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Title: A Comparative View of the Mortality of the Human Species, at All Ages
Author: Black, William
Language: English
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     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_.

                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.



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.

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 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.



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 of society,_                              24

_The human species diversified by their ages,_                        25

_The distinction of the sexes into male and female,
    form two important groups,_                                       27

_The comparative produce of marriages in city and country,_           28

_The general proportion of births to the mortality
    in various kingdoms,_                                             30

_The comparative births of males and females,_                        32


_Of public registers, of births, burials, and diseases,_              35

_The primary orders of medical architecture not yet established,_     37

_The mortality of the human race in city and
    country, and from birth to the extreme of existence,_             38

_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 throughout the globe,_                           49

_The probabilities or expectation of life,_                           51

_A general chart of mortality in city and country,
    and in different kingdoms,_                                   54, 55

_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 the
    whole globe; with exceptions: a sort of
    medical geometry and trigonometry,_                               60

_The number and proportion of diseases not to
    be estimated by the mortality of each,_                           63

_A medical catalogue of all the diseases and casualties
    by which mankind are destroyed or annoyed,_                       65

_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 comparison of sickly
    years in city and country,_                                       72


_Of fevers,_                                                          75

    _Intermittent fevers,_                                            78

    _Remittent fevers,_                                               84

    _Nervous and putrid fevers,_                                      90

    _Inflammatory fever,_                                             97

    _Small pox,_                                                     102

    _Measles,_                                                       111

    _Scarlet fever,_                                                 113

    _Plague,_                                                        115

    _Sweating sickness,_                                             121

_Of the predisposing and occasional causes of all
    the preceding fevers,_                                           121

_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

_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

    _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 hystericks, to other diseases,_                      325

    _Morbid and irregular menstruation, including
        chlorosis, obstruction, suppression,_                        328

    _Uterine relaxation, including excessive menstruation
        and fluor albus,_                                            330

    _Final cessation of menstruation,_                               334

    _Hystericks,_                                                    335

    _Childbed, the proportion of mortality,_                         339

    _Abortives and twins, the proportion,_                           340

    _Conception and pregnancy,_                                      343

    _Parturition, natural, laborious, preternatural, and complex,_   350

    _The principal diseases in consequence of
        pregnancy, and also after parturition,_                      362

    _Abortion and uterine hemorrhage,_                               366

    _Convulsions,_                                                   370

    _Irregularity of the lochia, comprehending
        excess, obstruction, and suppression,_                       371

    _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



A Comparative View, _&c._



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 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 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.

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 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 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 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 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, 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 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 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 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 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, 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.



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 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.

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 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 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 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 _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 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, 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  |  Decr.
       |  living.  | of life.
-------+-----------+----------
   0   |    1000   |   320
   1   |     680   |   133
   2   |     547   |    51
   3   |     496   |    27
   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
  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
  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  |  Decr.
       |  living.  | 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
  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
-------+-----------+----------
  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
  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  |  Decr.
       |  living.  | 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
-------+-----------+----------
  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
  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


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  |  Decr.
       |  living.  | 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
  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
  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
    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
                   { 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  |  Decr.
       |  living.  | 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
  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
  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
  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  |  Decr.
       |  living.  | 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
-------+-----------+----------
  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
  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


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.


-------+-----------+----------
 Ages. |  Persons  |  Decr.
       |  living.  | 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
  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
  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_

        |       |       |       |            |   Holy    |
        |       |       |       |  Country   |  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.
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_

        |       |       |        |            |   Holy    |
        |       |       |        |  Country   |  Cross,   |  Pais de
 Ages.  |London.|Vienna.| Berlin.| parish of  |   near    |  Vaud, in
        |       |       |        |Brandenburg.|Shrewsbury.|Switzerland.
--------+-------+-------+--------+------------+-----------+------------
At birth| 2 to 1| 2 to 1|  2 to 1|    4 to 1  |   5 to 1  |    5 to 1
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 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; 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 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.

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.

The Total Amount of the Five Periods, or Seventy-five Years Mortality,
is added together in the Sixth Column.

-----------------------+-------+-------+-------+------+------+------------
                       |Fifteen|  From |  From | From | From |   Total
                       | Years,|  1717 |  1732 | 1747 | 1762 | Amount of
                       | from  |   to  |   to  |  to  |  to  |Seventy-five
       DISEASES        | 1701  |  1732.|  1747.| 1762.| 1777.|   Years
         AND           |  to   |       |       |      |      | Mortality,
      CASUALTIES.      | 1717. |       |       |      |      | from 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    |       |       |       |      |      |
  Cough, Cough         |    116|    632|  1,692| 2,755| 4,252|    9,573
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
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 Looseness |    820|    682|    248|   134|   120|    2,004
Cholic, Gripes, and    |       |       |       |      |      |
  Twisting of the Guts | 13,668| 11,032|  3,739| 1,475|   796|   29,710
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     |       |       |       |      |      |
  Strangury            |    789|    868|    700|   421|   429|    3,205
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
Headmold-shot, and     |       |       |       |      |      |
  Water in the Head    |    609|  2,374|  2,013| 1,022|   337|    6,355
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           |       |       |       |      |      |
  Mortification        |  1,071|  2,857|  3,362| 3,083| 3,023|   13,438
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,       |       |       |       |      |      |
  Wounded, Shot, &c.   |     15|     32|     13|  --  |  --  |       60
                       |       |       |       |      |      |
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,   |       |       |       |      |      |
  and Smothered        |     13|     34|     62|    90|    68|      276
Overlaid               |    817|  1,180|  1,293|   414|    95|    3,799
Found dead             |    388|    557|    668|   336|   133|    2,082
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    |       |       |       |      |      |
  Cats                 |   --  |      3|     14|    15|     6|       38
                       |       |       |       |      |      |
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 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.

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,
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 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 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 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, 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:
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 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 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 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 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 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 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 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, 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 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,
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 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 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, 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 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 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, 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
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.

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 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 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 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.

       *       *       *       *       *



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 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 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
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 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 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 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, 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; 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
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 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 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.

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 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; 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 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, 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 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, 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 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.

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 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.

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 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.

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, 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 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 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 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 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: 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 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 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 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.

_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.

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.

_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.

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 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 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; 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 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 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.

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 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 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; 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 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 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 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 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, 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, 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 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 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.

_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 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 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 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, 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 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 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.

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 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 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; 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; 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.

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 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 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.

_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 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.

_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 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, 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 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.

       *       *       *       *       *



_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 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 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 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; 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.

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 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 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, 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 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 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
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 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 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 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 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 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 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.

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 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, 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 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, 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,
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 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 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
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 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, 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 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 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 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.

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 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 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 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_, 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 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 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
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 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; 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 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.



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 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. 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 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 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 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 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
     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 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 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 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.



_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 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”.]





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