;
not sufficient exercise nor cleanliness; improper diet and gross food;
worms; foul stomach and intestines; scrophulous obstructed mesenteric and
lymphatic glands; diseased liver; general bad health, with hectic fever;
various causes of atrophy; difficult dentition; faulty state of ossification;
deficiency in the ossious rudiments; faults in the organs of nutrition.
Thrush. In the preceding century, Canker was often joined together in the
London registers with Thrush; but whether it should be coupled with this or
with gangrene, or with both, I cannot determine. Thrush is principally a
disease of early infancy: it is likewise often a concomitant symptom of
some febrile and acute diseases of adults. It infests not the young alone, but
also aged persons, especially in cold northern and moist climates, in damp
situations, and in warm rainy seasons. As an idiopathic disease of adults, it
is rare in this island. The disease generally appears first on the tongue and
roof of the mouth, in small superficial red specks, and ash-coloured ulcers,
spreading gradually over the palate, fauces, cheeks and lips; with anxiety,
restlessness, pain, difficulty of suction and deglutition, fever, nausea,
vomiting. After some time, the ulcers form thick, tenacious incrustations,
shining like lard, ash-coloured, brown, rarely black: these crustaceous
layers scale off, but, not unfrequently, after the interval of a few days, are
again renewed: the oftener the worse: and in such cases they may be
protracted weeks. When the raw skin appears dry under the crusts after
desquamation, they are reproduced; moisture there indicates a speedy and
favourable termination: diarrhœa frequently supervenes.
In order to prevent the superfluous multiplication of symptoms and
diseases, and which are common to all ages, I have, under the respective
titles of Vomiting and Acidity, Colick, Diarrhœa and Watery Gripes,
the infant waddles in its gait, the spine and bones of the lower extremities
become crooked and deformed, the breast prominent. The earlier rickets
commence, they are more contumacious; and when chronic or fatal, are
frequently accompanied with hectic fever: they may continue several years,
and at length terminate in general bad health, atrophy, dropsy. Should they
not be checked before the fifth, or at the utmost, the eighth year,
irremediable deformity must ensue, which in females is often the cause of
distorted pelvis, and difficult labours. The predisponent and occasional
causes are hereditary; weak diseased parents or nurses; negligent nursing;
not sufficient exercise nor cleanliness; improper diet and gross food;
worms; foul stomach and intestines; scrophulous obstructed mesenteric and
lymphatic glands; diseased liver; general bad health, with hectic fever;
various causes of atrophy; difficult dentition; faulty state of ossification;
deficiency in the ossious rudiments; faults in the organs of nutrition.
Thrush. In the preceding century, Canker was often joined together in the
London registers with Thrush; but whether it should be coupled with this or
with gangrene, or with both, I cannot determine. Thrush is principally a
disease of early infancy: it is likewise often a concomitant symptom of
some febrile and acute diseases of adults. It infests not the young alone, but
also aged persons, especially in cold northern and moist climates, in damp
situations, and in warm rainy seasons. As an idiopathic disease of adults, it
is rare in this island. The disease generally appears first on the tongue and
roof of the mouth, in small superficial red specks, and ash-coloured ulcers,
spreading gradually over the palate, fauces, cheeks and lips; with anxiety,
restlessness, pain, difficulty of suction and deglutition, fever, nausea,
vomiting. After some time, the ulcers form thick, tenacious incrustations,
shining like lard, ash-coloured, brown, rarely black: these crustaceous
layers scale off, but, not unfrequently, after the interval of a few days, are
again renewed: the oftener the worse: and in such cases they may be
protracted weeks. When the raw skin appears dry under the crusts after
desquamation, they are reproduced; moisture there indicates a speedy and
favourable termination: diarrhœa frequently supervenes.
In order to prevent the superfluous multiplication of symptoms and
diseases, and which are common to all ages, I have, under the respective
titles of Vomiting and Acidity, Colick, Diarrhœa and Watery Gripes,
Page 211
diseases so frequent and harassing in infancy, added the discriminating
marks and peculiarities in those early years. Small pox, measles, hooping
cough, croup, dropsy of the head and spine, phthisis, hectic and atrophy,
scald head, rash, worms, have each been the subjects of preceding
investigation: ruptures make a part of our subsequent inquiry.
A Miscellaneous group of diseases are here associated: several of them
unconnected in symptom, cause, or cure: others are of exotic origin, and
transplanted amongst us. Mankind left exposed, without defence or remedy,
against even this small morbid host, would soon be sensible of the
calamities and scourge of medicinal ignorance: and they would be less
surprised at the incorporation of medicine with divine worship in ancient
times.
Venereal Disease. Three hundred years have not altogether elapsed since the
discovery of America, and the importation of the venereal disease into the
old world. Before the discovery of its antidote, mercury, and in some
inferior degree of the native Indian remedy, the decoction of guiacum,
Europe was alarmed with universal confirmation at the rapid inroads of this
disease: multitudes, of all ranks, perished in lingering torture, under its
corroding ulcers, presenting before death hideous spectacles of cadaverous
corruption and deformity. In the last thirty years of the preceding century,
2360 deaths are recorded under French pox, in the London bills; and even at
this day, the chart of diseases demonstrates its fatality to be infinitely
greater than medical men could suspect.
It would, in this disease, be ridiculous to inspect hospital registers, for the
purpose of either ascertaining the ages wherein venereal ravages prevail, or
the proportion of cured and incurable. Its ravages cannot be in infancy, nor
in adolescence, nor in the decline of life. The merest smatterer in medicine
knows the infallible remedy and cure I except that in the application to
particular cases, some more judgment and dexterity is necessary. The
multitudes who now perish in these battles of Venus, are so many sacrifices
either to negligence or to indigence; or to the grossest ignorance and
empiricism of licenced murderers. There is no other disease wherein
professed quackery is so generally resorted to, or wherein its decoys are so
pernicious to the community. The great majority of these victims to
marks and peculiarities in those early years. Small pox, measles, hooping
cough, croup, dropsy of the head and spine, phthisis, hectic and atrophy,
scald head, rash, worms, have each been the subjects of preceding
investigation: ruptures make a part of our subsequent inquiry.
A Miscellaneous group of diseases are here associated: several of them
unconnected in symptom, cause, or cure: others are of exotic origin, and
transplanted amongst us. Mankind left exposed, without defence or remedy,
against even this small morbid host, would soon be sensible of the
calamities and scourge of medicinal ignorance: and they would be less
surprised at the incorporation of medicine with divine worship in ancient
times.
Venereal Disease. Three hundred years have not altogether elapsed since the
discovery of America, and the importation of the venereal disease into the
old world. Before the discovery of its antidote, mercury, and in some
inferior degree of the native Indian remedy, the decoction of guiacum,
Europe was alarmed with universal confirmation at the rapid inroads of this
disease: multitudes, of all ranks, perished in lingering torture, under its
corroding ulcers, presenting before death hideous spectacles of cadaverous
corruption and deformity. In the last thirty years of the preceding century,
2360 deaths are recorded under French pox, in the London bills; and even at
this day, the chart of diseases demonstrates its fatality to be infinitely
greater than medical men could suspect.
It would, in this disease, be ridiculous to inspect hospital registers, for the
purpose of either ascertaining the ages wherein venereal ravages prevail, or
the proportion of cured and incurable. Its ravages cannot be in infancy, nor
in adolescence, nor in the decline of life. The merest smatterer in medicine
knows the infallible remedy and cure I except that in the application to
particular cases, some more judgment and dexterity is necessary. The
multitudes who now perish in these battles of Venus, are so many sacrifices
either to negligence or to indigence; or to the grossest ignorance and
empiricism of licenced murderers. There is no other disease wherein
professed quackery is so generally resorted to, or wherein its decoys are so
pernicious to the community. The great majority of these victims to
Page 212
seduction, pleasure, and necessity, are in all probability amongst the swarm
of wretched and unfortunate female prostitutes; and in the male sex
amongst the lower orders: for in those of less straitened circumstances, a
small bribe to the searchers would conjure venereal mortality into sores or
ulcers, or into consumptions. Besides, were we to add to venereal carnage
the shattered constitutions, in consequence of these wounds and scars, it
would appear an object of sufficient magnitude to attract the attention,
interposition, and regulation of the legislature. In every metropolis,
especially amongst the unmarried, and in armies and navies, it is without
doubt, much more fatal to the community. Indeed, in cities, few of the male
sex, arrived at adult years, can boast of not having been, in some giddy
moment, fascinated into impure embraces.
There are two distinct genera, or species, of the venereal disease; the Local
Gonorrhœa, and what is called Confirmed Pox. The gonorrhœa generally
begins from two to six days after the infection, with titillation of the glans,
redness of the orifice of the urethra, and oozing of mucus; which tinges the
linen in spots and hardness. These symptoms are daily aggravated with
strangury, dysury, involuntary painful priapism, and nocturnal pollution.
Sometimes, though rarely, gonorrhœa is confined to the external mucous
glands about the neck or ring of the glans. In females, the gonorrhœa affects
principally the vagina, with pain, heat, and mucous discharge; but no
considerable dysury. The lues venerea confirmata, or syphilis, commonly
begins with either one or more ulcerations of the penis, or vagina; or with
inflammation in the glands of the groin. The ulcer or chancre appears as a
red spot on the glans, or prepuce, is hot, prurient; in a few days the top
changes into a white speck, ulcerates, and, if not prevented, gradually
spreads and corrodes all around. Inflammation, or bubo in the lymphatic
glands of the groin, may either originate from previous chancre, or without
it. In this a tumour and pain is felt in the groin, with enlargement of the
glands; this tumour and inflammation, if not checked, increases to a boil,
and suppuration; but often with tedious subsequent ulcerations, fistulas, and
sanious discharge.
These are the two usual and slight appearances of gonorrhœa, and of
confirmed pox, when the infection is first applied to the genitals; and
frequently these two genera are complicated. But in both genera, from
various causes, originating from the virulence of the disease, the
of wretched and unfortunate female prostitutes; and in the male sex
amongst the lower orders: for in those of less straitened circumstances, a
small bribe to the searchers would conjure venereal mortality into sores or
ulcers, or into consumptions. Besides, were we to add to venereal carnage
the shattered constitutions, in consequence of these wounds and scars, it
would appear an object of sufficient magnitude to attract the attention,
interposition, and regulation of the legislature. In every metropolis,
especially amongst the unmarried, and in armies and navies, it is without
doubt, much more fatal to the community. Indeed, in cities, few of the male
sex, arrived at adult years, can boast of not having been, in some giddy
moment, fascinated into impure embraces.
There are two distinct genera, or species, of the venereal disease; the Local
Gonorrhœa, and what is called Confirmed Pox. The gonorrhœa generally
begins from two to six days after the infection, with titillation of the glans,
redness of the orifice of the urethra, and oozing of mucus; which tinges the
linen in spots and hardness. These symptoms are daily aggravated with
strangury, dysury, involuntary painful priapism, and nocturnal pollution.
Sometimes, though rarely, gonorrhœa is confined to the external mucous
glands about the neck or ring of the glans. In females, the gonorrhœa affects
principally the vagina, with pain, heat, and mucous discharge; but no
considerable dysury. The lues venerea confirmata, or syphilis, commonly
begins with either one or more ulcerations of the penis, or vagina; or with
inflammation in the glands of the groin. The ulcer or chancre appears as a
red spot on the glans, or prepuce, is hot, prurient; in a few days the top
changes into a white speck, ulcerates, and, if not prevented, gradually
spreads and corrodes all around. Inflammation, or bubo in the lymphatic
glands of the groin, may either originate from previous chancre, or without
it. In this a tumour and pain is felt in the groin, with enlargement of the
glands; this tumour and inflammation, if not checked, increases to a boil,
and suppuration; but often with tedious subsequent ulcerations, fistulas, and
sanious discharge.
These are the two usual and slight appearances of gonorrhœa, and of
confirmed pox, when the infection is first applied to the genitals; and
frequently these two genera are complicated. But in both genera, from
various causes, originating from the virulence of the disease, the
Page 213
intemperance of the patient, or mismanagement of his medical pilot, many
adventitious and aggravated symptoms are superadded; in number and
severity varying in different persons; several of them, when violent and
precipitate, requiring speedy alleviation; and often to be treated as separate
diseases. In the malign train of gonorrhœa are violent inflammation and
constriction of the prepuce, before or behind the glans, or phymosis, and
paraphymosis; dysury, strangury, priapism; painful and inflamed testicles;
scirrhous and indurated testicles; chronic gleet; stricture, caruncles, and
obstructions in the urethra. Confirmed pox, in its inveterate and chronic
stages, contaminates the whole constitution; erodes the genitals, or anus;
ascends to the throat, and excites callous ulceration and dilapidation in the
uvula, tonsils, fauces, palate, nose; hence hoarse, guttural voice, fetid
breath: the patient is variously tormented with gnawing pains in the legs,
shoulders, and hand bones, which are exasperated in bed; with chronic
headach; with cutaneous eruptions on different parts of the face, trunk, or
extremities, and dry, scaly, humid, ulcerated, red, yellow, or purple; with
ophthalmy; with nodes and tumour of the forehead, exostoses and caries of
the bones; atrophy. Chronic warts about the genitals and anus, and called by
different names, porri, crystæ, condylomata, rhagades, thymi, moræ; are
generally innocuous.
The Causes. Infection by contact with the genitals: or the pox, when
inveterate, may be communicated by the mouth and nipples; by drinking
out of the same vessels, by touching any diseased or ulcerated part. When
inoculated by suction, it begins first in the mouth or nipples.
Scurvy. True scurvy is seldom or ever mentioned by any writer, before the
long voyages, first began three centuries ago by the moderns; that is, on the
discovery of the passage to Asia by the south cape of Africa; and the
discovery of America. Then, in consequence of living long on salted and
gross diet, and the want of fresh vegetables or fruits, together with their
ignorance of the cause and cure, this disease made dreadful havock amongst
naval squadrons, and the other busy hive employed in nautical commerce.
The ancient navigators, who seldom ventured out of sight of land, or capes;
and who probably were not under the necessity of subsisting long on salted
food, do not appear to have suffered by, nor even to have known, the
disease. Hippocrates is by some supposed slightly to allude to scurvy, under
the name of large spleen; accompanied also with spungy putrid gums, and
adventitious and aggravated symptoms are superadded; in number and
severity varying in different persons; several of them, when violent and
precipitate, requiring speedy alleviation; and often to be treated as separate
diseases. In the malign train of gonorrhœa are violent inflammation and
constriction of the prepuce, before or behind the glans, or phymosis, and
paraphymosis; dysury, strangury, priapism; painful and inflamed testicles;
scirrhous and indurated testicles; chronic gleet; stricture, caruncles, and
obstructions in the urethra. Confirmed pox, in its inveterate and chronic
stages, contaminates the whole constitution; erodes the genitals, or anus;
ascends to the throat, and excites callous ulceration and dilapidation in the
uvula, tonsils, fauces, palate, nose; hence hoarse, guttural voice, fetid
breath: the patient is variously tormented with gnawing pains in the legs,
shoulders, and hand bones, which are exasperated in bed; with chronic
headach; with cutaneous eruptions on different parts of the face, trunk, or
extremities, and dry, scaly, humid, ulcerated, red, yellow, or purple; with
ophthalmy; with nodes and tumour of the forehead, exostoses and caries of
the bones; atrophy. Chronic warts about the genitals and anus, and called by
different names, porri, crystæ, condylomata, rhagades, thymi, moræ; are
generally innocuous.
The Causes. Infection by contact with the genitals: or the pox, when
inveterate, may be communicated by the mouth and nipples; by drinking
out of the same vessels, by touching any diseased or ulcerated part. When
inoculated by suction, it begins first in the mouth or nipples.
Scurvy. True scurvy is seldom or ever mentioned by any writer, before the
long voyages, first began three centuries ago by the moderns; that is, on the
discovery of the passage to Asia by the south cape of Africa; and the
discovery of America. Then, in consequence of living long on salted and
gross diet, and the want of fresh vegetables or fruits, together with their
ignorance of the cause and cure, this disease made dreadful havock amongst
naval squadrons, and the other busy hive employed in nautical commerce.
The ancient navigators, who seldom ventured out of sight of land, or capes;
and who probably were not under the necessity of subsisting long on salted
food, do not appear to have suffered by, nor even to have known, the
disease. Hippocrates is by some supposed slightly to allude to scurvy, under
the name of large spleen; accompanied also with spungy putrid gums, and
Page 214
offensive breath: it is also, though indistinctly, noticed by Pliny, as affecting
a Roman army encamped on the banks of the Rhine.
Through all the northern kingdoms of Europe, particularly in the winter
season, and in Holland, amongst those who fed chiefly on salted fish and
gross diet; who drank bad waters, and dwelt either in morasses, or near the
sea coasts, and were exposed to cold and moisture, scurvy in the two last
centuries made cruel ravages. Several armies and besieged garrisons in
Germany, intercluded from fresh vegetables; and numbers of the new
settlers in the northern colonies of America, and who were in nearly the
same predicament, were cut off by the scurvy. The North Americans were at
last taught by the Baltickers and Swedes the sovereign benefit of
substituting spruce beer, when fresh vegetables cannot be found. The
industrious Dutch made drains and canals to carry off water, and trusted the
rest of the cure or prevention to pickled cabbages or sour crout. In the
northern parts of Russia, where scurvy is very universal, they found a
particular acidulated bread and sour drink, powerfully to resist this disease.
By these and other precautions, the scurvy is now much less formidable on
land; but at sea no other, the nervous and putrid fever not excepted, is so
inimical to navigators. On that element it is yet the devouring monster and
tyrant. In the first voyages of our East India Company’s ships, nearly one
fourth of the crews died at sea. Nautical records teem with tragical
narratives of scorbutic ravages. But at present, the causes and the effectual
antidotes, and the cure, are so well known, that the greatest part of the lives
now lost by scurvy at sea, are either sacrificed to gross negligence, or to
impolitic and inhuman economy. The temperature of sea air is more equal
than that on land: and that it is not pernicious, we have an undoubted proof
in one of the late Captain Cooke’s voyages; wherein, with a company of
118 men, during a voyage of three years, and through all climates, from 52
degrees north to 71 south, he lost only one man by sickness.
From 1671 to 1686, the deaths by scurvy are in the London bills 9,451; but
in the succeeding fifteen years, decrease to 569 only: and throughout the
present century, continue progressively on the declension. Even of this
trifling number, what proportion was engendered at sea, or whether they all
died of genuine scurvy, I cannot decide. The theory of the last century
imputed many diseases to this specific cacoethes, as they called it; which
would have some influence on the searchers reports. In London, the
a Roman army encamped on the banks of the Rhine.
Through all the northern kingdoms of Europe, particularly in the winter
season, and in Holland, amongst those who fed chiefly on salted fish and
gross diet; who drank bad waters, and dwelt either in morasses, or near the
sea coasts, and were exposed to cold and moisture, scurvy in the two last
centuries made cruel ravages. Several armies and besieged garrisons in
Germany, intercluded from fresh vegetables; and numbers of the new
settlers in the northern colonies of America, and who were in nearly the
same predicament, were cut off by the scurvy. The North Americans were at
last taught by the Baltickers and Swedes the sovereign benefit of
substituting spruce beer, when fresh vegetables cannot be found. The
industrious Dutch made drains and canals to carry off water, and trusted the
rest of the cure or prevention to pickled cabbages or sour crout. In the
northern parts of Russia, where scurvy is very universal, they found a
particular acidulated bread and sour drink, powerfully to resist this disease.
By these and other precautions, the scurvy is now much less formidable on
land; but at sea no other, the nervous and putrid fever not excepted, is so
inimical to navigators. On that element it is yet the devouring monster and
tyrant. In the first voyages of our East India Company’s ships, nearly one
fourth of the crews died at sea. Nautical records teem with tragical
narratives of scorbutic ravages. But at present, the causes and the effectual
antidotes, and the cure, are so well known, that the greatest part of the lives
now lost by scurvy at sea, are either sacrificed to gross negligence, or to
impolitic and inhuman economy. The temperature of sea air is more equal
than that on land: and that it is not pernicious, we have an undoubted proof
in one of the late Captain Cooke’s voyages; wherein, with a company of
118 men, during a voyage of three years, and through all climates, from 52
degrees north to 71 south, he lost only one man by sickness.
From 1671 to 1686, the deaths by scurvy are in the London bills 9,451; but
in the succeeding fifteen years, decrease to 569 only: and throughout the
present century, continue progressively on the declension. Even of this
trifling number, what proportion was engendered at sea, or whether they all
died of genuine scurvy, I cannot decide. The theory of the last century
imputed many diseases to this specific cacoethes, as they called it; which
would have some influence on the searchers reports. In London, the
Page 215
lodgings are now warm and dry, and the people in general tolerably well
cloathed: animal meat is eat fresh; vegetables, though perhaps not
universally consumed in sufficient quantity, are certainly in much greater
abundance than formerly: beer, fermented liquors, and tea, are drank by all
ranks. All these, in conjunction with exercise, powerfully resist the
tendency to scorbutic corruption.
The progressive gradations and virulence of scurvy, are distinguished under
the three following stages: the countenance becomes pale, sickly, and
bloated, with lassitude and aversion to motion, and debility, on any
exercise. But the cardinal symptom is red, spungy, enlarged gums, from
which, on being rubbed, blood issues, and the teeth begin to loosen and fall
out; the breath and urine are fetid; and, by degrees, bruises and black spots
are seen in various parts, especially the legs. In the next more aggravated
stage, the tendons at the hams begin to contract and swell; there are pains in
different parts; disposition to salivation and hemorrhages from the gums
and nose, with increased debility and proneness to syncope. In the last and
most inveterate stages, putrid ulcers are formed, particularly in the legs,
which are swelled and enlarged; or old cicatrices of former ulcers are
dissolved, and again break out, from which issue a sanious and fetid
discharge; and within them is generated fungous flesh, in confidence
resembling a bullock’s liver. Throughout there is no fever; nor is the disease
contagious; neither are the appetite and senses impaired, except that there is
great despondency and melancholy. The predisposing and occasional causes
are cold and moisture, and subsisting long on dried, smoked, salted flesh
meat or fish, without vegetables, or these in small quantity; putrid, and also
gross diet difficultly digested, not perspirable; corrupted stagnant water;
low marshy damp situations; cold situations; the winter season of northern
climates: wet cold cloaths, beds, houses; insufficient or suppressed
perspiration, hence the corrupted animal juices are not carried off;
indolence, sedentary life, confinement, dejection of mind, melancholy; bad
health; impurities of the blood; diseases of the spleen.
Scrofula, Struma, King’s Evil. In the last thirty years of the preceding
century, the mortality by evil is only 2,126, in the London bills; and
throughout the present century continues decreasing. This, however, is a
very partial representation of its fatality, which in its consequence is far
more destructive. The disease seldom appears under two years of age;
cloathed: animal meat is eat fresh; vegetables, though perhaps not
universally consumed in sufficient quantity, are certainly in much greater
abundance than formerly: beer, fermented liquors, and tea, are drank by all
ranks. All these, in conjunction with exercise, powerfully resist the
tendency to scorbutic corruption.
The progressive gradations and virulence of scurvy, are distinguished under
the three following stages: the countenance becomes pale, sickly, and
bloated, with lassitude and aversion to motion, and debility, on any
exercise. But the cardinal symptom is red, spungy, enlarged gums, from
which, on being rubbed, blood issues, and the teeth begin to loosen and fall
out; the breath and urine are fetid; and, by degrees, bruises and black spots
are seen in various parts, especially the legs. In the next more aggravated
stage, the tendons at the hams begin to contract and swell; there are pains in
different parts; disposition to salivation and hemorrhages from the gums
and nose, with increased debility and proneness to syncope. In the last and
most inveterate stages, putrid ulcers are formed, particularly in the legs,
which are swelled and enlarged; or old cicatrices of former ulcers are
dissolved, and again break out, from which issue a sanious and fetid
discharge; and within them is generated fungous flesh, in confidence
resembling a bullock’s liver. Throughout there is no fever; nor is the disease
contagious; neither are the appetite and senses impaired, except that there is
great despondency and melancholy. The predisposing and occasional causes
are cold and moisture, and subsisting long on dried, smoked, salted flesh
meat or fish, without vegetables, or these in small quantity; putrid, and also
gross diet difficultly digested, not perspirable; corrupted stagnant water;
low marshy damp situations; cold situations; the winter season of northern
climates: wet cold cloaths, beds, houses; insufficient or suppressed
perspiration, hence the corrupted animal juices are not carried off;
indolence, sedentary life, confinement, dejection of mind, melancholy; bad
health; impurities of the blood; diseases of the spleen.
Scrofula, Struma, King’s Evil. In the last thirty years of the preceding
century, the mortality by evil is only 2,126, in the London bills; and
throughout the present century continues decreasing. This, however, is a
very partial representation of its fatality, which in its consequence is far
more destructive. The disease seldom appears under two years of age;
Page 216
commonly between three and seven, and sometimes not until near puberty;
after which its evolution and first appearance is very rare. The children of
fair hair, rosy cheeks, smooth skin, soft delicate complexion and
temperament, are more obnoxious to scrofula than those of an opposite
temperament. It is sometimes introduced by a tumid upper lip, and chop in
the middle of it; at other times the first appearance is oval moveable
tumours in the lymphatic glands of the neck, under the chin, or below the
ears. These tumours often continue inert one, two, or more years, and
without pain, until they tend towards suppuration; and are various in size,
from a walnut to an egg, or larger. At length there is some fluctuation,
ulceration, and exudation of viscid serum, but no concocted pus; the ulcers
spread unequally; their edges are not callous; yet they are very tardy in
cicatrizing. In this way there is a succession of tumours and ulcers during
several years; the former alternately subsiding whilst the ulcers are open;
some cicatrizing, and others breaking out; and most so in the spring season.
Commonly after four or five years, or towards puberty, the cervical ulcers
finally close, leaving behind indelible scars. This entailed alloy is often the
source of bad health. Sometimes the eyes or eyelids are particularly
afflicted with scrofulous ophthalmy. In other cases it excites tumours, deep
seated abscess, anchylosis, and caries in various joints of the elbow, fingers,
knees, feet; or stubborn ulcers in different parts: and still more deleterious
consequences ensue from scrofulous glands of the lungs or mesentery
terminating in phthisis, or hectick. Some nations more than others, are
afflicted with scrofula. I have read that it is not frequent in tropical climates;
and it is not contagious. The predisposing and occasional causes are
hereditary: diseases of the lymphatic glands; consequence of small pox:
whether it is more prevalent in some countries than others from the air,
water, diet, or other causes, is not yet ascertained.
Leprosy. A considerable part of the Mosaical code, politically and
medicinally, is pointed against this disease. It is now, in a great degree,
eradicated and worn out of Europe. After the Crusades, in the twelfth
century, Europe was overspread with this hideous judaical scurf, imported
from Palestine. Lazarettoes for the confinement of the unclean, were then
numerous in many kingdoms: in France alone there were two thousand. At
present, in the cold northern island, Iceland, a sort of leprosy is congenial to
the natives, from their diet, climate, and mode of life. And in the history of
after which its evolution and first appearance is very rare. The children of
fair hair, rosy cheeks, smooth skin, soft delicate complexion and
temperament, are more obnoxious to scrofula than those of an opposite
temperament. It is sometimes introduced by a tumid upper lip, and chop in
the middle of it; at other times the first appearance is oval moveable
tumours in the lymphatic glands of the neck, under the chin, or below the
ears. These tumours often continue inert one, two, or more years, and
without pain, until they tend towards suppuration; and are various in size,
from a walnut to an egg, or larger. At length there is some fluctuation,
ulceration, and exudation of viscid serum, but no concocted pus; the ulcers
spread unequally; their edges are not callous; yet they are very tardy in
cicatrizing. In this way there is a succession of tumours and ulcers during
several years; the former alternately subsiding whilst the ulcers are open;
some cicatrizing, and others breaking out; and most so in the spring season.
Commonly after four or five years, or towards puberty, the cervical ulcers
finally close, leaving behind indelible scars. This entailed alloy is often the
source of bad health. Sometimes the eyes or eyelids are particularly
afflicted with scrofulous ophthalmy. In other cases it excites tumours, deep
seated abscess, anchylosis, and caries in various joints of the elbow, fingers,
knees, feet; or stubborn ulcers in different parts: and still more deleterious
consequences ensue from scrofulous glands of the lungs or mesentery
terminating in phthisis, or hectick. Some nations more than others, are
afflicted with scrofula. I have read that it is not frequent in tropical climates;
and it is not contagious. The predisposing and occasional causes are
hereditary: diseases of the lymphatic glands; consequence of small pox:
whether it is more prevalent in some countries than others from the air,
water, diet, or other causes, is not yet ascertained.
Leprosy. A considerable part of the Mosaical code, politically and
medicinally, is pointed against this disease. It is now, in a great degree,
eradicated and worn out of Europe. After the Crusades, in the twelfth
century, Europe was overspread with this hideous judaical scurf, imported
from Palestine. Lazarettoes for the confinement of the unclean, were then
numerous in many kingdoms: in France alone there were two thousand. At
present, in the cold northern island, Iceland, a sort of leprosy is congenial to
the natives, from their diet, climate, and mode of life. And in the history of
Page 217
the late discoveries in the Pacific Ocean, we read of a leprous scurf
infesting the natives, from their excessive indulgence in a hot spice amongst
their food. In our island, at this day, a considerable number are afflicted
with a disgusting cutaneous scurf; but greatly inferior in virulence to the
Asiatic leprosy. The absolute mortality in the London bills by this disease,
is almost undeserving of notice.
infesting the natives, from their excessive indulgence in a hot spice amongst
their food. In our island, at this day, a considerable number are afflicted
with a disgusting cutaneous scurf; but greatly inferior in virulence to the
Asiatic leprosy. The absolute mortality in the London bills by this disease,
is almost undeserving of notice.
Page 218
TO THE READER.
We must here abruptly, and with regret, but for obvious reasons, the size to
which this Publication is already swelled, cut off the remainder of our
comments, amounting to nearly one hundred pages more. Those left behind
unnoticed of the last group, comprehend most of the chronic cutaneous
diseases, the subjects, peculiarly, of the Cosmetic Art. Through the last
group of external accidents and diseases, I meant to have persevered in my
general plan. For instance, under Gangrene, I should have discriminated the
ages, mortality, cures; and at the same time, that originating from external
injuries, or surgical operations, and that from spontaneous corruption.
Under Fractures, I should have gauged the success and miscarriage of
amputation, both after sudden accidents, and in consequence of chronic
diseases. This is a most important part of military surgery, and I believe, in
a great measure, unexplored. From the trepan and lithotomy, I should also
have stated the blanks and prizes. With the surgical group I am obliged to
omit the casualties of London: one alone of which I could not entirely
postpone, without introducing a few observations in this place, that is the
Executed.
Executed. Murder, robbery, sedition, and war, are amongst the principal
political casualties, chronic distempers, fevers, and frenzies of every nation.
In ascertaining the numbers executed, particularly, the London bills of
mortality are shamefully erroneous and defective. As I thought it a casualty
of infinite importance to be exactly stated and recorded, I made numerous
efforts to procure authentic information, by successively and repeatedly
waiting upon the Keeper of Newgate, the Clerk of the Arraigns, the Clerk of
the Peace for the County, the Town-Clerk of London, the Sheriff’s office of
London, and the Secretary of State’s. Throughout this inquiry I was every
where treated with liberality and urbanity; and where there was any
prospect of information, was permitted access to the records. But, to my
astonishment and mortification, I could not find any vestige of records of
executions in London before 1754. These were in the Clerk of Arraigns’
office, but were buried in a heap of extraneous law rubbish; and to extract
which, the Clerk of the Arraigns told me, it would require three entire days
We must here abruptly, and with regret, but for obvious reasons, the size to
which this Publication is already swelled, cut off the remainder of our
comments, amounting to nearly one hundred pages more. Those left behind
unnoticed of the last group, comprehend most of the chronic cutaneous
diseases, the subjects, peculiarly, of the Cosmetic Art. Through the last
group of external accidents and diseases, I meant to have persevered in my
general plan. For instance, under Gangrene, I should have discriminated the
ages, mortality, cures; and at the same time, that originating from external
injuries, or surgical operations, and that from spontaneous corruption.
Under Fractures, I should have gauged the success and miscarriage of
amputation, both after sudden accidents, and in consequence of chronic
diseases. This is a most important part of military surgery, and I believe, in
a great measure, unexplored. From the trepan and lithotomy, I should also
have stated the blanks and prizes. With the surgical group I am obliged to
omit the casualties of London: one alone of which I could not entirely
postpone, without introducing a few observations in this place, that is the
Executed.
Executed. Murder, robbery, sedition, and war, are amongst the principal
political casualties, chronic distempers, fevers, and frenzies of every nation.
In ascertaining the numbers executed, particularly, the London bills of
mortality are shamefully erroneous and defective. As I thought it a casualty
of infinite importance to be exactly stated and recorded, I made numerous
efforts to procure authentic information, by successively and repeatedly
waiting upon the Keeper of Newgate, the Clerk of the Arraigns, the Clerk of
the Peace for the County, the Town-Clerk of London, the Sheriff’s office of
London, and the Secretary of State’s. Throughout this inquiry I was every
where treated with liberality and urbanity; and where there was any
prospect of information, was permitted access to the records. But, to my
astonishment and mortification, I could not find any vestige of records of
executions in London before 1754. These were in the Clerk of Arraigns’
office, but were buried in a heap of extraneous law rubbish; and to extract
which, the Clerk of the Arraigns told me, it would require three entire days
Page 219
for myself and one of his clerks. I called twice at the Old Bailey, anxious to
undertake this task, however laborious; but it so happened, that at both
times they were full of business in the office, and could not spare time, nor
even room, for my inquiry. By other means, I have come near part of the
truth. (Vid. Chart.)
The two first columns, from 1732 to 1762, are formed from an average of
executions, during twenty-two years of that interval, by Sir Theodore
Jansen, Chamberlain of London. The last column, of fifteen years, is
formed from an average of the last seven years, with which Mr. Akerman
politely furnished me, from his books. In consequence of the riots and
conflagration in 1780, his records were all consumed, and do not include
that year, wherein there was a notorious glut of executions. During the
seven years, beginning with 1781, the executed in Mr. Akerman’s books
were 439. But every one knows that there are two theatres, a great and a
small one, appropriated for human slaughter in this metropolis; these are
Tyburn, now removed to Newgate; and for the large Borough of Southwark,
Kennington Common. I took a low average of the executions in the latter,
allotting three annually, to the two first columns, and six to the last column,
and added the whole together. Amongst the London malefactors there are a
few pirates, whose crimes are cognizable in the Admiralty Court.
Two thirds, probably, of all those capitally condemned, are afterwards
pardoned. Few, comparatively, of the executed have committed murder, not
one in twenty; most of the rest are for robberies of various kinds. Many
more are reported as murdered in the bills of mortality: but these are not
cases of premeditated and malicious homicide, and are softened into
manslaughter on trial. Nineteen out of twenty of the executed are males;
and by far the greatest proportion between eighteen and forty years of age.
What is the proportion of London executions to the whole nation, is a
problem which perhaps our judges cannot unravel. They possibly, like the
generality of physicians, drive and strut away, “secundum artem,” in the
beaten rotine of their profession, without ever attending to a plain political
and mercantile axiom, to state their transactions and accounts in numbers
and figures. Vice and executions are universally more prevalent in every
metropolis: but there is reason to believe, that at present the executions
throughout Britain and Ireland, are double or treble to those of London. The
comparative population is as nine million to six hundred and fifty thousand.
undertake this task, however laborious; but it so happened, that at both
times they were full of business in the office, and could not spare time, nor
even room, for my inquiry. By other means, I have come near part of the
truth. (Vid. Chart.)
The two first columns, from 1732 to 1762, are formed from an average of
executions, during twenty-two years of that interval, by Sir Theodore
Jansen, Chamberlain of London. The last column, of fifteen years, is
formed from an average of the last seven years, with which Mr. Akerman
politely furnished me, from his books. In consequence of the riots and
conflagration in 1780, his records were all consumed, and do not include
that year, wherein there was a notorious glut of executions. During the
seven years, beginning with 1781, the executed in Mr. Akerman’s books
were 439. But every one knows that there are two theatres, a great and a
small one, appropriated for human slaughter in this metropolis; these are
Tyburn, now removed to Newgate; and for the large Borough of Southwark,
Kennington Common. I took a low average of the executions in the latter,
allotting three annually, to the two first columns, and six to the last column,
and added the whole together. Amongst the London malefactors there are a
few pirates, whose crimes are cognizable in the Admiralty Court.
Two thirds, probably, of all those capitally condemned, are afterwards
pardoned. Few, comparatively, of the executed have committed murder, not
one in twenty; most of the rest are for robberies of various kinds. Many
more are reported as murdered in the bills of mortality: but these are not
cases of premeditated and malicious homicide, and are softened into
manslaughter on trial. Nineteen out of twenty of the executed are males;
and by far the greatest proportion between eighteen and forty years of age.
What is the proportion of London executions to the whole nation, is a
problem which perhaps our judges cannot unravel. They possibly, like the
generality of physicians, drive and strut away, “secundum artem,” in the
beaten rotine of their profession, without ever attending to a plain political
and mercantile axiom, to state their transactions and accounts in numbers
and figures. Vice and executions are universally more prevalent in every
metropolis: but there is reason to believe, that at present the executions
throughout Britain and Ireland, are double or treble to those of London. The
comparative population is as nine million to six hundred and fifty thousand.
Page 220
If they are treble, then 4000 are executed every fifteen years in the two
islands; and 26,000 in a century: and both the disease and panacea are
rapidly increasing. Five or six times this number are, in the same period,
transported to distant regions, and partly also lost to the community,
together with their blighted procreation.
We are struck with horror even on reading the history of savage
jurisprudence, customs, and butchery of mankind in ancient times; such as
the sanguinary codes of Draco and other regal monsters; the sacrifices to
idols; the martyrs to gloomy fanaticism; the brutal spectacles of the
Romans, wherein gladiators, lions and tygers, were exposed to tear each
other to pieces. But I doubt whether, in the most flagitious and facinorous
ages of Rome, the Tarpeian rock was besmeared with the blood of such a
multitude of human victims; or that in any part of the globe, from London
to the Antipodes, out of an equal proportion of mankind, there are so many
sacrifices annually made to violated jurisprudence; and to the modern idol,
property and money! I meant to have contrasted the executed with those
destroyed in wars, by the sword of the enemy (exclusive of diseases) during
the present century; but the introduction would be here premature; nor
could I launch out in sufficient illustration.
Besides the political patients doomed to the radical cure, or extermination,
by the executioner, if we may credit one of our best writers, they are a mere
handful compared to those who are consigned to a slow and lingering death.
Dr. Johnson, in one of his excellent essays in the Rambler, against perpetual
imprisonment for debt, calculates, that half a million of mankind are
destroyed in a century in the prisons of Great Britain, by the complicated
horror of confinement, sorrow, famine, filth, and disease; and to these I
would add suicide. I am inclined, however, to believe, that Dr. Johnson’s
computation is exaggerated, by at least four hundred thousand. By far the
largest proportion of these are unfortunate sacrifices to poverty and
misfortunes, and to the callous vindictiveness of avarice. In the juridical
pharmacopœia, this may be compared to the hot iron and cautery of the
coarse empiricks of antiquity; with which they outrageously and
indiscriminately tortured their patients. It would not disgrace the
christianity or humanity of our legislature and lawyers, were they to revise
their catechism and breviary of jurisprudence, both as affecting life and
liberty: or, throwing religion and humanity to one side, let the question be
islands; and 26,000 in a century: and both the disease and panacea are
rapidly increasing. Five or six times this number are, in the same period,
transported to distant regions, and partly also lost to the community,
together with their blighted procreation.
We are struck with horror even on reading the history of savage
jurisprudence, customs, and butchery of mankind in ancient times; such as
the sanguinary codes of Draco and other regal monsters; the sacrifices to
idols; the martyrs to gloomy fanaticism; the brutal spectacles of the
Romans, wherein gladiators, lions and tygers, were exposed to tear each
other to pieces. But I doubt whether, in the most flagitious and facinorous
ages of Rome, the Tarpeian rock was besmeared with the blood of such a
multitude of human victims; or that in any part of the globe, from London
to the Antipodes, out of an equal proportion of mankind, there are so many
sacrifices annually made to violated jurisprudence; and to the modern idol,
property and money! I meant to have contrasted the executed with those
destroyed in wars, by the sword of the enemy (exclusive of diseases) during
the present century; but the introduction would be here premature; nor
could I launch out in sufficient illustration.
Besides the political patients doomed to the radical cure, or extermination,
by the executioner, if we may credit one of our best writers, they are a mere
handful compared to those who are consigned to a slow and lingering death.
Dr. Johnson, in one of his excellent essays in the Rambler, against perpetual
imprisonment for debt, calculates, that half a million of mankind are
destroyed in a century in the prisons of Great Britain, by the complicated
horror of confinement, sorrow, famine, filth, and disease; and to these I
would add suicide. I am inclined, however, to believe, that Dr. Johnson’s
computation is exaggerated, by at least four hundred thousand. By far the
largest proportion of these are unfortunate sacrifices to poverty and
misfortunes, and to the callous vindictiveness of avarice. In the juridical
pharmacopœia, this may be compared to the hot iron and cautery of the
coarse empiricks of antiquity; with which they outrageously and
indiscriminately tortured their patients. It would not disgrace the
christianity or humanity of our legislature and lawyers, were they to revise
their catechism and breviary of jurisprudence, both as affecting life and
liberty: or, throwing religion and humanity to one side, let the question be
Page 221
tried by commercial scales; and, like the Venetian Jew, human flesh
estimated in ounces and pounds with brutes, metals, and chattels!
OF the Institution of the London Bills of Births, Mortality, and Diseases;
their Defects, besides those already pointed out; important and easy
Improvements recommended.
We shall now, with all possible brevity, enquire into the degrees of
credibility and stability of the mathematical and medical data, furnished
from the bills of mortality. The births, genealogies, procreation,
multiplication, and deaths, of those few miracles of longevity, from Adam
to Noah; from Noah’s descendants down to Abraham, Moses, and Christ,
are recorded in scripture: some chapters of Genesis are plain registers of
births and mortality. The male Israelites, above twenty years of age, were, at
distant intervals, mustered and numbered by Moses and his successors; and
in a few uncommon pestilences, the devastation is ascertained in the Jewish
history. The descent and pedigree of kings, and other great men, have also
been kept in most nations, who had made any progress in civilization: but
general annual registers of births, diseases, and deaths, are modern
establishments, and were unknown to the ancients.
On the continent of Europe, registers were instituted fifty or a hundred
years before their introduction into England. In 1538, exact records of
weddings, christenings, and burials, were first ordered by the King and
council, to be kept in every parish church of England, by either the vicar or
curate. But this order was very negligently obeyed in many parishes, until
1559, when, to prevent registers from rotting in damp churches, they were
directed to be written on parchment. At first, they seem, both in Germany
and England, to have been designed to prove the birth, death, and descent of
individuals, and the right of inheritance in property or lands. In 1592, a year
of pestilence, bills of mortality for London were instituted; but were
discontinued until 1603, another year of pestilential desolation; which was
the only distemper then taken notice of in the printed reports. In 1626, the
different diseases and casualties of those who died in London, together with
the distinction of the sexes, were added and published; and in 1728, the
different ages of the dead were ordered to be specified in the London bills.
Upon first establishing the distinction of diseases and casualties in the bills
estimated in ounces and pounds with brutes, metals, and chattels!
OF the Institution of the London Bills of Births, Mortality, and Diseases;
their Defects, besides those already pointed out; important and easy
Improvements recommended.
We shall now, with all possible brevity, enquire into the degrees of
credibility and stability of the mathematical and medical data, furnished
from the bills of mortality. The births, genealogies, procreation,
multiplication, and deaths, of those few miracles of longevity, from Adam
to Noah; from Noah’s descendants down to Abraham, Moses, and Christ,
are recorded in scripture: some chapters of Genesis are plain registers of
births and mortality. The male Israelites, above twenty years of age, were, at
distant intervals, mustered and numbered by Moses and his successors; and
in a few uncommon pestilences, the devastation is ascertained in the Jewish
history. The descent and pedigree of kings, and other great men, have also
been kept in most nations, who had made any progress in civilization: but
general annual registers of births, diseases, and deaths, are modern
establishments, and were unknown to the ancients.
On the continent of Europe, registers were instituted fifty or a hundred
years before their introduction into England. In 1538, exact records of
weddings, christenings, and burials, were first ordered by the King and
council, to be kept in every parish church of England, by either the vicar or
curate. But this order was very negligently obeyed in many parishes, until
1559, when, to prevent registers from rotting in damp churches, they were
directed to be written on parchment. At first, they seem, both in Germany
and England, to have been designed to prove the birth, death, and descent of
individuals, and the right of inheritance in property or lands. In 1592, a year
of pestilence, bills of mortality for London were instituted; but were
discontinued until 1603, another year of pestilential desolation; which was
the only distemper then taken notice of in the printed reports. In 1626, the
different diseases and casualties of those who died in London, together with
the distinction of the sexes, were added and published; and in 1728, the
different ages of the dead were ordered to be specified in the London bills.
Upon first establishing the distinction of diseases and casualties in the bills
Page 222
of the British metropolis, the primary intention seems to have been, to
distinguish the numbers destroyed by the plague, and to detect concealed
murders.
Public records of births and mortality are now partly become the rules of
political arithmetic: but unfortunately for politicians, calculators of
annuities, and medical men, they are yet every where far too incorrect and
incomplete. Registers of diseases and deaths in London are entrusted to old
women, two of whom are nominated in each parish, and called Parish
Searchers, and who consider, the ultimatum of their commission is merely
to prevent private funerals and concealed murder. The whole business in
London is conducted in the following manner: Upon either being sent for to
inspect a corpse, or on hearing the bell toll, and inspecting the books kept in
the different churches, the searchers are apprised from whence notice has
been sent of a death, in order that a grave may be opened. The two
parochial matrons then, whose industry is stimulated by a small fee on each
corpse, and whose report is necessary previous to interment, set out to
examine that no violence is committed upon the dead, of which they have
taken an official oath to make true declaration, and afterwards negligently
enquire from the relations the name of the disease, adding the age and sex:
or sometimes they are stopped in the hall, and dismissed without any
scrutiny. These records, together with the christenings, in the latter of which
the searchers have no concern, are deposited with the respective clerks of
each parish church, and by the clerks the christenings of the established
church, and the burials in their respective parochial church-yards alone, are
carried once every week to a general hall in the city: on the following day
the weekly bill, comprehending these partial returns, is printed and
published; and at the end of the year a general bill, in which all the weekly
returns are consolidated.
The law ordains, that every person who dies in the registered parishes of
London, Westminster, and Southwark, is to be inspected by two parish
searchers, and reported to the parish clerk, who then grants his certificate
for the interment: or, if the corpse is carried away to a different parish of the
metropolis for interment, the searchers report, and the clerk’s certificate, are
equally necessary; otherwise that parish where the corpse is buried is liable
to a fine. This process was originally intended to detect the plague, and
concealed murders; in both which respects, during the present century, the
distinguish the numbers destroyed by the plague, and to detect concealed
murders.
Public records of births and mortality are now partly become the rules of
political arithmetic: but unfortunately for politicians, calculators of
annuities, and medical men, they are yet every where far too incorrect and
incomplete. Registers of diseases and deaths in London are entrusted to old
women, two of whom are nominated in each parish, and called Parish
Searchers, and who consider, the ultimatum of their commission is merely
to prevent private funerals and concealed murder. The whole business in
London is conducted in the following manner: Upon either being sent for to
inspect a corpse, or on hearing the bell toll, and inspecting the books kept in
the different churches, the searchers are apprised from whence notice has
been sent of a death, in order that a grave may be opened. The two
parochial matrons then, whose industry is stimulated by a small fee on each
corpse, and whose report is necessary previous to interment, set out to
examine that no violence is committed upon the dead, of which they have
taken an official oath to make true declaration, and afterwards negligently
enquire from the relations the name of the disease, adding the age and sex:
or sometimes they are stopped in the hall, and dismissed without any
scrutiny. These records, together with the christenings, in the latter of which
the searchers have no concern, are deposited with the respective clerks of
each parish church, and by the clerks the christenings of the established
church, and the burials in their respective parochial church-yards alone, are
carried once every week to a general hall in the city: on the following day
the weekly bill, comprehending these partial returns, is printed and
published; and at the end of the year a general bill, in which all the weekly
returns are consolidated.
The law ordains, that every person who dies in the registered parishes of
London, Westminster, and Southwark, is to be inspected by two parish
searchers, and reported to the parish clerk, who then grants his certificate
for the interment: or, if the corpse is carried away to a different parish of the
metropolis for interment, the searchers report, and the clerk’s certificate, are
equally necessary; otherwise that parish where the corpse is buried is liable
to a fine. This process was originally intended to detect the plague, and
concealed murders; in both which respects, during the present century, the
Page 223
parish clerks and the searchers have been almost useless. There is now no
plague to detect; there are very few murders, and they are always
proclaimed by some other means. Even in the preceding century, when the
plague raged in London, the searchers report was rarely trusted without a
physician or surgeon attending, to prevent mistakes.
Notwithstanding this ceremony of inspection by the searchers, and of
making their reports to the parish clerk, it does not hence follow, that the
clerk makes the return of the death to the general hall, unless the corpse is
buried in his own ground, or parochial church-yard. If the corpse is carried
to any dissenting ground, and to various other places of sepulture not within
the bills, the death and disease is so much waste paper, and is never heard of
amongst the burials. But if the corpse is carried to a different parish,
together with a certificate, and such burying ground is registered within the
bills, then the death and disease is returned to the hall by the clerk of that
parish where the corpse is interred.
I made it my business to visit, and to converse with a variety of parish
clerks in this metropolis, most of whom agreed with me, that, besides
radical defects in the christenings and burials, there were many other gross
omissions. One instance I shall mention, and many more might be
collected. The parish clerk of Bethnal-green, in which are also three private
madhouses, made no return to the general hall, during the year 1780, of
either births or burials, and in the preceding year he returned only four
burials: whereas in former years, this parish alone annually returned from
three to five hundred burials. I was assured, that the company of parish
clerks in their corporate capacity, even if willing, have no power of
compulsion over any of their refractory and negligent members, to make
regular and correct returns: it seems almost optional. It is obvious what
flagrant discordance and error this must occasion in various calculations.
Exclusive of gross mismanagement and error from searchers and parish
clerks, there are other inherent defects in the London registers, both of
burials and births. They comprehend the births alone of those belonging to
the established church, and the burials of such only who are interred in the
registered parochial church-yards. Jews, Quakers, Papists, Protestant
Dissenters of various sects, are not included in the annual christenings; and
great numbers of their burials, and of the burying-places not only of the
dissenting, but likewise of the established church, are omitted: of the former
plague to detect; there are very few murders, and they are always
proclaimed by some other means. Even in the preceding century, when the
plague raged in London, the searchers report was rarely trusted without a
physician or surgeon attending, to prevent mistakes.
Notwithstanding this ceremony of inspection by the searchers, and of
making their reports to the parish clerk, it does not hence follow, that the
clerk makes the return of the death to the general hall, unless the corpse is
buried in his own ground, or parochial church-yard. If the corpse is carried
to any dissenting ground, and to various other places of sepulture not within
the bills, the death and disease is so much waste paper, and is never heard of
amongst the burials. But if the corpse is carried to a different parish,
together with a certificate, and such burying ground is registered within the
bills, then the death and disease is returned to the hall by the clerk of that
parish where the corpse is interred.
I made it my business to visit, and to converse with a variety of parish
clerks in this metropolis, most of whom agreed with me, that, besides
radical defects in the christenings and burials, there were many other gross
omissions. One instance I shall mention, and many more might be
collected. The parish clerk of Bethnal-green, in which are also three private
madhouses, made no return to the general hall, during the year 1780, of
either births or burials, and in the preceding year he returned only four
burials: whereas in former years, this parish alone annually returned from
three to five hundred burials. I was assured, that the company of parish
clerks in their corporate capacity, even if willing, have no power of
compulsion over any of their refractory and negligent members, to make
regular and correct returns: it seems almost optional. It is obvious what
flagrant discordance and error this must occasion in various calculations.
Exclusive of gross mismanagement and error from searchers and parish
clerks, there are other inherent defects in the London registers, both of
burials and births. They comprehend the births alone of those belonging to
the established church, and the burials of such only who are interred in the
registered parochial church-yards. Jews, Quakers, Papists, Protestant
Dissenters of various sects, are not included in the annual christenings; and
great numbers of their burials, and of the burying-places not only of the
dissenting, but likewise of the established church, are omitted: of the former
Page 224
32, and of the latter 35, according to Short’s list. Maitland, 1729, (see his
History of London) discovered 181 religious congregations, whose
christenings were not published, and 63 burying-places in and contiguous to
the metropolis, wherein 3038 were annually buried, but excluded from the
registers. The large modern and populous parishes of Pancras and Mary-le-
bone, in one of which also stands the Foundling Hospital, are omitted in the
annual bills. Six hundred abortive and stillborn, who have arrived at an age
thought deserving of funeral, are added to the annual deaths, but omitted in
the list of births; as are also many young infants who die before baptism.
I said, very few of the christenings of the dissenting sects in London were
included in the public registers; but several of them are buried according to
the formalities, or at least in the cemeteries of the established church; which
must unnaturally magnify the comparative list of deaths. Another defect in
the burials is, that numbers are carried into the country who are not
accounted for: it is agreed, that several hundreds more are annually carried
out of than are brought into London for interment. Most of the nobility and
gentry are removed from London, after death, to their family seats. Dr.
Price calculates the present annual deficiency in the London burials at 6000;
and of the births somewhat greater; neither of which are brought to account
in the registers.
The following is an average, which I have formed from the London bills of
christenings and burials:
London bills at a medium annually.
Years. Christenings. Burials.
From 1671 to 1681 12,325 19,144
1681 to 1691 14,439 22,363
1691 to 1700 14,938 20,770
1700 to 1710 15,623 21,461
1711 to 1720 17,111 23,990
1721 to 1730 18,203 27,522
1731 to 1740 16,831 26,492
1741 to 1750 14,457 25,351
1751 to 1756 15,119 21,080
History of London) discovered 181 religious congregations, whose
christenings were not published, and 63 burying-places in and contiguous to
the metropolis, wherein 3038 were annually buried, but excluded from the
registers. The large modern and populous parishes of Pancras and Mary-le-
bone, in one of which also stands the Foundling Hospital, are omitted in the
annual bills. Six hundred abortive and stillborn, who have arrived at an age
thought deserving of funeral, are added to the annual deaths, but omitted in
the list of births; as are also many young infants who die before baptism.
I said, very few of the christenings of the dissenting sects in London were
included in the public registers; but several of them are buried according to
the formalities, or at least in the cemeteries of the established church; which
must unnaturally magnify the comparative list of deaths. Another defect in
the burials is, that numbers are carried into the country who are not
accounted for: it is agreed, that several hundreds more are annually carried
out of than are brought into London for interment. Most of the nobility and
gentry are removed from London, after death, to their family seats. Dr.
Price calculates the present annual deficiency in the London burials at 6000;
and of the births somewhat greater; neither of which are brought to account
in the registers.
The following is an average, which I have formed from the London bills of
christenings and burials:
London bills at a medium annually.
Years. Christenings. Burials.
From 1671 to 1681 12,325 19,144
1681 to 1691 14,439 22,363
1691 to 1700 14,938 20,770
1700 to 1710 15,623 21,461
1711 to 1720 17,111 23,990
1721 to 1730 18,203 27,522
1731 to 1740 16,831 26,492
1741 to 1750 14,457 25,351
1751 to 1756 15,119 21,080
Page 225
1759 to 1768 15,710 22,956
1770 to 1780 17,218 21,000
The parishes, but not all the burial grounds in these parishes, now included
within the London bills of mortality, amount to 147: of which there are 97
within the old city walls; 17 without the walls, but within the city liberties;
23 out parishes in Middlesex and Surry; and 10 out parishes in the city and
liberties of Westminster. All the 97 parishes within the walls have not, for
many years past, at a medium, buried 2000 annually: some of them do not
make a return of a single burial in several years. We may name several
parishes without the walls, any two of which united, return a number of
annual deaths equal to the 97 parishes within the walls. In collecting and
conducting the bills of these parishes, there is a rabble of 294 female
searchers, and 147 parish clerks.
To render the returns of births, christenings, weddings, and burials in
London complete, the clergyman of every religious sect should be
compelled by law to make, every three months, a return of their
christenings and weddings to the nearest parochial church. All the church-
yards and burying grounds hitherto excluded from the bills, together with
the parishes of Pancras, Mary-le-bone, and all the other modern additions
and population to London, should likewise be comprehended in the
registers; together with the numerous villages and excrescences of the
metropolis, within seven miles of its circumference. The christenings
should specify the name, sex, twins or tergemini, illegitimate if known, and
the religious sect. The weddings should discriminate the place of abode, of
the parties, the names and ages of each pair; whether first, second, or third
marriages, and on which side; whether natives or foreigners, and the
religious sect.
There appears at present no necessity to return weekly bills from the
different parishes. This was originally intended to warn the London
inhabitants of the numbers destroyed by the plague, and the infected
parishes. Quarterly returns to the general hall would be sufficient; and one
general annual bill, in which the quarterly mortality should be
distinguished; in order to point out the seasons most noxious, and the
reigning diseases; or to mark the hurricanes and monsoons of mortality. In
infancy, and the early part of life, when the tide of devastation is strong and
1770 to 1780 17,218 21,000
The parishes, but not all the burial grounds in these parishes, now included
within the London bills of mortality, amount to 147: of which there are 97
within the old city walls; 17 without the walls, but within the city liberties;
23 out parishes in Middlesex and Surry; and 10 out parishes in the city and
liberties of Westminster. All the 97 parishes within the walls have not, for
many years past, at a medium, buried 2000 annually: some of them do not
make a return of a single burial in several years. We may name several
parishes without the walls, any two of which united, return a number of
annual deaths equal to the 97 parishes within the walls. In collecting and
conducting the bills of these parishes, there is a rabble of 294 female
searchers, and 147 parish clerks.
To render the returns of births, christenings, weddings, and burials in
London complete, the clergyman of every religious sect should be
compelled by law to make, every three months, a return of their
christenings and weddings to the nearest parochial church. All the church-
yards and burying grounds hitherto excluded from the bills, together with
the parishes of Pancras, Mary-le-bone, and all the other modern additions
and population to London, should likewise be comprehended in the
registers; together with the numerous villages and excrescences of the
metropolis, within seven miles of its circumference. The christenings
should specify the name, sex, twins or tergemini, illegitimate if known, and
the religious sect. The weddings should discriminate the place of abode, of
the parties, the names and ages of each pair; whether first, second, or third
marriages, and on which side; whether natives or foreigners, and the
religious sect.
There appears at present no necessity to return weekly bills from the
different parishes. This was originally intended to warn the London
inhabitants of the numbers destroyed by the plague, and the infected
parishes. Quarterly returns to the general hall would be sufficient; and one
general annual bill, in which the quarterly mortality should be
distinguished; in order to point out the seasons most noxious, and the
reigning diseases; or to mark the hurricanes and monsoons of mortality. In
infancy, and the early part of life, when the tide of devastation is strong and
Page 226
rapid, the mortality should be measured in shorter intervals. The first year
from birth should be divided into interstices, from birth to six months, when
teething commences; from six months to one year; from one to two; two to
three; three to four; four to five; five to ten; ten to twenty; and so on to one
hundred and upwards. Exclusive of abortions and stillborn, those who die in
the first month before baptism, and of course cannot be included in the
christenings, should be distinguished, in order to determine more accurately
the amount of the births. Separate columns should be assigned for the name
of the disease or casualty; for the cause, if known; and the duration of the
affliction. Annexed to each disease should be the numbers dying at different
ages of that malady. Males grown up to maturity who die, should be
distinguished either as married, widowers, or bachelors; and females also of
this description, either as married, widows, or virgins. Those carried out of
London, or into it, for interment; the parochial children who die at nurse in
the vicinity of the metropolis; the rank, profession, or trade; whether native
or foreigner; should all appear in the general annual report in separate
columns. The annual reports of all the hospitals, dispensaries, and prisons,
and of the executed, should also be made to the hall, and included in the
general annual register.
There are often objections and scruples to apply effectual remedies, or
radical cures, to ancient institutions, however defective and inadequate.
There certainly is no necessity for such a cumbrous complex machinery, or
multitude of parish searchers and clerks, for conducting the London bills.
Indeed they might probably be all dispensed with. The reports of the
relations of the deceased, or of the parish officers, to the curate of the
different churches, would perhaps answer every purpose; and the
perquisites would be a considerable addition to the clerical pittance. I mean,
however, only to offer a simple, easy, and unexceptionable palliative; which
is, to appoint a physician to superintend the general hall, and the reports of
births, burials, and diseases: and the whole to be subjected to the inspection
of a committee of the Medical College, or of the Royal or Medical
Societies. This would give authenticity, credibility, and respectability to the
registers. From such a rich mine, and an authentic magazine, the most
important and beneficial information would be derived; the increase or
decrease of deaths, marriages, and births; the annual waste of the
metropolis; the health, mortality, the diseases most fatal, their growth or
declension; the effects of diet, drink, and medical practice. Calculators of
from birth should be divided into interstices, from birth to six months, when
teething commences; from six months to one year; from one to two; two to
three; three to four; four to five; five to ten; ten to twenty; and so on to one
hundred and upwards. Exclusive of abortions and stillborn, those who die in
the first month before baptism, and of course cannot be included in the
christenings, should be distinguished, in order to determine more accurately
the amount of the births. Separate columns should be assigned for the name
of the disease or casualty; for the cause, if known; and the duration of the
affliction. Annexed to each disease should be the numbers dying at different
ages of that malady. Males grown up to maturity who die, should be
distinguished either as married, widowers, or bachelors; and females also of
this description, either as married, widows, or virgins. Those carried out of
London, or into it, for interment; the parochial children who die at nurse in
the vicinity of the metropolis; the rank, profession, or trade; whether native
or foreigner; should all appear in the general annual report in separate
columns. The annual reports of all the hospitals, dispensaries, and prisons,
and of the executed, should also be made to the hall, and included in the
general annual register.
There are often objections and scruples to apply effectual remedies, or
radical cures, to ancient institutions, however defective and inadequate.
There certainly is no necessity for such a cumbrous complex machinery, or
multitude of parish searchers and clerks, for conducting the London bills.
Indeed they might probably be all dispensed with. The reports of the
relations of the deceased, or of the parish officers, to the curate of the
different churches, would perhaps answer every purpose; and the
perquisites would be a considerable addition to the clerical pittance. I mean,
however, only to offer a simple, easy, and unexceptionable palliative; which
is, to appoint a physician to superintend the general hall, and the reports of
births, burials, and diseases: and the whole to be subjected to the inspection
of a committee of the Medical College, or of the Royal or Medical
Societies. This would give authenticity, credibility, and respectability to the
registers. From such a rich mine, and an authentic magazine, the most
important and beneficial information would be derived; the increase or
decrease of deaths, marriages, and births; the annual waste of the
metropolis; the health, mortality, the diseases most fatal, their growth or
declension; the effects of diet, drink, and medical practice. Calculators of
Page 227
annuities, reversions, survivorships, and insurances, would then be supplied
with certain, instead of conjectural data: at present this alone is a prodigious
article of traffick and commerce in this country: much litigation and
expence respecting births and deaths, and the right to inheritance, would
also be prevented. In a word, a vast variety of most interesting medical and
political propositions, which are entangled in intricacy and obscurity,
would, by this means, be evolved, and indisputably demonstrated.
It is also most devoutly to be wished, for the health, comfort, and decency
of the metropolis, that all, or at least the majority of the burying grounds,
were ordered to be formed in some dry spots of ground at the different
extremities of the city; and that the dead were more detached from the
living. No one whose curiosity for information has led him to these
melancholy wrecks of human vanity, and to behold the yawning mouths of
sepulchres, can reflect without pain and astonishment, on the manner in
which between twenty and thirty thousand corpses are annually crammed
into various holes, corners, public thoroughfares, and churches of this city:
a feeling mind must shudder at, and shrink from the description. Nor can
these cadaverous exhalations fail to pollute the air, and to engender
diseases. Let the clerical revenue arising from graves be transferred to the
new cemeteries.
We shall conclude, by pointing out the most celebrated treatises on human
propagation, existence, mortality, and morbid devastation, by several
philosophers. This is the epoch of a new science in politicks, philosophy,
and medicine. Meritorious and successful efforts have been made to
calculate the prospects of life and death, as the chances on dice, or the
blanks and prizes in a lottery wheel. Graunt, somewhat later than the middle
of the last century, first wrote a treatise on the London bills of births and
mortality, and was followed soon after by Petty, King, and Davenant. The
present century has produced several treatises on this subject; of which the
most celebrated are Dr. Halley’s; De Moivre’s Treatises on Annuities and
Chances; Susmilch’s Calculations; Simpson’s Select Exercises; some essays
in the Philosophical Transactions; Dr. Jurin on the Small Pox only; Dr.
Short’s Observations on various Bills of Mortality; M. Messance; Dr.
Price’s Essays, the Archimedes in annuitant and reversionary calculation;
Birch’s Collection of the London Bills of Mortality to 1759; Dr. Percival’s
with certain, instead of conjectural data: at present this alone is a prodigious
article of traffick and commerce in this country: much litigation and
expence respecting births and deaths, and the right to inheritance, would
also be prevented. In a word, a vast variety of most interesting medical and
political propositions, which are entangled in intricacy and obscurity,
would, by this means, be evolved, and indisputably demonstrated.
It is also most devoutly to be wished, for the health, comfort, and decency
of the metropolis, that all, or at least the majority of the burying grounds,
were ordered to be formed in some dry spots of ground at the different
extremities of the city; and that the dead were more detached from the
living. No one whose curiosity for information has led him to these
melancholy wrecks of human vanity, and to behold the yawning mouths of
sepulchres, can reflect without pain and astonishment, on the manner in
which between twenty and thirty thousand corpses are annually crammed
into various holes, corners, public thoroughfares, and churches of this city:
a feeling mind must shudder at, and shrink from the description. Nor can
these cadaverous exhalations fail to pollute the air, and to engender
diseases. Let the clerical revenue arising from graves be transferred to the
new cemeteries.
We shall conclude, by pointing out the most celebrated treatises on human
propagation, existence, mortality, and morbid devastation, by several
philosophers. This is the epoch of a new science in politicks, philosophy,
and medicine. Meritorious and successful efforts have been made to
calculate the prospects of life and death, as the chances on dice, or the
blanks and prizes in a lottery wheel. Graunt, somewhat later than the middle
of the last century, first wrote a treatise on the London bills of births and
mortality, and was followed soon after by Petty, King, and Davenant. The
present century has produced several treatises on this subject; of which the
most celebrated are Dr. Halley’s; De Moivre’s Treatises on Annuities and
Chances; Susmilch’s Calculations; Simpson’s Select Exercises; some essays
in the Philosophical Transactions; Dr. Jurin on the Small Pox only; Dr.
Short’s Observations on various Bills of Mortality; M. Messance; Dr.
Price’s Essays, the Archimedes in annuitant and reversionary calculation;
Birch’s Collection of the London Bills of Mortality to 1759; Dr. Percival’s
Page 228
Essays; Dr. Millar’s Calculations respecting the Diseases of Great Britain,
and Military Diseases; and Dr. Robinson’s, respecting Maritime Diseases.
Our curtain being now ready to fall, we shall address a few words to the
Reader.—The present Publication had its origin in so short a time from the
following circumstance. About six months ago, the President of the Medical
Society of London called upon the author, at the desire of the Society, to
request that he would deliver the annual oration, which was then fixed at
four months distance only from that period: to which, with some reluctance,
he consented. Indeed, he considered the solicitation both as a compliment,
and a literary challenge: because, by the rules of the Society, one year’s
previous notice to the orator had been the invariable practice. In the
execution of this arduous and unprecedented attempt, the author is not
ashamed to boast of industry and zeal. Were he to enumerate, in narrative
and detail, the difficulties and fatigue which he had to encounter in
collecting merely the materials of new information, he is persuaded that
most gentlemen would have considered that alone sufficient exercise for
their industry, patience, and perseverance during many months. Had he
chosen to have followed the rhetorical path of the London College, his talk
would have been far less onerous. But notwithstanding the eminent talents
scattered throughout that learned body, from Linacre down to Hulse,
Wintringham, Baker, Warren, Turton, &c. their united catalogue of public
declarations, however classical, have not much contributed to medical
edification, or public utility.
FINIS.
and Military Diseases; and Dr. Robinson’s, respecting Maritime Diseases.
Our curtain being now ready to fall, we shall address a few words to the
Reader.—The present Publication had its origin in so short a time from the
following circumstance. About six months ago, the President of the Medical
Society of London called upon the author, at the desire of the Society, to
request that he would deliver the annual oration, which was then fixed at
four months distance only from that period: to which, with some reluctance,
he consented. Indeed, he considered the solicitation both as a compliment,
and a literary challenge: because, by the rules of the Society, one year’s
previous notice to the orator had been the invariable practice. In the
execution of this arduous and unprecedented attempt, the author is not
ashamed to boast of industry and zeal. Were he to enumerate, in narrative
and detail, the difficulties and fatigue which he had to encounter in
collecting merely the materials of new information, he is persuaded that
most gentlemen would have considered that alone sufficient exercise for
their industry, patience, and perseverance during many months. Had he
chosen to have followed the rhetorical path of the London College, his talk
would have been far less onerous. But notwithstanding the eminent talents
scattered throughout that learned body, from Linacre down to Hulse,
Wintringham, Baker, Warren, Turton, &c. their united catalogue of public
declarations, however classical, have not much contributed to medical
edification, or public utility.
FINIS.
Page 229
ERRATA.
Page 9, line 15, personl, read personal; p. 37, l. 21, science, read sciences;
p. 42, l. 26, coctaneous, read cœtaneous; p. 48, l. 17, Rocherches, read
recherches; p. 71, l. 3, and extravasated, read by extravasated; p. 114, l. 8,
the face is overspread, read overspreading the face; p. 124, l. 20, pressing,
read depressing; p. 198, l. 16, lactation, read ablactation; p. 224, l. 8, read
sounds are scarcely audible; and there is confused noise in the ears; p. 220,
l. 25 and 6, eyes, pharynx, tongue, read the eyes, the pharynx, the tongue; p.
229, l. 17, lucubrious, read lugubrious; p. 233, l. 20, remnant amongst, read
remnant sunk amongst; p. 258, l. 5, its deficiency and excess, read
deficiency and excess of its; p. 260, l. 7, Epididymis, read Epididymidis; p.
262, l. 9, scirrhous, read scirrhus; p. 279, l. 24, manbile, read morbile; p.
283, l. 12, consistence and size, read consistence, size, and number; p. 286,
l. 13, lactation, read ablactation; p. 326, l. 13, muliri, read mulieri; p. 329, l.
9, debility with, read with debility.
[Transcriber’s Note. As well as correcting the errata above, the following
changes have been made to the text:
Page 12: analagous to analogous—“perhaps analogous”.
Page 41: adoloscence to adolescence—“years of adolescence”.
Page 67: diarrhæa to diarrhœa—“dysentery, diarrhœa, cholick”.
Page 67: locheal to lochial—“lochial excess”.
Page 68: “befored escribed” to “before described”.
Page 68: spinaventosa to “spina ventosa”.
Page 72: peripneumenies to peripneumonies—“contagious
peripneumonies”.
Page 89: diarrhea to diarrhœa—“diarrhœa or dysentery”.
Page 98: peripnuemonies to peripneumonies—“and peripneumonies are”.
Page 110: symtoms to symptoms—“Additional symptoms”.
Page 9, line 15, personl, read personal; p. 37, l. 21, science, read sciences;
p. 42, l. 26, coctaneous, read cœtaneous; p. 48, l. 17, Rocherches, read
recherches; p. 71, l. 3, and extravasated, read by extravasated; p. 114, l. 8,
the face is overspread, read overspreading the face; p. 124, l. 20, pressing,
read depressing; p. 198, l. 16, lactation, read ablactation; p. 224, l. 8, read
sounds are scarcely audible; and there is confused noise in the ears; p. 220,
l. 25 and 6, eyes, pharynx, tongue, read the eyes, the pharynx, the tongue; p.
229, l. 17, lucubrious, read lugubrious; p. 233, l. 20, remnant amongst, read
remnant sunk amongst; p. 258, l. 5, its deficiency and excess, read
deficiency and excess of its; p. 260, l. 7, Epididymis, read Epididymidis; p.
262, l. 9, scirrhous, read scirrhus; p. 279, l. 24, manbile, read morbile; p.
283, l. 12, consistence and size, read consistence, size, and number; p. 286,
l. 13, lactation, read ablactation; p. 326, l. 13, muliri, read mulieri; p. 329, l.
9, debility with, read with debility.
[Transcriber’s Note. As well as correcting the errata above, the following
changes have been made to the text:
Page 12: analagous to analogous—“perhaps analogous”.
Page 41: adoloscence to adolescence—“years of adolescence”.
Page 67: diarrhæa to diarrhœa—“dysentery, diarrhœa, cholick”.
Page 67: locheal to lochial—“lochial excess”.
Page 68: “befored escribed” to “before described”.
Page 68: spinaventosa to “spina ventosa”.
Page 72: peripneumenies to peripneumonies—“contagious
peripneumonies”.
Page 89: diarrhea to diarrhœa—“diarrhœa or dysentery”.
Page 98: peripnuemonies to peripneumonies—“and peripneumonies are”.
Page 110: symtoms to symptoms—“Additional symptoms”.
Page 230
Page 123: harships to hardships—“fatigue, hardships”.
Page 131: candaverous to cadaverous—“fetid cadaverous”.
Page 172: deletirious to deleterious—“superlatively deleterious”.
Page 191: cattarh to catarrh—“angina and catarrh”.
Page 221: idopathick to idiopathick—“are idiopathick as well”.
Page 269: dyspnæa to dyspnœa—“abdomen, dyspnœa”.
Page 279: mombile to mobile—“pain being mobile”. This change is instead
of the erratum noted above for page 279.
Page 373: iritation to irritation—“irritation to urine”.]
Page 131: candaverous to cadaverous—“fetid cadaverous”.
Page 172: deletirious to deleterious—“superlatively deleterious”.
Page 191: cattarh to catarrh—“angina and catarrh”.
Page 221: idopathick to idiopathick—“are idiopathick as well”.
Page 269: dyspnæa to dyspnœa—“abdomen, dyspnœa”.
Page 279: mombile to mobile—“pain being mobile”. This change is instead
of the erratum noted above for page 279.
Page 373: iritation to irritation—“irritation to urine”.]
Page 231
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