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

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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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[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!

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[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.

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[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”.]