The Solar System
consists of the Sun, of seven Planets surrounded by ten or more Moons, and of the Comets. The other siderial lights with which the vault of Heaven is studded, and which are denominated Fixed Stars, have a very distant affinity with our planetary sphere: they are infinitely too remote to be enlightened by our luminary; and therefore astronomers, with good reason, imagine each star to be a sun to encircling planets, though invisible to us; and to constitute throughout boundless space thousands, or perhaps millions, of habitable worlds. Numbers of those stars, most luminous and proximate, are arranged into arbitrary clusters, called Constellations, or Signs; and serve to mark the several stages of the rotating orbs in our system.
The Sun, whose magnitude far surpasses that of the seven planets united, is placed in the center, suspended in the immense celestial expansion and firmament. Surrounding him, at different distances, and in the following order, are the planets Mercury, Venus, the Earth, Mars, Jupiter, Saturn, Georgium Sidus. These planets are incessantly revolving from west-by-south to east, and within certain intervals of time, make a complete circle round the Sun; which is the length of each planet’s year; and is larger and longer in proportion to their respective distances. The velocity of their revolution in their annual orbits, together with their gradations of light and heat, are also in proportion to their solar proximity. From the Sun, the Planets, with their surrounding moons, derive heat and light; and when this is intercepted by any planet, or its satellite, an eclipse or darkness ensues. In what periods those tremendous celestial bodies, named Comets, revolve round the Sun, is not yet exactly adjusted.
One of the seven planets, the Earth, this small domain of restless mortals, and to which all our future observations shall be directed, is distant from the Sun 95,173,000 miles. In shape, it has more resemblance to a turnip than to a globe. Its diameter is 7,970 miles: its circumference 360 degrees; which amounts to 24,840 English miles. Geographers divide the globe of our planet into two equal parts, or hemispheres, the northern and southern, by an imaginary girdle, or ring, named the Equator. Two other imaginary girdles surrounding the earth, and distant from the equator on each side 23½ degrees, north and south latitude, are named the Tropicks of Cancer and Capricorn; comprehending between them the torrid zone. From these tropical circles the zones, called Temperate, extend on each side 43 degrees: and at their extreme boundaries, we reach the polar circles 23½ degrees distant from each pole. The north and the south poles are in the middle of each hemisphere of the earth; and the distance of each from the equator is 90 degrees.
The earth has several incessant motions: one in which it turns, like a suspended wheel upon its own axis, from west to east, every twenty-four hours, which is the length of its day and night: the second, where it is rolling progressively in its great annual circle, or journey round the Sun: the third, the alternate inclination of its poles towards the sun at different times of the year: the fourth, the small circle which it describes monthly round the common center of gravity, or balance, with its moon. The earth’s diurnal revolution upon its axis, is at the rate of fifteen degrees, or 1,035 miles hourly. But the rapidity with which it is whirled in its annual orbit, is, hourly, 68,243 miles: whereas the swiftness of a ball discharged from a cannon is, in the same time, only 480 miles. Projected through the vacuity of heaven with this amazing velocity, in the space of 365 days, 5 hours, and 49 minutes, the earth completes its annual circle; which is the length of our year. The earth’s rotation every twenty-four hours upon its axis, is the cause of day and night, or of light and darkness. In this successive rotation, one half of its globular surface is always enlightened; the other half being then obscured in nocturnal gloom, except when enlivened by the reflected rays of the moon, or of one of the planets, or by the fainter glimmering of the fixed stars. The alternate spiral inflection and declination of the earth’s poles during its annual journey round the Sun, is the cause of the different lengths of Days and Nights; of the Seasons; of Summer and Winter; of the Equinoxes, and Solstices: and as each pole inclines or recedes, it is summer and winter, alternately, in their respective hemispheres. The effects of this compound terrestrial circumvolution on the animal and vegetable creation, would alone be a magnificent theme for many volumes.
One Moon only is allotted to our earth; from which it is distant 240,000 miles. The moon’s diameter is nearly one fourth less than that of the earth, which it obsequiously accompanies throughout its annual circuit; and round which it makes a perpetual revolution, from west to east, every lunar month. The constant agitation and periodical surges of the ocean, are greatly influenced by the moon, assisted, however, by the centrifugal force of the earth’s motion. It is also ascertained, that in some diseases, the human body is considerably under the lunar influence; and its energy is still more conspicuous at periodical changes, during the month and the year. Many arguments might be suggested to invalidate and overturn the ancient astrological systems, and to prove that the celestial influences upon us are not, in any considerable degree, derived from sources more remote than the solar confines.
The first Element in pre-eminence and subtility, without which all would be lifeless chaos in our system, is Heat and Light. Cold is a negative quality, and merely a comparative diminution of heat. The middle regions of the earth being repeatedly more exposed to the Sun’s vertical rays, are consequently most heated and scorched. From the equator to the poles, are all the gradations of heat and cold; but for reasons too prolix to enumerate, these gradations are not in exact measurement with the geographical distances from the equator; neither in the same continent, nor in different continents. By the scale of Farenheit’s thermometer, water boils at 212, freezes at 32; and blood-heat, or that of the human body, is about 97. The most intense heat of the tropical regions, as measured by the same thermometer, is frequently many degrees above the human temperature; and the most intense cold of the polar regions, often many degrees below 1 or 0 of the same scale. Neither of these noxious extremes of pestilential heat, nor of deadning blasts from boreal snow, could be long endured by the human species, were their bodies not protected and skreened by fences of nature or of art. Atmospheric heat, equal even to that of the human body, is felt intolerably scorching and suffocating. Every one also knows, by personal experience, that in different latitudes, and in summer and winter, the degrees of heat and cold, the duration, recurrence, and changes, are extremely variable. But within the equatorial limits, these variations are much less conspicuous, both in the thermometer and barometer. From this main spring and soul of animated nature, blessings and bounties are diffused, in thousands of channels, to every order of the creation; and from its extremes and vicissitudes, a multitude of evils and diseases are inflicted upon man.
Between the earth and celestial vacuum is interposed an element, called the Atmosphere, or Air. This invisible elastic fluid is floating equally round our planet, to the distance of at least forty-five miles perpendicular elevation. It has been compared by some philosophers, to packs of wool heaped on each other: that nearest the ground is most dense, compact, and ponderous; and as we ascend, it becomes gradually more rare, light, and cold. The prodigious gravity, or pressure, of this atmospherick column, appears incredible to those who are ignorant of experimental philosophy, and of the air-pump and barometer. Upon a man’s body, of middle stature, its weight is equal to thirty-two or thirty-three thousand pounds: but in rainy and variable weather, and especially on the summit of high mountains, there is a diminution in its pressure of many thousand pounds. This great mass of air, as well as the waters of the ocean and of rivers, is in constant agitation; sometimes gliding in gentle calms; sometimes, with wild uproar, raging in storms and hurricanes, and dispersed in a variety of currents, over different parts of the earth and ocean in Winds, constant, periodical, variable, and irregular. Without the concurrent support of air, animal and vegetable life would soon be annihilated. On them great and sensible effects are produced by the atmosphere and winds: by the air’s noxious impregnation, stagnation, want of elasticity, heat, cold, moisture, dryness; by the points from whence winds blow, their constancy, irregularity, recurrence, velocity.
The earth is the cistern, and one principal fountain of another still grosser element. From the Sun’s heat, and from the successive streams of air and winds, a prodigious evaporation is carried on from the surface of the ocean, from the land, and from vegetables. Whether part of the atmospherick air is also converted into vapour, is a question too intricate and diffuse for our present inquiry. The critical analysis and history of a single element, would alone far exceed the limits of this Dissertation. It is sufficient for us to observe, that these vapours, terrestrial and aerial, are collected into clouds, condensed, and again discharged upon the earth in Dews, Mists, Fogs, Rains, Snow, and Hail. The precipitation likewise of this accumulated vapour upon different parts of the globe, is periodical, regular, and variable. In quantity, duration, recurrence, and extent, these aqueous modifications are greatly diversified by the climate and soil, the vicinity to mountains and sea-coasts; the points from whence winds blow; and by many other causes, of which a detail cannot be here expected. From this source also ensue salutary and baneful effects, innumerable to animal and vegetable life.
Another subtile and active agent in the secret machinery of nature, is the Electrical Emanation; which, somewhat perhaps analogous to the aqueous evaporation and congestion before mentioned, is collected into clouds, and, with loud explosion, again discharged and dispersed into the air and earth: the fabulous thunderbolts and artillery of Omnipotence.
We now alight upon that solid mass, Earth, the most fixed and substantial of all the elements. The surface of our planet is composed of dry land and water; of which the ocean, without including lakes and rivers, occupies by much the largest extent. But the partition of the dry land into four continents, Europe, Asia, Africa, and America, is not well founded. Nature has in reality formed only three great insulated continents, exclusive of the smaller islands. Europe and Asia are contiguous, and cemented together as England and Scotland; or as France and Germany; and their boundaries artificial: whereas Africa, except the slender neck of land near Alexandria, is surrounded by sea. Of these four continents, Europe is the most diminutive. Asia and America stand dignified, above all the others, in superior magnitude. The dry land in Europe, Asia, and America, stretches to a great northern latitude, considerably within the arctick, or polar circles; and, spreading also in that part to a wide extent, east and west, forms nearly a complete bridge between Asia and America. Within the tropical circles are included the belly and bulge of Africa, and of South America, with a considerable portion of the broken southern extremities of Asia; together with most of the principal islands in the Pacific and Atlantic oceans. In all the hemisphere south of Capricorn, the land is greatly disproportioned to the ocean. The conical south point of America is but 55, and that of Africa only 35 degrees distant from the equator. A vast orbicular segment of this extreme of our planet, furnishes habitation for fishes only. The dry land is also diversified by elevations and plains; but in no part of the earth’s circumference do those stately monuments of nature’s workmanship ascend to five miles perpendicular elevation.
The Creator has bountifully stored the earth and the ocean with animals and vegetables. Our attention is here circumscribed to the most exalted class, the Human Species; leaving to the naturalist a description of quadrupeds, birds, fishes, insects, and vegetables. By far the largest proportion of the human species are stationed to the north side of the equator, and even to the north of the tropick of cancer. The populous continents of Europe and Asia, comprehending most of the powerful kingdoms in our planet, are in the northern hemisphere. Within the tropical circles and furnace of the earth, are stationed the next considerable hive of mankind. To the south of Capricorn there are few inhabitants. Some wretched human beings are also scattered through those dreary wastes of ice and snow within the northern polar circles.
Calculators differ enormously respecting the number of the Human Species. Some sink the collected herd so low as three hundred million, whilst others exaggerate them to treble and quadruple that amount. It forms no part of my scheme to investigate the comparative population of the earth, one, two, and three thousand years ago. Europe, in all probability, since the era of Roman grandeur, has, together with advancement in civilization, likewise added to the number of its inhabitants. Those parental nurseries of the arts and sciences in Asia and Africa, have no doubt undergone various revolutions in population. If we were to draw any inferences from the numerous Asiatic armies, during the successive despotism of Assyrian, Babylonian, Medean, and Persian monarchies, we should conclude that, in remote ages, the south of Asia abounded in men. The extensive empire of China, at this day, resembles an industrious beehive, and is gorged with mankind. We have still more aversion to plunge into the mysterious archives of Africa, and with critical affectation to pronounce upon the population of that quarter before the decay of its political, commercial, and literary fame with Thebes, Carthage, and Alexandria. That modern-discovered transatlantic continent, from the cruelties and desolation of its first conquerors, and of a loathsome infectious disease exchanged for another, has probably suffered considerable diminution of its original feeble hive, notwithstanding the recruit from Europe; and in the scale of population, as yet ascends to a very subordinate rank amongst the other continents. The most probable calculations estimate the whole human race at eight hundred million: of which number, Europe boasts of little more than one hundred million. The great swarm is in Asia; amounting to between four and five hundred million. Africa is supposed to contain one third or fourth of the latter number. Over the fertile wilderness of America are scattered not altogether twenty million.
But if in London alone, where registers of various kinds may be consulted, calculators are, notwithstanding, at variance respecting its population upwards of one hundred thousand, and in the whole island more than a million; it may be reasonably suspected, that in forming a gross estimate of the aggregate terrestrial inhabitants, we may err perhaps, one, two, or even three hundred million. As well might we expect a correct list of the lions, crocodiles, and monkies of Africa, as of the outcast human race in those burning and illiterate regions. To determine the exact amount of inhabitants in any civilized kingdom, the most certain method would be, to make an universal and arithmetical numeration throughout every dwelling. This is often done in several kingdoms; and in none more culpably neglected than in this island. English calculators, therefore, have been under the necessity, by other laborious processes, to form at least plausible conjectures of the national population. One of their methods is, by collecting the number of houses, and allotting five, or four and a half inhabitants to each house; which, at a general medium, was found near the standard of truth, in a multitude of large towns and open districts in England, Holland, Germany, Switzerland, and Italy; as may be seen recorded in the writings of Short, Susmilch, Price, and many others. In some particular cities, however, such as Berlin, Vienna, Paris, and Edinburgh, where several families are crowded into one house, this rule would lead into error. Besides, in ours, and many other large kingdoms, we are not yet supplied with an authentick register of all the dwellings. And in Asia and Africa, whose political institutions and customs are so different from us, this scale of mensuration may be still more erroneous. Another method, but still more complex and uncertain, of computing the population is, by the annual christenings and burials. When these are equal, and consequently there is no increase or decrease of the inhabitants, we are directed to multiply the usual prospect or decrement of life, or in the mathematical phrase, the expectation of an infant at birth in that city, town, or district, by the general medium of christenings; which will be the total local amount of the inhabitants. But as the christenings and burials are rarely equal, or a correct list of either can be ascertained from the imperfect registers, this process is very defective.
The Multiplication of the human species depends greatly on society. There are more inhabitants concentrated into one large metropolis of Asia or Europe, than could be collected in many thousand miles of the North-American wilderness on its first discovery. The population of the earth is by no means regulated by the extent of country. If, on the one hand, high refinement and large cities are obstacles to population, a wild state of nature is still more detrimental. A few tribes of North American natives, prowling like hungry wolves, can scarce find precarious subsistence in a wide extent of uncultivated desarts. Their infants, from necessity, are suckled several years; and after rearing two or three, the period of propagation is nearly over. A medium state between the vicious extremes of refinement and rude savageness; or the middle stages between the iron and golden ages of the ancient philosophers, is most favourable to the increase of our species. But the causes conducive to population and depopulation, are of infinite compass; and are of a compound nature, medical and political. They are connected with the state of government, religion, climate, genius, industry, riches, poverty, taxes, luxury, refinement, wars, colonization, emigration, commerce, agriculture, the unequal distribution and monopoly of property and farms, the plenty, scarcity, and cheapness of food; and, with many other causes, closely allied to our future medicinal investigation. Under governments and nurture, directed with political and moral, together with medical prudence and circumspection, the earth and ocean would probably afford ample nutriment, and their population might be multiplied to three times eight hundred million.
Extending our views over the surface of the globe, we perceive striking distinctions between the human species; not only in the four great continents, but also in different parts of the same continent. These differences are principally manifest in the colour of the skin; in the complexion, countenance, physiognomy, hair, form, and stature. We attend here merely to corporeal distinction, without including the intellectual. These great Classes of mankind may be divided into the Laplander, the Tartar, the Chinese, the European, the African-negro, and the native American. The modern-discovered inhabitants in the islands of the Pacific ocean, seem to have no remarkable cast of countenance or figure to sever them into a separate class. But throughout a considerable extent of the globe, from conquest, emigration, colonization, and commercial intercourse, many nations are now blended and assimilated into one; and their elementary characteristic features more faintly imprinted. Besides, every one’s experience and observation will instruct him, that in populous kingdoms those classes branch out into innumerable intermixtures, orders, and genera; and that the species and varieties are as numerous as the individuals of the human race. Amongst the ab-origines, and stationary inhabitants of most kingdoms, there are indeed some prominent features peculiar to each community; which are, in some degree, conspicuous in the corporeal, and still more in the mental outlines. Mankind, exclusive of their original mould, as issued from the mint of the Creator, are afterwards diversified by climate, soil, diet, government, religion, association, occupation, and habit.
By Civilization, mankind are arranged and connected into an infinite series of descending and dependent links. In a state of nature there are few gradations in society; few professions or mechanical arts. Mr. Voltaire makes two great divisions of mankind; the oppressors, and the oppressed. Descending the mole-hill and ladder from the throne to the cottage, we may trace a multitude of gradations in the scale of polished communities. We descend thro’ nobility and gentry of independent fortunes, in lands or money; through literary professions, including divinity, medicine, law, and various other branches of active or speculative science: all of which united, constitute, even in the most opulent nations, but a small portion of the community. We next descend to a fertile hive of husbandmen and artizans, laborious drudges in mechanical trades, arts, manufactories, and commerce: to a numerous class of retailers or venders of merchandize, and of the necessaries of life: to soldiers, sailors, domestick servants: to no inconsiderable multitude buried under ground, and occupied in digging metals and fuel from the bowels of the earth: to infirm, cripples, diseased, puerperal, aged; and to many other links and gradations, which must be greatly diversified by the variety in governments, religion, climate, national genius, and other causes which will occur to philosophers, and to gentlemen of reflection. It is of essential importance, not only in an enlarged political, but also in a medicinal view, to contemplate these constituent portions of a community.
The inhabitants crowded into Cities and towns, and those dispersed in small villages, and in the Country, constitute other large groups of society. If the result of Susmilch’s researches and materials, collected throughout Germany can be depended upon as a criterion for other European nations, the inhabitants in the country are to those in cities and towns as 3½ to 1. Great cities, if we except Rome and Constantinople, are of modern date in most kingdoms of Europe. In the ninth century, a few towns had been built in Germany; but in England, corporations and considerable towns are posterior to the Norman invasion. Cities, associated communities, and towns, during the religious frenzy of crusading, and after the termination of this epidemical distemper, were asylums from aristocratic tyranny; and when of moderate size, are seats of politeness, refinement, emulation, arts, and society; but when overgrown, they check population; they are drains of the human species, the graves of infants, and nurseries of vices. Unfortunately also for succeeding generations, numerous cities, towns, and harbours, have been founded upon low, unhealthy situations, surrounded by morasses and hills. Most cities seem to have grown to maturity by accident and time: their streets are narrow, irregular, not sufficiently ventilated; and the inhabitants absurdly and perniciously thronged together. There are moderate-sized towns, and even country districts, whose situations are so noxious, as to make the burials exceed the births. We need not travel to new uncultivated continents and islands, nor to rank tropical climates for proofs: we have only to consult Dr. Short’s Registers of several parts in this kingdom.
The assemblages of the human race are greatly diversified by their Ages. During nine months only of uterine incubation, and from the most minute tadpole, an infant at birth has grown to between sixteen inches and two feet; and from five to ten pounds in weight. After birth, the increase is slower; and it proceeds to shoot upwards a few inches annually, but not always in successive progression, and to make additions to its weight and dimensions. Between puberty and twenty-one years of age, man has generally attained to the summit of his altitude; females, rather earlier; and those still earlier who inhabit warm climates. Excluding that fragment of pigmy mortals, the Laplanders, between five and six feet in height is the most universal and mean standard of the human race; and their gravity in various gradations, from eight to twenty stone; in both which respects, females usually fall short of males. Nature, however, is not limited to one model of altitude or gravity; she sometimes deviates into extravagancies, producing human giants, from nine, down to diminutive dwarfs of two feet; together with shapeless monsters wallowing in fat, and weighing upwards of forty stone. Let us next endeavour to form arithmetical estimates of the human race, at different ages. Davenant calculates the inhabitants of England (not including Scotland) at five million and a half; and their sundry ages as follows:—Under one year of age, 170,000; under five years of age, 820,000; under ten years of age, 1,500,000; under sixteen years of age, 2,240,000: from sixteen years of age to the extreme of existence, 3,260,000; of which number he estimates 600,000, or about one ninth part of the whole community, to have passed sixty years of age; and of which veteran group the males constitute 270,000; the females, 330,000. Dr. Price supposes nearly an equal proportion living under 16, and above that age; but that the latter are the most numerous class: Davenant states the medium at 20. Dr. Halley supposed the number living under 16, to comprize about one third of the community; and also, that those living between 20 and 42, were about one third of the whole. The preceding analysis of the numbers living at different ages in one kingdom, may with facility be applied to any numerical extent. If we wish to calculate the proportion living at similar ages amongst one hundred million, we have only to multiply by 18 each of the preceding groups composing five million and an half of inhabitants.
Two large and important classes are formed in society, by the distinction of the Sexes into male and female. So soon as the organs of generation are completely evolved; that is, when the two sexes arrive at puberty, they are inflamed with a new passion and pleasing sense. In most warm climates, this generative period is somewhat earlier than in northern latitudes; and in the former also, women are said to be more prolifick. We shall therefore devote a few words to the union of the sexes, from whence ensue procreation and births. Some calculators have computed, that amongst five million and an half of inhabitants in England, there are annually about forty-one thousand legal marriages: of which one sixth part are widows and widowers; about one marriage to every one hundred and four inhabitants; and the annual marriages to the births, as 1 to 4, or 4½. The mean ages at which marriages in this island commence, is computed from 32 to 35 on the side of the man, and 25 on that of the woman; but in this estimate, second and third marriages are included.
In cities, not only fewer enter into the matrimonial state, but the product also of city and country-marriages is observed to differ. Marriages in cities, one with another, seldom produce above four; generally between three and four, and sometimes not three children: whereas country-marriages seldom produce less than four, and generally between four and five. Whether this disparity between the product of city and country-marriages is to be imputed to dissipation, libertinism, and incontinence, both in the single and married state; to the cloudy apprehensions and fears of overstocking their house; to later, fewer, and less frequent unions in the matrimonial bond; or to all these and other causes combined, I submit to the reader’s consideration. From authentick registers of a variety of small towns and country parishes in England, Dr. Short found, that each marriage produced four and a half children, at a medium; for some married pairs have only one or two: others six, eight, twelve, or more; and a small remnant are unprolifick. Natural, or illegitimate children, are enrolled in the public records of christenings, and swell their proportion to the registered weddings somewhat greater than they would appear without this extraneous addition. In some German registers, Dr. Short found, that of 333,655 births, the illegitimate amounted to one thirty-seventh part; and in an inland town of England, that of 10,337 births, 284, or about one thirtieth part, were illegitimate.
If the number of inhabitants in any kingdom, city, or village, continues the same without increase or decrease, and supported by their own procreation only, it is evident, that there the annual births and burials will be equal, and the supply proportioned to the waste; and in equal numbers, as many will die at all ages as are born in the year, on a general average; and the numbers dying any year at one, two, three years of age, and so on to the extreme of existence, will be just equal with the numbers who successively attain to those different ages at which the others die. The total annual births amongst five million and an half of inhabitants in England, are calculated by Davenant at 190,000; which is about one birth to every twenty-five inhabitants; and amongst nine million of inhabitants in Britain and Ireland, the annual procreation will considerably exceed three hundred thousand; and the annual mortality should be somewhat inferior. In the kingdom of Prussia, from the year 1715 to 18, there were christened, at an annual medium, 78,826; buried, 55,852. In the kingdom of Sweden, the annual average of births during nine years, ending in 1763, was 90,240; burials, 69,125. In Norway, in 1761, the christenings were 11,024; burials, 6,926. In France, during three years, ending in 1772, the annual average of births was 920,918; burials, 780,040. In the county district of Vaux, in Switzerland, during ten years, the births were 3,155; burials, 2,504. The country, says Graunt, has 6,339 births for 5,280 burials. In that little fertile atlantic island Madeira, the inhabitants have been computed to double themselves in eighty-four years; so great is the difference between the births and burials. In some provinces of North America, if Dr. Franklin’s calculations are correct, the inhabitants double themselves in the short space of twenty-five, twenty-two, and even in fifteen years. On the other hand, in all the large cities of Europe: in Paris, Vienna, Rome, Dresden, Berlin, Amsterdam, London, Edinburgh, Dublin, and in almost all towns of considerable magnitude and population, the total annual births are inferior to the burials. It is calculated, that in London, within the last 150 years, near a million more of the human species have been wasted, beyond what were reared by its own original growth and procreation. But in small villages and country districts, the annual births exceed the burials; and it is from this redundance that a supply is furnished for the extraordinary consumption of armies, navies, war, colonization, emigration; exclusive of sickness, and other morbid casualties: the country and village surplus prevents depopulation.
Providence has also wisely ordained, that throughout those European kingdoms, of which we have any registers, a few more Males should be born than Females; and indeed such a surplus is rendered necessary from the waste by wars, emigration, intemperance, mechanical arts, and trades, the inclemency and vicissitudes of the weather and seasons, the vices and misfortunes to which political punishments are annexed; with various other noxious casualties, to all which the male sex are most exposed. In Dr. Arbuthnot’s Table, printed in the London Philosophical Transactions, of the proportion between the births of the sexes; in forty-six years were baptized of males, 329,742; of females, 308,644: excess of males only, 21,098. By the London bills, from 1657 to 1776, I find that there have been christened of males, 1,041,149; of females, 983,061, or as 18 to 17: and therefore, that in this long interval of 120 years, and comprehending two million of births, there is only a trifling excess of males, amounting to 58,088: a number which would scarce recruit the consumption of a few active campaigns. The excess of male beyond female births, is not so considerable as books of calculation have represented. In volume the 7th of the Philosophical Transactions abridged, there is an account of the annual births during several years at Vienna, Breslaw, Dresden, Leipsic, and Ratisbon: and in those cities, male and female births were as nineteen to eighteen. Amongst the abortives and stillborn, we also find the plurality of males. Lastly, if the registers can be depended upon, it appears that there are more births in Winter than in Summer, both in town and country. But although the fruit of the human womb may not have arrived at maturity before winter, it is no proof against the general law of the spring and summer influence on animals and vegetables, in contributing to fecundity and generation.
[CHAPTER I.]
The Comparative Mortality of the Human Species, and of the Sexes at every Age, in City, Town, and Country; and in different Kingdoms of Europe: illustrated with a Chart, and with Tables. The Comparative Mortality of the Human Species, by different Diseases and Casualties: exhibiting a Chart, and Tables of all the Mortal Diseases and Casualties in London during Seventy-five Years: illustrated by and contrasted with the united Observations of Medical Authors, with various Hospital Registers; and with a Variety of Materials, Observations, and Comments of the Author.
That learned Physician, Dr. Arbuthnot, in his Preface to Huygen’s “de Ratiociniis in ludo aleæ”, says, There are very few things which we know, which are not capable of being reduced to a mathematical reasoning; and when they cannot, it is a sign the knowledge of them is very small and confused; and, when a mathematical reason can be had, it is as great a folly to make use of any other, as to grope for a thing in the dark when you have a candle standing by you. Medical writers, almost universally, have neglected, or barely skimmed the surface of the following important subjects. The public registers of births, burials, and diseases, are overlooked by all the modern systematick authors: they leave us equally ignorant of the aggregate, or comparative number, or force of those fiends which haunt and ravage the globe. To speak metaphorically, in medical books, the extensive desolation of the most rapacious tyrants and conquerors are confounded with the uninteresting history, and petty depredations of a robber. The detached observations of physicians, or other literary individuals, confined perhaps to a small town or parish, a meagre detail of village remarks, furnish, in innumerable instances, foundations too slight for the erection and stability of general proportions. In order to form useful tables of the ratio of mortality at various ages, to determine upon the absolute and relative havock by different diseases, upon the general effects of climate, season, local situation, diet, drink, luxuries, new customs, and manners, &c. we should extend our views far beyond the narrow bounds of a parish, or even of a province; we should include an interval of many years, collective numbers, and large groups of mankind.
It appears to me, that a great number of the fundamental principles, or of the primary orders of medical architecture, have not yet been established, neither in Pathology, to which this Dissertation is chiefly related; and much less in Therapeuticks. The lumber and mountain of ponderous systems, heaped together from Galen to Stahl, can only be compared to Egyptian pyramids. Except what has been done by a few authors, hereafter to be mentioned, the sciences of Medical Arithmetick and Universal Prognosticks, are new in medicine. In emergencies, the constant appeal has been, with oracular reverence, to aphorisms and opinions of individuals. In a word, no medical author has yet attempted to take the gages of life and death, and of morbid devastation, and, in one general survey, to encircle the horizon of human existence and distempers. I have made some, at least laborious efforts, to rescue a momentous part of active medicine from that conjectural stigma with which the whole profession has been branded in the lump. And, however it may be slighted as an heretical innovation, I would strenuously recommend Medical Arithmetick, as a guide and compass through the labyrinth of Therapeuticks.
We are now to view the human race unexpectedly arrested, and struggling in the tragical and last stages of their terrestrial pilgrimage. The vision of human life is soon at an end: we are ushered into the world with lamentable exclamation; and are too often torn out of it in pain and agony. Bills of Mortality, however defective and inaccurate, yet sufficiently demonstrate this awful truth, that very few of the human species die of old age, or natural decay: by far the greater proportion are prematurely cut off by diseases. Of all the animal tribe, who usually bring forth one at a birth, none die in such numbers, in infancy, as the human race. In London, Vienna, Berlin, and every other overgrown metropolis of Europe, on an average, one half of the children born, die under three years of age. But in country towns and villages, the proportion of infant mortality greatly abates. In some country towns of England, of considerable magnitude and population, as Manchester, half the children die under five; at Norwich, half under six; at Northampton, half under ten years of age. London, therefore, will have lost, out of equal capitals, a number in the intermediate space, between three and ten, more than Northampton.
Attend next to the small proportion of Infant Mortality in open country districts. By Dr. Short’s registers of several small country villages in England, the major part born live to 25, 27, 33, and 40. In many healthy country parishes, half the inhabitants born live to mature age; to 40, 46, and a few even to 50 and 60; and rear large families of children. In some extensive country districts of Switzerland, similar observations have been made by Susmilch and Muret. Here, therefore, is an astonishing disparity between the duration of city and country life: but particularly, let it be engraved upon the memory, in the early stages of puerile exigence. Infants in cities resemble tender delicate plants excluded from fresh air; or fish confined in stagnant putrid water: they perish before acquiring a solidity and seasoning to endure the adulterated quality of the surrounding element; and their thread of life is then suspended by a tender cobweb.
Mortality, universally, during the first year after birth, is the most enormous in the funeral catalogue. A London infant at birth, has but an equal chance of living to three years old; whereas in the country, as before observed, half born survive to maturity. Upon reaching the third year, in cities, infants are somewhat seasoned, and the hurricane of puerile carnage is greatly abated. There is not afterwards such a prodigious disproportion between city and country mortality; and, in a few years after, from seven to ten, they approach nearer to an equality. From the London registers of burials, it appears that more die in the metropolis under two years of age, than from two to upwards of forty; and more under five years of age, than from five to between fifty and sixty: yet under five, there are but an inconsiderable number alive, compared to the latter class above that age: the deaths are greatly disproportioned to the living numbers or capitals. A few more die in the short interval between five and ten years of age, than in the succeeding double interval from ten to twenty. Between eight and sixteen years of age, one of every seventy of the Christ School boys is computed to die. Davenant rates the decrement in these years at only one per cent. After reaching the tenth year, the torrent of mortality in city, town, and country, is subsided; and during the next eight or ten years of adolescence, very few die. From seven to ten, may be termed the highest pinnacle: having surmounted all the dangers and precipices of the early preceding journey, there is no stage wherein the future prospects of existence and longevity are so extensive. From birth to ten, the tide of life continues in annual gradation to increase; and from ten to the ultimate verge of existence, vitality continues gradually to ebb. Between twenty and thirty, more die in London than in the fifteen preceding years; and the burial list continues turgid to sixty; at which latter stage, the mortality is computed between four and five per cent.
One reason, but not the only one, as I shall hereafter prove, of the great surge in the London bills, from twenty up to forty, is, that within this interval of life, the majority of the new settlers or recruits, arrive; and consequently augment the burials, from twenty to forty, beyond their natural proportion. After passing the meridian, and in the evening of life, the seasoned inhabitants of cities are said by Dr. Price, to have the advantage of the country, in health and longevity: that is to say, although the number who have survived in the country to sixty, seventy, and eighty, are greater proportionally than in cities, yet the latter class arrived at those years in London, have, comparatively, surer expectations of life. I do not, however, find this assertion verified in fact; the balance, if any, vibrating alternately on each side. The proportion of inhabitants who reach eighty years of age are computed, in London and Vienna, at one of every forty: but in country parishes, at one of every twenty-two; and in some, even one of every eleven. In both city and country, the few survivors at ninety, out of each thousand cœtaneous births, will have lost almost all their fellow-travellers in the journey, long before reaching that goal; and about three or four only out of each thousand, on an average, will be then left alive.
There are a few instances of extraordinary Longevity, to 150 and 165; such are Jenkins and Par, in this island. In Bacon Lord Verulam’s History of Long Livers, male and female; their climate, diet, mode of life, appetites, exercises, studies, passions, dispositions, habits, and complexions, were exceedingly dissimilar. It is however probable, from observation and analogy, that the indigent and laborious class of mankind do not attain to longevity in the same proportion with the middling and more opulent ranks. The wandering Savages of America are notoriously short-lived. Throughout Europe, Asia, Africa, and America, the rich, the poor, the inhabitants of city and country, with very different complexion, climate, soil, diet, and conveniences, all seldom exceed the usual term of life allotted to man: seventy and eighty is mentioned in holy writ, as the brink of our earthly duration. Since the days of Moses; that is, between three and four thousand years, human existence has been circumscribed within the same narrow bounds. In the London registers of mortality, during a period of thirty years, from 1728 to 1758, the total mortality is 750,332; and of all this number, 242 only reached beyond 100 years of age; one of whom arrived at 138. In some races and families of men, longevity seems to be hereditary; and his age, though little more than a dream, exceeds that of all other living creatures, a few only excepted. Amongst the quadruped creation, the elephant surpasses man in longevity: amongst the birds, the Swan, and a few others, have survived upwards of a century. The age of fishes is determined with more ingenuity than certainty: some seem to rival man in years. Among the numerous vegetable tribes, the Oak, Chestnut, and some other great trees, survive centuries.
On contrasting the mortality of Males and Females, it appears, that, notwithstanding the surplus of male births, the perils of childbearing, the many vexatious diseases peculiar to the fair sex, and that physicians and apothecaries have many more patients of the latter; yet the total aggregate number of living females exceeds that of males, in most European kingdoms. Upon a numerical inquest in Edinburgh, and some other great cities, it was found, that females were to males as 4 to 3: in London, as 13 to 10; and in some other cities and towns, as 9 to 8. But in country districts, Graunt and Susmilch agree, that the two sexes approach nearer to an equality. In the province of Jersey, in North America, the males were found the majority. From 1702 to 1752; that is, during a period of fifty years, I find the proportion of male and female mortality in London as follows: Male deaths, 618,076; Female deaths, 626,692. Whence, therefore, does it happen, that female deaths preponderate over the male, when more of the latter are born, and, as calculators assert, the mortality of males, at all ages, is greater than that of females? As a solution of this difficulty and partial exception, I should suggest a greater exportation and transportation of males to the sea and land service, to nautical commerce, and to unhealthy climates.
Even in the Marriage State, the chance of survivorship seems considerably in favour of the wife. In Breslaw, during eight years, five married men died to three married women. Susmilch, on a scrutiny through several kingdoms and principalities of Germany, found, that three married men died to two married women. Dr. Price estimates the chance in favour of the wife being the survivor in marriage, as 3 to 2: and this calculation is confirmed by the experience of the general Clerical Society in Scotland, who have long established funds to support their widows. From their records, it appears that twenty married clergymen have died to twelve wives; or, as 5 to 3. By an accurate survey of several principalities and cities in Germany, and collected by Susmilch, the widows were to the widowers as 3, and even 4 to 1. At marriage, it should be observed, there is generally a disparity of age; the bridegroom is from six to twelve years older than the bride; and therefore should, in the course of nature, die sooner: and perhaps also more widowers, comparatively with the other sex, enter into a second marriage; which tends to reduce their numbers. Besides, husbands are more exposed to the vicissitudes of the weather and seasons, to excessive labour and noxious trades, and to many other causes of diseases. Dr. Price finds, that the sexes respectively commence to be widowers and widows about 52 and 44; that is, men and women entering into matrimony, on a general average, at the age of 33 and 25, will become widowers and widows at 52 and 44: consequently, that each marriage will be dissolved by the death of one of them, in nineteen years; which is the ultimate term and probability of the husband and wife being both alive. For although some marriages may be protracted forty and fifty years, yet others may be dissolved in one year, or in a shorter time.
We have not yet sufficient information to determine the comparative chances of Female Longevity in the married and single state. At Berlin, indeed, calculators have remarked, that there were more married women alive at great ages, than of those who remained single. But such result might naturally be expected from a greater proportion in the decline of life of widows and wives, compared to antiquated virgins. From the ages of fifteen to twenty-five, married women likewise are said to have the advantage of the single, in whom the dictates of nature are frustrated and violated.
Comparing the mortality of the Seasons, Dr. Short found, from a variety of country-registers, that mortality generally begins its reign in December; that at March it is in its zenith; and at May in its declension. In twenty-five country towns and parishes, he found the winter to the summer mortality as 50 to 41. At Manchester, a country town of England, Dr. Percival found the winter to the summer mortality as 11 to 8. At Vevey, in Switzerland, during sixty years, Mr. Muret found the burials, during the four winter months, as 5 to 4 to those of the summer. Another proof of this is recorded in the Recherches sur la Population, par Messance: The total sick admitted into the Hotel Dieu hospital in Paris, from 1724 to 1763 (forty years) were, in the four winter months, December, January, February, and March, 314,824; and in the four summer months, June, July, August, September, 238,522; or as 4 to 3. In London too, the undertaker’s, harvest is in winter. There is one obvious reason why, in every metropolis, the winter mortality should exceed that of summer, from the greater concourse of inhabitants of all ranks: but, independent of additional population in winter, the same law seems to prevail in country places. In a subsequent part I shall attempt to throw some collateral illustration upon the subject.
Let us close this humiliating scene with a general abstract of human carnage. If we scan the dolorous mansions of disease, we find, on an average, 1 death, annually, out of every 5 families in cities: but in country towns, and open districts, 1 of 7, 8, 9; and in a few healthy places, 1 of every 10 families. Including the whole assemblage of inhabitants in city, town, and country, from birth to the extreme of existence, they are computed to die in the following annual proportion to the living: In London, 1 of 21; Dublin, 1 of 22; Edinburgh, 1 of 21; Vienna, 1 of 20; Amsterdam, 1 of 22; Berlin, 1 of 26. This is nearly Dr. Price’s calculation; but Halley and Susmilch compute only 1 of 22 to 29 to die annually in cities. In smaller cities and towns, such as Norwich and Northampton, the general average of deaths is 1 of 24 to 26; but in several provinces and healthy country villages, 1 of 32 and 33, up to 45, 50, and even 60, is the annual drain: 1 of 43 to 50 was the average in upwards of a thousand country parishes on the continent; and recorded in Susmilch. Within the above short intervals of time, there will have died in the respective cities and country places enumerated, a number equal to the whole inhabitants. But the annual decrease of the oppressed Negroes, in the West India islands, is estimated at 1 of 7.
The ancient Egyptians allotted 3 generations to a century, which is bordering upon the truth; at this day, 1 of 32 and 33 up to 35, is near the measure of a generation, and to the general decrease of a community throughout Europe, comprehending all the inhabitants in city, village, and country: that is, mankind share amongst them from about 32 and 33 to 35 years each of existence: and within this fugitive interval of time, a number equal to all the present inhabitants of this island, or of the whole earth, will be exterminated. If we extend this estimate to the whole human race, eight hundred million will die in 33 years; about twenty-eight million annually; seventy or eighty thousand daily; about three thousand hourly; and from fifty to sixty every minute. It is perhaps superfluous to add, that, in the same intervals, an equal or superior number will be born.
According to De Moivre and Dr. Price, “the probabilities or expectation of life, decrease as we advance from childhood to old age, in an arithmetical progression; that is, in such a manner that the difference is always the same between the number of persons living at the beginning of any one year, and the number living at the beginning of the following year.” Or, in other words, less enveloped in mathematical obscurity, out of any specified number, an hundred or a thousand, the same proportion will continue to die every year until near 80 years of age and upwards: consequently, the probabilities of life are constantly decreasing; because notwithstanding the progressive annual drain from the capitals, yet the deaths continue throughout equal. But this proportion is certainly erroneous in the first stages of life, and until about 10. View the above proposition in another light.
From any given number there will be an equal drain annually, until what De Moivre terms the complement or maximum, or utmost probable extreme of life, which he fixes at 86, all are dead. The probability, therefore, that the whole of any limited number whatsoever, or age, will all be exterminated is the number of years between 86 and the year such a number are all alive. Of 56 persons alive at 30, they should all be dead in 56 years, because 56 added to 30 amounts to 86, the maximum: of 46 persons alive at 40 years of age, they should all be dead in 46 years: and 36 persons alive at 50 years of age, should be dead in 36 years; for 50 and 36 complete the maximum. Again, the expectation of any single life is only half the maximum or complement, or half the space between that age and the ultimate term of existence: but here we must repeat the former exception, and draw the line after 10 years of age. The expectation of two equal joint lives, according to De Moivre, is one third of the complement of life. Example: two lives, aged 40, have an even chance or probable prospect of continuing together in exigence only 15 years; which is the third of the complement, reckoning from 40 to 86: the expectation of the survivor is also 15. Or, suppose a lot of marriages of persons at 40 years of age, they will, on an average, continue together 15½ years; and the survivors the same time after. This expectation, therefore, is the probable duration of each marriage, and the share of each person’s life. But it may be proper to add, that the duration of marriages, and the value of single and joint lives, will, on a promiscuous calculation, be different from the registers of annuitant and insurance offices; because they are scrupulously vigilant to exclude all diseased and unhealthy persons from becoming members.
The following Chart and Tables, present a distinct prospect of the fates clipping the mortal thread, from birth to old age, in city and country. But we are not to suppose that in every instance there will be annually a regular arithmetical diminution, as marked in the different tables: some years will be more fatal than others; and we are to form estimates from an average of several years. The first column points out the age, the second the number living at that age, the third the number who die during the year; and so on to the end of the table. But observe, that the number of infants, at the beginning of the second column, are supposed to be all born together on the first day of that year; and this rule applies throughout all the remaining ages. The two short tables of 15 and 30 years mortality in London, demonstrate the gradations at longer intervals than a single year. From these different tables may be estimated the annual waste, out of any specified number, at all ages, the ultimate prospects of existence, and the odds or probability of a person in health surviving a stated number of years.
A GENERAL CHART, with different Tables,
Exhibiting the Gradations of Mortality in City and Country.
Shewing the Probability of the Duration of Life in London, deduced by Mr. Simpson, from Observations on the Bills of Mortality in London for Ten Years, from 1728 to 1737. The total Number of Inhabitants, probably, about 650,000 in Winter. One Half born died under Three Years of Age.
| Ages. | Persons living. | Decr. of life. |
| 0 | 1000 | 320 |
| 1 | 680 | 133 |
| 2 | 547 | 51 |
| 3 | 496 | 27 |
| 4 | 469 | 17 |
| 5 | 452 | 12 |
| 6 | 440 | 10 |
| 7 | 430 | 8 |
| 8 | 422 | 7 |
| 9 | 415 | 5 |
| 10 | 410 | 5 |
| 11 | 405 | 5 |
| 12 | 400 | 5 |
| 13 | 395 | 5 |
| 14 | 390 | 5 |
| 15 | 385 | 5 |
| 16 | 380 | 5 |
| 17 | 375 | 5 |
| 18 | 370 | 5 |
| 19 | 365 | 5 |
| 20 | 360 | 5 |
| 21 | 355 | 5 |
| 22 | 350 | 5 |
| 23 | 345 | 6 |
| 24 | 339 | 6 |
| 25 | 333 | 6 |
| 26 | 327 | 6 |
| 27 | 321 | 6 |
| 28 | 315 | 7 |
| 29 | 308 | 7 |
| 30 | 301 | 7 |
| 31 | 294 | 7 |
| 32 | 287 | 7 |
| 33 | 280 | 7 |
| 34 | 273 | 7 |
| 35 | 266 | 7 |
| 36 | 259 | 7 |
| 37 | 252 | 7 |
| 38 | 245 | 8 |
| 39 | 237 | 8 |
| 40 | 229 | 7 |
| 41 | 222 | 8 |
| 42 | 214 | 8 |
| 43 | 206 | 7 |
| 44 | 199 | 7 |
| 45 | 192 | 7 |
| 46 | 185 | 7 |
| 47 | 178 | 7 |
| 48 | 171 | 6 |
| 49 | 165 | 6 |
| 50 | 159 | 6 |
| 51 | 153 | 6 |
| 52 | 147 | 6 |
| 53 | 141 | 6 |
| 54 | 135 | 6 |
| 55 | 129 | 6 |
| 56 | 123 | 6 |
| 57 | 117 | 5 |
| 58 | 112 | 5 |
| 59 | 107 | 5 |
| 60 | 102 | 5 |
| 61 | 97 | 5 |
| 62 | 92 | 5 |
| 63 | 87 | 5 |
| 64 | 82 | 5 |
| 65 | 77 | 5 |
| 66 | 72 | 5 |
| 67 | 67 | 5 |
| 68 | 62 | 4 |
| 69 | 58 | 4 |
| 70 | 54 | 4 |
| 71 | 50 | 4 |
| 72 | 46 | 4 |
| 73 | 42 | 3 |
| 74 | 39 | 3 |
| 75 | 36 | 3 |
| 76 | 33 | 3 |
| 77 | 30 | 3 |
| 78 | 27 | 2 |
| 79 | 25 |
Shewing the Probabilities of Life in London for all Ages. Formed from the Bills for Ten Years, from 1759 to 1768. By Dr. Price.
| Ages. | Persons living. | Decr. of life. |
| 0 | 1518 | 486 |
| 1 | 1032 | 200 |
| 2 | 832 | 85 |
| 3 | 747 | 59 |
| 4 | 688 | 42 |
| 5 | 646 | 23 |
| 6 | 623 | 20 |
| 7 | 603 | 14 |
| 8 | 589 | 12 |
| 9 | 577 | 10 |
| 10 | 567 | 9 |
| 11 | 558 | 9 |
| 12 | 549 | 8 |
| 13 | 541 | 7 |
| 14 | 534 | 6 |
| 15 | 528 | 6 |
| 16 | 522 | 7 |
| 17 | 515 | 7 |
| 18 | 508 | 7 |
| 19 | 501 | 7 |
| 20 | 494 | 7 |
| 21 | 487 | 8 |
| 22 | 479 | 8 |
| 23 | 471 | 8 |
| 24 | 463 | 8 |
| 25 | 455 | 8 |
| 26 | 447 | 8 |
| 27 | 439 | 8 |
| 28 | 431 | 9 |
| 29 | 422 | 9 |
| 30 | 413 | 9 |
| 31 | 404 | 9 |
| 32 | 395 | 9 |
| 33 | 386 | 9 |
| 34 | 377 | 9 |
| 35 | 368 | 9 |
| 36 | 359 | 9 |
| 37 | 350 | 9 |
| 38 | 341 | 9 |
| 39 | 332 | 10 |
| 40 | 322 | 10 |
| 41 | 312 | 10 |
| 42 | 302 | 10 |
| 43 | 292 | 10 |
| 44 | 282 | 10 |
| 45 | 272 | 10 |
| 46 | 262 | 10 |
| 47 | 252 | 10 |
| 48 | 242 | 9 |
| 49 | 233 | 9 |
| 50 | 224 | 9 |
| 51 | 215 | 9 |
| 52 | 206 | 8 |
| 53 | 198 | 8 |
| 54 | 190 | 7 |
| 55 | 183 | 7 |
| 56 | 176 | 7 |
| 57 | 169 | 7 |
| 58 | 162 | 7 |
| 59 | 155 | 8 |
| 60 | 147 | 8 |
| 61 | 139 | 7 |
| 62 | 132 | 7 |
| 63 | 125 | 7 |
| 64 | 118 | 7 |
| 65 | 111 | 7 |
| 66 | 104 | 7 |
| 67 | 97 | 7 |
| 68 | 90 | 7 |
| 69 | 83 | 7 |
| 70 | 76 | 6 |
| 71 | 70 | 6 |
| 72 | 64 | 6 |
| 73 | 58 | 5 |
| 74 | 53 | 5 |
| 75 | 48 | 5 |
| 76 | 43 | 5 |
| 77 | 38 | 5 |
| 78 | 33 | 4 |
| 79 | 29 | 4 |
| 80 | 25 | 3 |
| 81 | 22 | 3 |
| 82 | 19 | 3 |
| 83 | 16 | 3 |
| 84 | 13 | 2 |
| 85 | 11 | 2 |
| 86 | 9 | 2 |
| 87 | 7 | 2 |
| 88 | 5 | 1 |
| 89 | 4 | 1 |
| 90 | 3 | 1 |
Shewing the Probabilities of Life at Vienna. Formed from the Bills for Eight Years, as given by Mr. Susmilch, in his Gottliche Ordnung. Contains upwards of 200,000 Inhabitants. One Half born died under Three Years of Age.
| Ages. | Persons living. | Decr. of life. |
| 0 | 1495 | 682 |
| 1 | 813 | 107 |
| 2 | 706 | 61 |
| 3 | 645 | 46 |
| 4 | 599 | 33 |
| 5 | 566 | 30 |
| 6 | 536 | 20 |
| 7 | 516 | 11 |
| 8 | 505 | 9 |
| 9 | 496 | 7 |
| 10 | 489 | 6 |
| 11 | 483 | 5 |
| 12 | 478 | 5 |
| 13 | 473 | 6 |
| 14 | 467 | 6 |
| 15 | 461 | 6 |
| 16 | 455 | 7 |
| 17 | 448 | 6 |
| 18 | 442 | 6 |
| 19 | 436 | 6 |
| 20 | 430 | 5 |
| 21 | 425 | 5 |
| 22 | 420 | 5 |
| 23 | 415 | 6 |
| 24 | 409 | 6 |
| 25 | 403 | 6 |
| 26 | 397 | 6 |
| 27 | 391 | 7 |
| 28 | 384 | 7 |
| 29 | 377 | 7 |
| 30 | 370 | 6 |
| 31 | 364 | 6 |
| 32 | 358 | 5 |
| 33 | 353 | 6 |
| 34 | 347 | 7 |
| 35 | 340 | 8 |
| 36 | 332 | 8 |
| 37 | 324 | 8 |
| 38 | 316 | 9 |
| 39 | 307 | 9 |
| 40 | 298 | 8 |
| 41 | 290 | 7 |
| 42 | 283 | 6 |
| 43 | 277 | 6 |
| 44 | 271 | 7 |
| 45 | 264 | 8 |
| 46 | 256 | 9 |
| 47 | 247 | 9 |
| 48 | 238 | 9 |
| 49 | 229 | 9 |
| 50 | 220 | 8 |
| 51 | 212 | 7 |
| 52 | 205 | 7 |
| 53 | 198 | 7 |
| 54 | 191 | 7 |
| 55 | 184 | 8 |
| 56 | 176 | 8 |
| 57 | 168 | 9 |
| 58 | 159 | 8 |
| 59 | 151 | 8 |
| 60 | 143 | 7 |
| 61 | 136 | 7 |
| 62 | 129 | 6 |
| 63 | 123 | 7 |
| 64 | 116 | 7 |
| 65 | 109 | 8 |
| 66 | 101 | 8 |
| 67 | 93 | 8 |
| 68 | 85 | 7 |
| 69 | 78 | 7 |
| 70 | 71 | 6 |
| 71 | 65 | 5 |
| 72 | 60 | 5 |
| 73 | 55 | 4 |
| 74 | 51 | 4 |
| 75 | 47 | 5 |
| 76 | 42 | 5 |
| 77 | 37 | 5 |
| 78 | 32 | 5 |
| 79 | 27 | 4 |
| 80 | 23 | 3 |
| 81 | 20 | 2 |
| 82 | 18 | 2 |
| 83 | 16 | 2 |
| 84 | 14 | 2 |
| 85 | 12 | 2 |
| 86 | 10 | 2 |
| 87 | 8 | 2 |
| 88 | 6 | 2 |
| 89 | 4 | 1 |
| 90 | 3 | 1 |
| 91 | 2 | 1 |
| 92 | 1 | 1 |
Shewing the Probabilities of Life at Berlin. Formed from the Bills from Four Years, from 1752 to 1755. Given by Mr. Susmilch, in his Gottliche Ordnung. Contains 134,000 Inhabitants. Half die under Three Years of Age.
| Ages. | Persons living. | Decr. of life. |
| 0 | 1427 | 524 |
| 1 | 903 | 151 |
| 2 | 752 | 61 |
| 3 | 691 | 73 |
| 4 | 618 | 45 |
| 5 | 573 | 21 |
| 6 | 552 | 16 |
| 7 | 536 | 13 |
| 8 | 523 | 9 |
| 9 | 514 | 7 |
| 10 | 507 | 5 |
| 11 | 502 | 4 |
| 12 | 498 | 4 |
| 13 | 494 | 4 |
| 14 | 490 | 4 |
| 15 | 486 | 4 |
| 16 | 482 | 5 |
| 17 | 477 | 5 |
| 18 | 472 | 5 |
| 19 | 467 | 6 |
| 20 | 461 | 6 |
| 21 | 455 | 6 |
| 22 | 449 | 6 |
| 23 | 443 | 7 |
| 24 | 436 | 8 |
| 25 | 428 | 7 |
| 26 | 421 | 9 |
| 27 | 412 | 9 |
| 28 | 403 | 9 |
| 29 | 394 | 9 |
| 30 | 385 | 9 |
| 31 | 376 | 8 |
| 32 | 368 | 7 |
| 33 | 361 | 7 |
| 34 | 354 | 7 |
| 35 | 347 | 8 |
| 36 | 339 | 9 |
| 37 | 330 | 10 |
| 33 | 320 | 10 |
| 39 | 310 | 10 |
| 40 | 300 | 10 |
| 41 | 290 | 9 |
| 42 | 281 | 8 |
| 43 | 273 | 7 |
| 44 | 266 | 7 |
| 45 | 259 | 7 |
| 46 | 252 | 7 |
| 47 | 245 | 7 |
| 48 | 238 | 7 |
| 49 | 231 | 7 |
| 50 | 224 | 7 |
| 51 | 217 | 7 |
| 52 | 210 | 7 |
| 53 | 203 | 8 |
| 54 | 195 | 8 |
| 55 | 187 | 8 |
| 56 | 179 | 8 |
| 57 | 171 | 8 |
| 58 | 163 | 9 |
| 59 | 154 | 9 |
| 60 | 145 | 8 |
| 61 | 137 | 7 |
| 62 | 130 | 6 |
| 63 | 124 | 6 |
| 64 | 118 | 6 |
| 65 | 112 | 6 |
| 66 | 106 | 7 |
| 67 | 99 | 7 |
| 68 | 92 | 6 |
| 69 | 86 | 6 |
| 70 | 80 | 6 |
| 71 | 74 | 6 |
| 72 | 68 | 6 |
| 73 | 62 | 5 |
| 74 | 57 | 5 |
| 75 | 52 | 5 |
| 76 | 47 | 5 |
| 77 | 42 | 5 |
| 78 | 37 | 5 |
| 79 | 32 | 4 |
| 80 | 28 | 4 |
| 81 | 24 | 3 |
| 82 | 21 | 2 |
| 83 | 19 | 2 |
| 84 | 17 | 2 |
| 85 | 15 | 2 |
| 86 | 13 | 2 |
| 87 | 11 | 2 |
| 88 | 9 | 2 |
| 89 | 7 | 1 |
| 90 | 6 | 1 |
| 91 | 5 | 1 |
| 92 | 4 | 1 |
Dr. Short’s Table, from January 1st, 1728, to 1743; a Period of Fifteen Years. Died by the London Bills, at all Ages, taken at an Annual Medium, in the following Proportions.
| Years of Age. | Died. | |||
| Under | ——— | 2 | 9910 | |
| { 2 | to | 5 | 2411 | |
| { 5 | ——— | 10 | 980 | |
| {10 | ——— | 20 | 851 | |
| {20 | ——— | 30 | 2060 | |
| {30 | ——— | 40 | 2471 | |
| From | {40 | ——— | 50 | 2510 |
| {50 | ——— | 60 | 2231 | |
| {60 | ——— | 70 | 1675 | |
| {70 | ——— | 80 | 1200 | |
| {80 | ——— | 90 | 634 | |
| {90 | ——— | 100 | 117 | |
| ——— | ||||
| Total Annual Medium of Deaths in this Period }—27,058 | ||||
A Table of Thirty Years, taken from the London Bills, beginning with 1728, and ending with 1757; shewing the Total Number of Deaths and Decrease in this Period, at every Age.
| Years of Age. | Died. | |||
| Under | ——— | 2 | 272903 | |
| { 2 | to | 5 | 64745 | |
| { 5 | ——— | 10 | 25912 | |
| { 10 | ——— | 20 | 22891 | |
| { 20 | ——— | 30 | 58474 | |
| { 30 | ——— | 40 | 71502 | |
| From | { 40 | ——— | 50 | 73258 |
| { 50 | ——— | 60 | 59872 | |
| { 60 | ——— | 70 | 47269 | |
| { 70 | ——— | 80 | 33679 | |
| { 80 | ——— | 90 | 16948 | |
| { 90 | ——— | 100 | 2496 | |
| {100 | ——— | 138 | 242 | |
| ——— | ||||
| Total Deaths in this Period, at all Ages } | 750,191 | |||
Shewing the Probabilities of Life in a Country Parish in Brandenburg. Formed from the Bills for Fifty Years, from 1710 to 1759, as given by Mr. Susmilch, in his Gottliche Ordnung. One Half born lived to 25 Years of Age.
| Ages. | Persons living. | Decr. of life. |
| 0 | 1000 | 225 |
| 1 | 775 | 57 |
| 2 | 718 | 31 |
| 3 | 687 | 23 |
| 4 | 664 | 22 |
| 5 | 642 | 20 |
| 6 | 622 | 15 |
| 7 | 607 | 12 |
| 8 | 595 | 10 |
| 9 | 585 | 8 |
| 10 | 577 | 7 |
| 11 | 570 | 6 |
| 12 | 564 | 5 |
| 13 | 559 | 5 |
| 14 | 554 | 5 |
| 15 | 549 | 5 |
| 16 | 544 | 5 |
| 17 | 539 | 4 |
| 18 | 535 | 4 |
| 19 | 531 | 4 |
| 20 | 527 | 5 |
| 21 | 522 | 5 |
| 22 | 517 | 5 |
| 23 | 512 | 5 |
| 24 | 507 | 5 |
| 25 | 502 | 4 |
| 26 | 498 | 3 |
| 27 | 495 | 3 |
| 28 | 492 | 3 |
| 29 | 489 | 3 |
| 30 | 486 | 4 |
| 31 | 482 | 5 |
| 32 | 477 | 5 |
| 33 | 472 | 5 |
| 34 | 467 | 5 |
| 35 | 462 | 6 |
| 36 | 456 | 6 |
| 37 | 450 | 6 |
| 38 | 444 | 6 |
| 39 | 438 | 6 |
| 40 | 432 | 5 |
| 41 | 427 | 5 |
| 42 | 422 | 5 |
| 43 | 417 | 5 |
| 44 | 412 | 6 |
| 45 | 406 | 6 |
| 46 | 400 | 6 |
| 47 | 394 | 6 |
| 48 | 388 | 7 |
| 49 | 381 | 7 |
| 50 | 374 | 7 |
| 51 | 367 | 8 |
| 52 | 359 | 8 |
| 53 | 351 | 8 |
| 54 | 343 | 9 |
| 55 | 334 | 10 |
| 56 | 324 | 10 |
| 57 | 314 | 10 |
| 58 | 304 | 11 |
| 59 | 293 | 11 |
| 60 | 282 | 11 |
| 61 | 271 | 11 |
| 62 | 260 | 12 |
| 63 | 248 | 12 |
| 64 | 236 | 12 |
| 65 | 224 | 11 |
| 66 | 213 | 11 |
| 67 | 202 | 12 |
| 68 | 190 | 12 |
| 69 | 178 | 12 |
| 70 | 166 | 13 |
| 71 | 153 | 15 |
| 72 | 138 | 16 |
| 73 | 122 | 15 |
| 74 | 107 | 14 |
| 75 | 93 | 13 |
| 76 | 80 | 12 |
| 77 | 68 | 9 |
| 78 | 59 | 8 |
| 79 | 51 | 7 |
| 80 | 44 | 6 |
| 81 | 38 | 6 |
| 82 | 32 | 6 |
| 83 | 26 | 6 |
| 84 | 20 | 5 |
| 85 | 15 | 4 |
| 86 | 11 | 3 |
| 87 | 8 | 2 |
| 88 | 6 | 2 |
| 89 | 4 | 1 |
| 90 | 3 | 1 |
| 91 | 2 | 1 |
| 92 | 1 | 1 |
Shewing the Probabilities of Life in the Parish of Holy Cross, near Shrewsbury, in England. Formed from a Register kept by the Rev. Mr. Gorsuch for Twenty Years, from 1750 to 1770. One Half born lived to 27 Years of Age.
| Ages. | Persons living. | Decr. of life. |
| 0 | 1000 | 189 |
| 1 | 811 | 49 |
| 2 | 762 | 45 |
| 3 | 717 | 35 |
| 4 | 682 | 23 |
| 5 | 659 | 23 |
| 6 | 636 | 18 |
| 7 | 618 | 14 |
| 8 | 604 | 9 |
| 9 | 595 | 6 |
| 10 | 589 | 4 |
| 11 | 585 | 4 |
| 12 | 581 | 4 |
| 13 | 577 | 4 |
| 14 | 573 | 4 |
| 15 | 569 | 4 |
| 16 | 565 | 5 |
| 17 | 560 | 5 |
| 18 | 555 | 5 |
| 19 | 550 | 5 |
| 20 | 545 | 6 |
| 21 | 539 | 7 |
| 22 | 532 | 7 |
| 23 | 525 | 7 |
| 24 | 518 | 6 |
| 25 | 512 | 6 |
| 26 | 506 | 5 |
| 27 | 501 | 5 |
| 28 | 496 | 5 |
| 29 | 491 | 5 |
| 30 | 486 | 5 |
| 31 | 481 | 5 |
| 32 | 476 | 5 |
| 33 | 471 | 5 |
| 34 | 466 | 6 |
| 35 | 460 | 6 |
| 36 | 454 | 7 |
| 37 | 447 | 7 |
| 38 | 440 | 7 |
| 39 | 433 | 7 |
| 40 | 426 | 8 |
| 41 | 418 | 8 |
| 42 | 410 | 9 |
| 43 | 401 | 8 |
| 44 | 393 | 7 |
| 45 | 386 | 7 |
| 46 | 379 | 7 |
| 47 | 372 | 7 |
| 48 | 365 | 6 |
| 49 | 359 | 6 |
| 50 | 353 | 6 |
| 51 | 347 | 7 |
| 52 | 340 | 7 |
| 53 | 333 | 7 |
| 54 | 326 | 8 |
| 55 | 318 | 8 |
| 56 | 310 | 9 |
| 57 | 301 | 9 |
| 58 | 292 | 9 |
| 59 | 283 | 10 |
| 60 | 273 | 10 |
| 61 | 263 | 10 |
| 62 | 253 | 10 |
| 63 | 243 | 10 |
| 64 | 233 | 10 |
| 65 | 223 | 10 |
| 66 | 213 | 10 |
| 67 | 203 | 10 |
| 68 | 193 | 11 |
| 69 | 182 | 11 |
| 70 | 171 | 10 |
| 71 | 161 | 10 |
| 72 | 151 | 9 |
| 73 | 142 | 8 |
| 74 | 134 | 8 |
| 75 | 126 | 7 |
| 76 | 119 | 7 |
| 77 | 112 | 7 |
| 78 | 105 | 7 |
| 79 | 98 | 8 |
| 80 | 90 | 9 |
| 81 | 81 | 10 |
| 82 | 71 | 10 |
| 83 | 61 | 10 |
| 84 | 51 | 10 |
| 85 | 41 | 9 |
| 86 | 32 | 8 |
| 87 | 24 | 7 |
| 88 | 17 | 6 |
| 89 | 11 | 4 |
| 90 | 7 | 2 |
| 91 | 5 | 1 |
| 92 | 4 | 1 |
Shewing the Probabilities of Life in the Country District of Vaud, in Switzerland, from the Registers of Forty-three Parishes. Given by Mr. Muret, in the First Part of the Bern Memoirs for the Year 1766. In this Country Province were 112,951 Inhabitants; and one Half born lived to the Age of 41.
| Ages. | Persons living. | Decr. of life. |
| 0 | 1000 | 189 |
| 1 | 811 | 46 |
| 2 | 765 | 30 |
| 3 | 735 | 20 |
| 4 | 715 | 14 |
| 5 | 701 | 13 |
| 6 | 688 | 11 |
| 7 | 677 | 10 |
| 8 | 667 | 8 |
| 9 | 659 | 6 |
| 10 | 653 | 5 |
| 11 | 648 | 5 |
| 12 | 643 | 4 |
| 13 | 639 | 4 |
| 14 | 635 | 4 |
| 15 | 631 | 5 |
| 16 | 626 | 4 |
| 17 | 622 | 4 |
| 18 | 618 | 4 |
| 19 | 614 | 4 |
| 20 | 610 | 4 |
| 21 | 606 | 4 |
| 22 | 602 | 5 |
| 23 | 597 | 5 |
| 24 | 592 | 5 |
| 25 | 587 | 5 |
| 26 | 582 | 5 |
| 27 | 577 | 5 |
| 28 | 572 | 5 |
| 29 | 567 | 4 |
| 30 | 563 | 5 |
| 31 | 558 | 5 |
| 32 | 553 | 5 |
| 33 | 548 | 4 |
| 34 | 544 | 5 |
| 35 | 539 | 6 |
| 36 | 533 | 6 |
| 37 | 527 | 7 |
| 38 | 520 | 7 |
| 39 | 513 | 7 |
| 40 | 506 | 6 |
| 41 | 500 | 6 |
| 42 | 494 | 6 |
| 43 | 488 | 6 |
| 44 | 482 | 6 |
| 45 | 476 | 7 |
| 46 | 469 | 8 |
| 47 | 461 | 10 |
| 48 | 451 | 10 |
| 49 | 441 | 10 |
| 50 | 431 | 9 |
| 51 | 422 | 8 |
| 52 | 414 | 8 |
| 53 | 406 | 9 |
| 54 | 397 | 9 |
| 55 | 388 | 11 |
| 56 | 377 | 13 |
| 57 | 364 | 16 |
| 58 | 348 | 17 |
| 59 | 331 | 17 |
| 60 | 314 | 15 |
| 61 | 299 | 13 |
| 62 | 286 | 12 |
| 63 | 274 | 12 |
| 64 | 262 | 12 |
| 65 | 250 | 14 |
| 66 | 236 | 16 |
| 67 | 220 | 18 |
| 68 | 202 | 18 |
| 69 | 184 | 16 |
| 70 | 168 | 15 |
| 71 | 153 | 13 |
| 72 | 140 | 11 |
| 73 | 129 | 10 |
| 74 | 119 | 10 |
| 75 | 109 | 11 |
| 76 | 98 | 13 |
| 77 | 85 | 14 |
| 78 | 71 | 13 |
| 79 | 58 | 12 |
| 80 | 46 | 10 |
| 81 | 36 | 7 |
| 82 | 29 | 5 |
| 83 | 24 | 4 |
| 84 | 20 | 3 |
| 85 | 17 | 3 |
| 86 | 14 | 3 |
| 87 | 11 | 2 |
| 88 | 9 | 2 |
| 89 | 7 | 2 |
| 90 | 5 | 1 |
The two following Tables are taken from Dr. Price. I have however omitted the fractions, for reasons which shall be explained when treating of the inaccuracy of the public registers. The expectations of life are here rated a few years inferior to the standard of most other authors.
The probable Expectations or Prospects of Life in
| Ages. | London. | Vienna. | Berlin. | Country parish of Brandenburg. | Holy Cross, near Shrewsbury. | Pais de Vaud, in Switzerland. | |||||||
| At birth | 18 | yrs. | 17 | yrs. | 18 | yrs. | 33 | yrs. | 33 | yrs. | 37 | yrs. | |
| Age | 12 | 34 | 36 | 36 | 44 | 44 | 44 | ||||||
| 25 | 26 | 28 | 27 | 36 | 35 | 35 | |||||||
| 30 | 24 | 26 | 25 | 32 | 32 | 31 | |||||||
| 35 | 22 | 23 | 24 | 26 | 28 | 28 | |||||||
| 40 | 20 | 21 | 21 | 25 | 26 | 24 | |||||||
| 45 | 18 | 18 | 19 | 22 | 23 | 21 | |||||||
| 50 | 16 | 16 | 16 | 18 | 20 | 18 | |||||||
| 55 | 14 | 14 | 14 | 15 | 17 | 15 | |||||||
| 60 | 13 | 12 | 13 | 12 | 15 | 12 | |||||||
| 65 | 11 | 10 | 11 | 10 | 12 | 10 | |||||||
| 70 | 9 | 9 | 9 | 8 | 10 | 8 | |||||||
| 75 | 7 | 7 | 7 | 6 | 8 | 6 | |||||||
| 80 | 5 | 6 | 6 | 5 | 5 | 5 | |||||||
The Odds or Probability of living ONE Year in
| Ages. | London. | Vienna. | Berlin. | Country parish of Brandenburg. | Holy Cross, near Shrewsbury. | Pais de Vaud, in Switzerland. | |||||||
| At birth | 2 | to 1 | 2 | to 1 | 2 | to 1 | 4 | to 1 | 5 | to 1 | 5 | to 1 | |
| Age | 12 | 75 | to 1 | 84 | to 1 | 123 | to 1 | 112 | to 1 | 144 | to 1 | 160 | to 1 |
| 25 | 56 | to 1 | 66 | to 1 | 50 | to 1 | 110 | to 1 | 100 | to 1 | 117 | to 1 | |
| 30 | 45 | to 1 | 56 | to 1 | 44 | to 1 | 107 | to 1 | 96 | to 1 | 111 | to 1 | |
| 40 | 31 | to 1 | 36 | to 1 | 32 | to 1 | 78 | to 1 | 55 | to 1 | 83 | to 1 | |
| 50 | 24 | to 1 | 27 | to 1 | 30 | to 1 | 50 | to 1 | 50 | to 1 | 49 | to 1 | |
| 60 | 18 | to 1 | 19 | to 1 | 18 | to 1 | 25 | to 1 | 26 | to 1 | 23 | to 1 | |
| 70 | 12 | to 1 | 11 | to 1 | 12 | to 1 | 11 | to 1 | 16 | to 1 | 10 | to 1 | |
| 80 | 7 | to 1 | 7 | to 1 | 7 | to 1 | 6 | to 1 | 8 | to 1 | 4 | to 1 | |
Having in the preceding part endeavoured to establish the mortality of the human species at different ages, I am now to attempt a more arduous task; to ascertain the mortality by different diseases. I propose therefore, in imitation of the geographers, to spread out and to review, in one general Chart, the enormous host of diseases which disgorge their virulence over the earth, and, with frightful rapacity, wage incessant hostilities with mankind. By this means, we shall, to use a military phrase, reconnoitre more distinctly our enemies arranged in hostile front; and be warned to make the best disposition and preparation for defence where the greatest danger is apprehended, and the most formidable assaults to be sustained. Armed with diseases, the grim King of Terrors appears in the most hideous aspect. Under all these predatory disguises and morbifick forms, I shall track him grappling with mankind, and with his tremendous scythe mowing down generations. The learned Sauvages thus expresses himself: “Utinam numerus respectivus diversorum morborum a nostratibus inquirarentur.” It is, in some measure, from ignorance in this subject, that the streams of medical inquiries, of academick rudiments, and of charitable donations to poverty in disease, have not yet been pointedly directed to publick utility.
I could easily have exhibited tables of the Diseases and Casualties in London during the greater part of the last century. But, compared to its present magnitude, the British metropolis was then insignificant in size: 23 new parishes have been since gradually added to the London bills: there is also a chasm of 10 years in which the registers are lost. Again, until 1665 and 6, London was infested with the plague; which disease, previous to that date, seems to have been one primary object of the registers: and to adopt Graunt and Short’s sentiments, these records, from various political and religious obstacles, were then very negligently managed. During the early part of this interval, the kingdom was distracted with civil war; and after the great pestilence in 1665, London must have required some years to recruit. Besides, had I attempted to form tables for even the latter part of the last century, the reader would have been fruitlesly embarrassed; and such an attempt must ever prove abortive. For example, under one and the same title, in the annual bills of mortality, are often confounded flox, small pox, and measles: consumptions and tissick: cancer, canker, and thrush: wolf, cancer, gangrene, and fistula: cancer, gangrene, fistula, and mortification: gout and sciatica: vapours and water in the head: quinsey and thrush: teeth and worms: sores, ulcers, bruised and broken limbs: cough, cold, and chincough, &c. These are a few specimens of Nosological absurdity in the superintendents of the publick registers.
Notwithstanding this rabble of diseases in commenting upon the London bills and diseases of the present century, I constantly refer back, and contrast them with the bills of the last thirty years of the preceding century; so that, as near as the imperfection of the materials will admit, the mortality and diseases of 105 years in London is presented at one view; and comprehends the various acute and chronic diseases, by which about two million and a half of the human species have been destroyed. The few authors who have written on bills of mortality, have obscured their works in a cloud of figures and calculation: the reader must have no small portion of phlegm and resolution to follow them throughout with attention: they often tax the memory and patience with a numerical superfluity, even to a nuisance.
For the above, and many other reasons, I have compressed into one chart, the London Diseases and Casualties of seventy-five years in the present century: each disease and casualty arranged in a progressive series of fifteen years mortality; in a fifth column is added together the mortality of the preceding five divisions. During this period, London has been more populous and stationary in numbers: and by this means, the actual and comparative magnitude, rise, and declension of different diseases, will be more conspicuous in each period or interval: and by measuring the mortality with the population, we are enabled, with certain precautions and exceptions, to make the diseases and casualties of London serve as a morbid barometer to the whole nation. The important reason which determined me in forming an arrangement of fifteen years, in preference to any other number or period, was, that the annual havock by similar diseases and casualties, throughout this and the neighbouring island, might be computed with some probability by each fifteen years of the London bills; and thereby to elicite a new, curious, and comprehensive proportion in medicine. For instance, if we suppose the standing number, on an average, of the London inhabitants at six hundred thousand; and the total inhabitants in Britain and Ireland at nine million; and if the same diseases and casualties were equally diffused and fatal to this whole community, then, in such case, the London bills would serve as a scale or index of mortality to both kingdoms: as many would die annually of every disease and casualty throughout nine million, as are cut off in fifteen years in London; for six hundred thousand multiplied by fifteen, amounts to nine million.
But to supply the probable deficiency in the annual mortality of London by different diseases and casualties, we must make an addition to each of one third or fourth. To the mortality of Small-Pox, in London, during fifteen years, and rated at thirty thousand, we should add one third or fourth more to raise it to its just standard; that is, to about thirty-eight thousand; which would be the annual mortality amongst nine million in Britain and Ireland, supposing small-pox equally universal, one time or other, and destructive. By the same hypothesis, amongst two hundred million in Europe Variolous mortality annually, would amount to four hundred thousand; and, amongst eight hundred million; that is, the whole human race would exceed three million annually. On this simple principle, a gross estimate may be formed of the annual havock by every other disease and casualty; taking the precaution, however, to attend to the subsequent criticisms on the London bills.
Another curious corollary may be grounded on the above hypothesis; which is, to form a probable conjecture of the numbers who are annually Sick, or afflicted with different diseases. Example: if one of every seven die of the Small Pox, and the variolous deaths throughout Britain and Ireland are rated at thirty-eight thousand annually, this number, multiplied by seven, amounts to two hundred and sixty-six thousand annually, infected with variolous contagion. Apply the same rule to Childbed mortality; rate the annual havock by parturition in the two islands at four thousand: it will hereafter be shewn, that in London one of seventy-four women die in childbed: multiply therefore 4,000 by 74, the product is 296,000, which, in reality, cannot be very distant from the total annual procreation in both islands. And in these two examples, I have suggested what may be termed an inverse proof of both propositions. From these tables and commentaries, we are likewise furnished with a key to the comparative mortality of each disease amongst a community: whether its devastation is in the proportion of a fifth, tenth, twentieth, or hundredth. Gentlemen who have not particularly attended to the subject of morbid calculations (and very few of the medical profession have) will, on better information, be astonished at the flagrant errors daily committed by authors when treating of these topicks. Out of the many examples which might be enumerated, I shall merely select one in proof. Baron Dimsdale, in a Treatise on Inoculation, dedicated to the present Empress of Russia, calculated that, at least, two million were annually destroyed by Small Pox alone in the Russian empire; and it was not until after the publication of my Observations on his different Inoculating Essays, that this error and others were erased.
I would request the reader’s particular attention to another circumstance: which is, that on comparing the gradations of mortality in the following chart, we are not to estimate the relative number, frequency, or proportion of certain diseases, compared to others by the absolute mortality of each. For instance, Apoplexy kills rather more annually in London than Measles; but yet the latter disease is infinitely more universal and diffused amongst the community, and consequently less dangerous to life: Cancerous and Venereal cases are widely different in the annual number afflicted with each, although the deaths are not far distant from an equality. The same observations will apply to Rheumatism, compared to the Dropsy, and to many other diseases.
There are between eighty and ninety diseases and casualties enumerated in the London bills, which, in the subsequent comments, I have disentangled into their separate genera. But, to prevent the possibility of aberration, after the chart of London diseases, I have added a correct Medical Chart of all the principal diseases and casualties with which mankind, in every part of the earth and ocean, are afflicted or harrassed. This will operate as a check and correction to the public registers; and by this, the defects and errors in the London bills will be apparent; and it will serve as an index to our future commentaries. But objections and difficulties occur in our researches for collateral information and illustration from hospital records. The reasons are glaring, why, in the latter, diseases should be less fatal; and in this respect, cities should have the advantage of the country. We cannot therefore apply hospital registers as a general criterion to a nation. Whenever authentic and systematic records of diseases, recovery, and mortality, are kept in hospitals, domestick as well as military, and annually published, whatever may be alledged respecting the importance and demerits of such institutions, the community, at all events, will derive much useful information.
[A CHART of all the Fatal Diseases and Casualties in London, during 75 Years;]
Beginning from 1701, and ending with 1776.
Collected from the London Bills of Mortality, and arranged into Five separate progressive Periods of Fifteen Years each.
The Total Amount of the Five Periods, or Seventy-five Years Mortality, is added together in the Sixth Column.
| DISEASES AND CASUALTIES. | Fifteen Years, from 1701 to 1717. | From 1717 to 1732. | From 1732 to 1747. | From 1747 to 1762. | From 1762 to 1777. | Total Amount of Seventy-five Years Mortality, from 1701 to 1777. |
| Ague | 80 | 198 | 82 | 99 | 109 | 574 |
| Fevers. Malignant, Spotted, Scarlet, and Purple | 50,955 | 53,330 | 57,995 | 45,621 | 48,594 | 256,085 |
| Small Pox | 22,219 | 34,448 | 29,462 | 29,165 | 36,276 | 151,570 |
| Measles | 1,972 | 2,618 | 2,858 | 3,099 | 3,319 | 13,866 |
| Quincy, Sore Throat | 226 | 169 | 287 | 306 | 309 | 1,297 |
| Pleurisy | 384 | 602 | 811 | 407 | 321 | 3,525 |
| Rheumatism | 368 | 447 | 310 | 175 | 128 | 1,468 |
| Gout | 313 | 645 | 769 | 803 | 1,010 | 3,236 |
| Consumption | 42,541 | 49,680 | 66,009 | 61,749 | 68,949 | 288,928 |
| Chin Cough, Hooping Cough, Cough | 116 | 632 | 1,692 | 2,755 | 4,252 | 9,573 |
| Asthma and Tissick | 5,090 | 7,938 | 9,460 | 5,699 | 6,154 | 34,341 |
| Apoplexy and Suddenly | 2,228 | 3,013 | 3,287 | 3,271 | 3,353 | 15,152 |
| Palsy | 332 | 550 | 621 | 1,021 | 1,020 | 3,544 |
| Lethargy | 105 | 126 | 116 | 105 | 74 | 526 |
| Meagrims | 13 | 10 | — | — | — | 23 |
| Headach | 21 | 32 | 6 | 18 | — | 77 |
| Lunatick | 412 | 513 | 777 | 1,126 | 1,048 | 3,876 |
| Spleen and Vapours | 53 | 52 | 20 | — | — | 125 |
| Rising of the Lights | 1,219 | 1,239 | 197 | 30 | 10 | 2,074 |
| Stoppage of the Stomach | 4,139 | 2,557 | 2,286 | 304 | 179 | 9,465 |
| Vomiting and Looseness | 820 | 682 | 248 | 134 | 120 | 2,004 |
| Cholic, Gripes, and Twisting of the Guts | 13,668 | 11,032 | 3,739 | 1,475 | 796 | 29,710 |
| Flux | 178 | 200 | — | 252 | 341 | 971 |
| Bloody Flux | 133 | 248 | 167 | 94 | 93 | 745 |
| Worms | 697 | 662 | 161 | 115 | 56 | 1,691 |
| Jaundice | 1,261 | 1,798 | 2,032 | 1,729 | 2,089 | 8,909 |
| Gravel, Stone, and Strangury | 789 | 868 | 700 | 421 | 429 | 3,205 |
| Diabetes | 37 | 48 | 19 | 16 | 5 | 125 |
| Dropsy and Tympany | 11,626 | 15,430 | 16,036 | 13,410 | 14,038 | 70,506 |
| Livergrown | 76 | 95 | 75 | 23 | — | 269 |
| French Pox | 917 | 1,372 | 1,663 | 997 | 1,016 | 5,965 |
| Scurvy | 63 | 28 | 14 | 59 | 42 | 226 |
| Evil | 1,020 | 519 | 426 | 197 | 198 | 2,360 |
| Leprosy | 19 | 53 | 69 | 39 | 15 | 1,915 |
| Rash | 77 | 128 | 47 | 59 | 24 | 341 |
| Itch | — | — | 42 | 31 | 11 | 84 |
| Childbed | 3,560 | 3,894 | 3,412 | 3,005 | 3,186 | 17,057 |
| Abortion, and Stillborn | 8,746 | 10,231 | 8,793 | 8,820 | 10,241 | 46,831 |
| Chrisoms and Infants | 850 | 315 | 606 | — | — | 1,771 |
| Miscarriage | — | — | 47 | 56 | 49 | 152 |
| Convulsions | 91,660 | 114,718 | 111,966 | 85,196 | 89,221 | 492,761 |
| Headmold-shot, and Water in the Head | 609 | 2,374 | 2,013 | 1,022 | 337 | 6,355 |
| Teeth | 18,478 | 25,199 | 20,274 | 13,978 | 11,918 | 89,847 |
| Thrush | 839 | 1,191 | 1,512 | 1,391 | 1,101 | 6,034 |
| Scald Head | 9 | 15 | 29 | 22 | — | 75 |
| Rickets | 3,916 | 1,383 | 954 | 112 | 104 | 6,569 |
| Inflammation | 8 | 67 | 698 | 894 | 1,394 | 3,061 |
| Imposthume | 790 | 694 | 387 | 191 | 84 | 2,130 |
| St. Anthony’s Fire | — | 73 | 36 | 63 | 69 | 241 |
| Gangrene and Mortification | 1,071 | 2,857 | 3,362 | 3,083 | 3,023 | 13,438 |
| Canker | 138 | 181 | 123 | 77 | 61 | 580 |
| Cancer | 1,041 | 1,059 | 774 | 682 | 719 | 2,475 |
| Sores and Ulcers | 695 | 485 | 402 | 253 | 236 | 2,071 |
| Fistula | 360 | 202 | 210 | 134 | 119 | 1,025 |
| Bursten and Ruptures | 310 | 309 | 304 | 163 | 140 | 1,226 |
| Swelling and Wen | 6 | — | 47 | 49 | 37 | 139 |
| Killed by Falls, Bruises, Fractures, and other Accidents | 828 | 917 | 926 | 1,084 | 1,065 | 4,820 |
| Self-Murder | 445 | 667 | 693 | 555 | 509 | 2,869 |
| Murdered | 135 | 109 | 147 | 71 | 77 | 539 |
| Stabbed, Killed, Wounded, Shot, &c. | 15 | 32 | 13 | — | — | 60 |
| Executed | — | — | 495 | 495 | 1,020 | |
| Drowned | 907 | 1,193 | 1,444 | 1,718 | 1,781 | 7,043 |
| Burnt | 90 | 54 | 90 | 127 | 132 | 493 |
| Scalded | 19 | 36 | 45 | 51 | 40 | 191 |
| Stifled, Suffocated, and Smothered | 13 | 34 | 62 | 90 | 68 | 276 |
| Overlaid | 817 | 1,180 | 1,293 | 414 | 95 | 3,799 |
| Found dead | 388 | 557 | 668 | 336 | 133 | 2,082 |
| Grief | — | 267 | — | 87 | 77 | 421 |
| Frightened | 8 | 14 | 8 | 13 | 2 | 45 |
| Surfeits | 685 | 131 | 59 | 31 | 27 | 933 |
| Starved | — | 17 | 96 | 53 | 57 | 223 |
| Excessive Drinking | 19 | 267 | 678 | 189 | 69 | 1,222 |
| Bleeding | 87 | 69 | 57 | 70 | 114 | 397 |
| Poisoned | 2 | 7 | 7 | 24 | 10 | 40 |
| Bit by Mad Dogs and Cats | — | 3 | 14 | 15 | 6 | 38 |
| Bedridden | — | 104 | — | 56 | 105 | 265 |
| Aged | 27,341 | 34,708 | 30,058 | 25,109 | 22,032 | 139,248 |
A MEDICAL CATALOGUE of all the principal Diseases and Casualties by which the Human Species are destroyed or annoyed.
Fevers. Intermittent, quotidian, tertian, quartan, species and varieties.
—— Remittent, Continued, and Eruptive; remittent, and the species, nervous and putrid, miliary, inflammatory, small pox natural and inoculated, measles, scarlet fever, some cutaneous eruptions, mixed and anomalous fevers, plague, sweating sickness.
Fevers with topical inflammation of the brain, of the fauces, including angina inflammatory and putrid, pleurisy, and peripneumony, inflammations of the heart, diaphragm, liver, spleen, stomach, intestines, kidneys and ureters, bladder, peritoneum, erysipelas, acute and chronic rheumatism, regular and irregular gout. Internal suppuration and gangrene.
Injured respiration and coughs, catarrh, pulmonary hæmorrhage, pulmonary consumption, hectick, atrophy and tabes, asthma, hooping cough, croup.
Natal hemorrhage, headach, nightmare, lethargy, vertigo, apoplexy, epilepsy, fainting, resemblance of death from drowning, foul air, &c. palpitation of the heart, internal polypus and aneurism, tetanus and locked jaw, catalepsy, spasm, cramp, Saint Vitus’s dance, tremor, palsy, berbiers, insanity furious and melancholy, hypochondriasm.
Diseases of the sight, hearing, smell, taste, voice, and speech, sterility of the sexes, morbid irritability of the genitals, diseases of the teeth, deglutition obstructed.
Diseases of the stomach, and of the complex organization, subservient to appetite and digestion, gall-stones, jaundice, cholera, dysentery, diarrhœa, cholick, worms, tenesmus, costiveness, hemorrhage from the stomach and anus.
Morbid symptoms and diseases from various poisons, canine madness, venomous bites and stings.
Obstruction and suppression of urine, stone in the bladder, diabetes and incontinence of urine, ulcers of the kidney and bladder, bloody urine.
Watery effusions, or dropsies of the head, spine, chest, pericardium, external cellular membrane, abdomen, ovarium, fallopian tubes, womb, scrotum, tympany, corpulency, and excess of fat.
Venereal disease, scurvy, scrophula, leprosy, yaws, itch; several chronic cutaneous defedations, morb. pedicul.
Female Diseases. Obstruct. mens. chlorosis, excessive menstr. fluor alb. hystericks, pregnancy, parturition, natural, laborious, preternatural, and complex, some diseases during pregnancy, abortion and miscarriage, uterine hemorrhage, fainting, convulsions, lochial excess and suppression, uterine inflammation, puerperal fever, after-pains, weed, milk fever, inflammation of the breast, excess and defect of milk.
Infant Diseases. Convulsions internal spasms, dentition, rickets, thrush.
N. B. Vomiting, diarrhœa and watery gripes, hectick and atrophy, small pox, measles, rash, hooping cough and worms, dropsy of the head and spine, are before described, under their respective titles.
Internal schirrus affecting various parts, the lungs, stomach, intestines, liver, spleen, kidneys, ovaria, womb, testicles; also internal cancer, external scirrhus and cancer.
External inflammation, suppuration, gangrene, burns, wounds, and contusions, fractures simple and compound, luxations and sprains, herniæ, or ruptures, abscess and ulcers, white swelling, spina ventosa, external aneurism and varix, polypus of the nose, fauces, vagina, womb, wens, bronchocele, corns, warts, chilblains.
An abstract of the general causes of diseases and mortality, of the seasons and elements, food and drink, excretions and secretions, exercise and rest, sleep and waking, passions of mind, venery.
An abstract of mortality in various domestic and military hospitals.
The Poet has, in just and emphatical language, stiled health the vital principle of bliss. In the rude state of science and medicine, and in the ages of superstition and credulity, it was usual to ascribe diseases to the immediate resentment of some invisible demon, or to divine displeasure and chastisement; on which account, in barbarous nations, their physicians have been a set of stupid conjurors. Two centuries have barely elapsed, since the people of England could, with difficulty, be persuaded that the jail distemper, communicated at the Oxford assizes, from the prisoners to the spectators, was not kindled up by witchcraft and necromancy: but learning and philosophy have now discarded such supernatural agents. Others again equally err, in supposing diseases to be unsteady motions of the human machine, excited by something hurtful. This popular error seems to originate from confounding diseases themselves with the versatility of medical remedies and practice. Beyond a doubt, diseases are presented to us, over and over again, in nearly the same form and shape: the diseases delineated two thousand years ago by Hippocrates, at this day retain the same essential marks and prominent features; tho’ in degree and violence, there are many gradations and shades to vary the picture.
A disease, in the pathological language, is when one or more of the various corporeal or mental functions, cannot be performed as in usual health. The symptoms of all diseases are indicated by few or many derangements of the corporeal functions, of the excretions, and of the sensible qualities: such are pain, disagreeable sensation, anxiety, irritation internal or external; the exercise of some of the external or internal senses impeded; of sleep and waking; of the muscular or moving fibres; of the digestive and intestinal functions: of the lacteal, lymphatic, or absorbent system; of the respiration, sanguiferous circulation, and arterial pulsation; of the different excretions and secretions, the feces, urine, perspiration, bile, pancreatic fluid, saliva, milk, menses, semen, mucus, oil, lymph, by extravasated blood: by the countenance, actions, gestures, debility, strength, heat, colour, smell, taste, magnitude, hardness, softness, the nature and appearance of the excretions, &c. I studiously avoid all minute pathological discrimination of symptoms; as symptoms of the disease, of the cause, of symptoms, of reacting nature; of primary, pathognomic, accidental, and accessary symptoms. Nor in briefly enumerating the various causes of diseases, shall I waste time in the explanation of what may be learned from pathological systems and vocabularies: such as the technical distinction of causes into external and internal, predisponent, exciting and occasional, remote and proximate.
There is both fiction and much truth in the warbling melody of the Roman poet: “Post ignem etherea domo subductum macies, et nova febrium cohors incubuit terris.” Consumptions and Fevers we see, by arithmetical demonstration, are amongst the most universal and fatal maladies of our metropolis and Island. I begin this morbid survey with the latter. The principal and most general febrile epidemicks which infested England during two intire centuries, are enumerated in a short abstract, by Dr. Short; and consist of plagues, agues, remittent fevers, summer and autumnal dysenteries, spotted putrid fevers, slow fevers, small pox, measles, putrid and contagious peripneumonies, fatal spring pleurisies, and peripneumonies, and epidemical catarrhs. Throughout all countries, in epidemical diseases, there are years when they are more or less prevalent. Great national calamities, from this source, are rare: none ever inundate a whole kingdom (catarrh in some instances excepted): they sometimes indeed spread from one province to another, but all the community are never attacked at once; nor are large populous kingdoms, or even cities, totally exempt from them. Fevers of various generic forms, as intermittent, remittent, nervous and putrid, scarlet, small-pox, measles, &c. may be local and circumscribed to one city or district, whilst others in the vicinity, continue at the same time healthy; the disease dissipating its virulence within a small boundary. From a comparison of 150 different parish registers, Dr. Short calculates, that within a certain period, some have had 8 to 14 sickly years, and others, in the same interval, only one. He estimates 5, 6, and 8 years interval, as a common rotine of irruption by some epidemical distemper, even in remote country parishes: and a few of them have been so fortunate as to escape any uncommon or remarkable mortality during 11, 12, or even 20 and 30 years. In all the seasons denominated sickly in the country parishes, the burials exceeded the christenings; and according to the nature of the epidemick, the morbid state of the seasons, the medical treatment, and many other circumstances, the gradations of mortality, even by the same disease, were extremely various.
Collating the annual average of deaths in a sickly year of London, and other great cities, with sickly years in the country parishes, Dr. Short found, that cities and towns, in this respect, have the advantage of the country. In spacious open country districts where fatal epidemicks burst out, according to this author, more died in one year than during 6, 10, 12, or sometimes 15 healthy years: whereas, says he, in London, and such other cities, not above one third, fourth, or fifth beyond the ordinary consumption are swept away. Pestilential mortality is a solitary exception to this proportion. In the London bills we may frequently observe, that in different months, the deaths are double or treble above equal periods of the same year: but during the present century, I find no instance of triple, very rarely of double excess in the annual London burials. Dr. Short adds, that mortality is more constant and regular in cities, and not so many destroyed “per saltum” from raging epidemicks, as in the country. In pure open air, he suggests, that contagion and infection, or other adulterated effluvia, are more virulent. Or perhaps he should have said, or at least have added, that in cities where the atmosphere is charged with a load of smoke, and other heterogeneous vapours, epidemical poisons may be blunted, decompounded, or annihilated; that likewise in cities, human bodies are more early seasoned and habituated to such noxious external impressions, and, like doctors and nurses, are in some degree fortified by habit: that besides, in every large metropolis, small-pox, measles, and, some other febrile epidemicks, are almost constant residents; and consequently the devaluation from these diseases is more regular and equal than in the country, where several years intervene between their invasions.
The absolute mortality by fevers in the London bills, without including the small pox and measles, amounts to nearly one seventh of the whole funeral catalogue. In the London dispensaries, the Aldersgate and Westminster, and in the Newcastle hospital, fevers were a fourth and sixth to all other diseases. De Haen computes, that out of two thousand sick, admitted into the hospitals in Vienna, seven hundred of them laboured under acute and febrile diseases. Dr. Cleghorn estimates the summer fevers in that warm Mediterranean island Minorca, as constituting three-fourths of all the diseases in that island. Dr. Lind calculates, that nineteen out of twenty of all the numerous Europeans who visit the sultry climates of Africa, America, and of the East and West Indies, are destroyed by intermittent, remittent fevers, and fluxes; and probably he also should have added, or by chronic diseases and broken constitutions, the consequence of those fevers. In the London bills of mortality, many different genera of fevers are crammed into one indiscriminate heap, from which it is impossible to extricate the specific nature or genus of febrile carnage. I was anxious to determine with some probability, the ratio of desolation in London, by each of the different febrile genera: because it would be an important guide to the prevention and cure. I knew that most of our hospital registers were in this particularly defective; on that account I was favoured by a medical friend, with the perusal of the books of the Aldersgate dispensary. But although no gentlemen are better qualified to discriminate diseases, I perceived, on inspection, that too often the genus of fevers was not marked, only by the general outlines of the class. However, I converted this scrutiny to some other use, as will hereafter appear.
We shall first trace the prominent features of the general febrile Class, descending progressively through the different Orders and Genera. In most fevers, of whatsoever genus, one or more of the following symptoms occur: shivering, chilliness, and heat of the skin alternating: the circulation of the blood, and consequently of the pulse, as felt at the wrist, accelerated more than in the natural state; in adults, to upwards of 96 strokes every minute; and in infants, is considerably more increased in velocity: also general languor, lassitude, and debility of the nerves and muscles; dryness of the mouth and tongue, thirst; little or no sleep, or disturbed and not refreshing, and generally headach: in most of the continued and remittent fevers, there is total suspension of appetite, sickness at the stomach, nausea and vomiting; increased heat of the skin, at least burning sensation; aversion to motion; the sick are mostly confined to bed, unable to walk, or frequently even to sit erect; and this is commonly the case, even in the intermittent genera during the febrile paroxism: the remittent and continued have usually an evening or nocturnal febrile exacerbation: the voice and countenance frequently express condolence: and in the genera of topical inflammations, there is fixed pain in the different parts affected.
Intermittent Fevers,
or Agues, notwithstanding their febrile type, fall under the Chronic class. They are usually distinguished into different genera, or types; into Quotidian, Tertian, Quartan, with their separate species and varieties. It would seem, by the London registers, that very few die of agues, from which no age is exempted, but to which adults are much more obnoxious. Intermittent havock, if not immediately, yet in its chronic effects, is far more fatal than the London bills represent. Towns in general, it is true, are less harrassed with agues than country places. Pringle remarks, that during the campaigns of the British troops in the marshy countries of Holland and Flanders, where, in all such climates, and in damp soils and situations, agues and remittent fevers are epidemick, that the soldiers quartered in towns were less afflicted than those stationed in country cantonments: that in the former, the fires, sewers, drains, and paved streets, prevented an exuberance of moisture: and that, if the men slept in the upper floors of the house, they were still more secure from damp and intermittent sickness.
The invasion of Intermittent Paroxisms, is during certain periods only, and generally consists of a successive series of shivering and cold, burning heat, and profuse sweats: and exhibits the fundamental outlines of all fevers. Intermittent paroxisms, and consequently the genera and species, vary in duration, in recurrence, and in the symptoms. Quotidians, Tertians, and Quartans, consist of paroxisms, at the respective intervals of 24, 48, and 72 hours. An interval denotes the length of time from the beginning of one paroxism to the next succeeding: an intermission the vacation between paroxisms. Other distinctions, perhaps too refined, are made of intermittents, as Quintanæ, Septiminæ, Decimanæ, Erraticæ, Vagæ. Each of the three primary intermittent genera, are likewise subdivided into duplex and triplex. The double tertian is a very universal form, but may be referred to remittents: it implies that every other or second day the paroxisms are similar, but different in the intermediate days. Again, the type of intermittents is often obscured under a cloud of irregular and adventitious symptoms; and from one predominant symptom, or from similarity to various other diseases, these three fundamental genera are split by Nosologists into other species and varieties; the Quotidiana or intermittens, into simplex, cephalalgia, ophthalmica, nephralgica, stranguriosa, ischiadica, sputatoria, catarrhalis, anginosa, epileptica, hysterica, partialis: the Tertiana into simplex, hemitritæa, duplex, triplex, pleuritica, asthmatica, arthritica, emetica, hysterica, apoplectica, urticata, and other species of double tertian enumerated under the remittent type: the Quartana into cataleptica, epileptica, hysterica, maniaca, comatosa, nephralgica, splenetica, arthritica.
The three stages of intermittent fevers, during their periodical revolution, affect, more or less, the brain and nerves, the inherent muscular power, the heart and arteries, the stomach and intestines, and the sensible qualities of the body; the symptoms usually succeeding in the following progressive order: languor, sluggishness, debility, impaired sensibility, sometimes drowsiness and coma, oscitation, sensation of coldness in the back and spine, overspreading the body and extremities; accelerated and weak pulse; laborious respiration with anxiety; impaired appetite, and often sickness, nausea, and vomiting of bile; thirst; limpid urine; pale face, extremities, and trunk, and cutaneous collapse; rigor and trembling of the extremities and trunk, and gnashing of the teeth, as if cold water was poured on the body. This stage is various in duration in different persons, and in the different intermittent types. Nature at length rallies its powers with success, and with the expulsion of the cold, the second or hot stage is kindled up with undulating flushes of heat, and its preternatural increase over the body; the cutaneous blood vessels are dilated with suffusion of the countenance, redness, and burning heat; the pulse becomes strong, full, and more regular; the respiration continues oppressed, and is accelerated; with headach, throbbing of the temporal arteries, and sometimes delirium. After some continuance of this febrile struggle, and tumultuary rage of the re-acting organs of sensation and motion, the third stage of sweat is introduced by some moisture oozing throughout all the cutaneous pores, and poured out often in profuse streams: with this the heat of the body, the pulse, respiration and appetite become more natural; the urine less transparent deposits a sediment; the febrile tempest abates to a calm; and the body recovers the exercise of all its usual functions. Sometimes indeed there are varieties; such as little or no cold stage, or sweat.
Intermittent paroxisms are always terminated in less than twenty-four hours. Quotidians have the least cold stage, but the longest paroxism: tertians are in the intermediate degree in both respects; quartans have the most violent, or at least the longest cold stage, but the shortest paroxism: their cold stage may be two hours, or longer. The hot and sweating stages therefore constitute the greatest portion of intermittent conflict. Quotidian paroxisms rarely exceed eighteen hours: tertians are from six to twelve: quartans somewhat shorter. Quotidians generally assault in the morning; tertians and quartans in the noon and afternoon. Vernal are said not to be so refractory as autumnal intermittents. But in young sound constitutions, agues, if not inveterate, are frequently cured after a few paroxisms. When death happens in them, it is generally during the cold stage. More frequently their fatality is by transition into some other chronic diseases: such as maladies of the stomach, digestive organs, liver, and intestinal tube; bilious cachexy, jaundice, consumptions, dropsy. Some inveterate corporeal infirmities have been relieved by intermittents. During their revolution the type is frequently changed: quartan and tertian into quotidian: the latter into remittent; and these into continued fever.
Remittent Fevers:
fevers with remissions and exacerbations, or which have not a temporary and total cessation, are the most universal febrile form in all parts of the globe. Throughout the equatorial oven, or middle regions of the earth, from Cancer to Capricorn, intermittents, but, above all, remittents and dysenteries are the most universal type of fever. They are the locusts which devour whole crops of mankind. During the periodical rainy seasons of the tropical zones; particularly where they are choaked up with woods and morasses, and in uncultivated new settlements, these fevers often ravage with the desolation of an Egyptian pestilence; and are sometimes so precipitate as to kill in one or two paroxisms, if not sooner repulsed; the doctor, lawyer, and priest quickly succeeding each other in their visits. They destroy not only multitudes immediately, especially of the new European settlers; but when improperly treated, or when convalescents from irregularity, fall back into relapses, they often terminate in fatal chronic diseases, similar to those recently enumerated under the intermittent train.
Not only within the tropicks, but likewise through the northern hemisphere, to the verge nearly of the polar circles, we can descry this remittent febrile host. In the sultry summer and autumnal seasons of Europe, in low marshy countries, soils and situations such as Italy and Hungary, where the summers are long and intense; and in that northern morass, Holland, these are the epidemical tyrants. Armies encamped are often at that season grievously infested with them, and with dysenteric fluxes. In Britain and Ireland also, they are frequent and fatal epidemicks; and are not confined to the summer season only. Even in most dry countries and situations without the tropicks, after an unusual close sultry summer, with long protracted heats, we often see, or read of, such fevers and fluxes. The humours then, says Pringle, are corrupted, the solids relaxed; and in such a disposition of body, irregularities in diet, wet cloaths, and damp air, may give activity to such latent indisposition. In that small southern Mediterranean island, as described by Cleghorn, where the soil is rocky, but the summer heats excessive, such fevers have raged with atrocious severity.
Fevers intermittent and remittent, and those strictly simple inflammatory, are greatly regulated, not only by the climate, latitude, soil, local elevation or depression, but also in the same country by the different seasons of the year. In summer and autumn, fevers tend in various degrees to affect the stomach and intestines with sickness; they are then, more or less remittent, and participate less of the inflammatory. “In Holland,” continues Pringle, “towards June, a healthy month, the inflammatory fevers begin to recede; and the remittent, bilious, and putrid often succeed throughout the summer and autumn, until the return of winter, when the inflammatory again recommence; the seasons and diseases insensibly interchanging and running into each other.” We may also add, that in all warm climates there is a copious and superabundant secretion of bile; and that none of the animal fluids so soon turn putrid. They are more obnoxious to remittent fevers who are constantly exercised in labour and fatigue, and exposed to the external air, than other ranks who are comfortably accommodated, cloathed, and fed. Pringle remarks, that the peasants of Holland were always greater sufferers by the summer, autumnal, and remittent fevers, than those of the more opulent class; and also, that during summer and winter, in the field and in garrison, the private soldiers were more sickly than the officers, and liable to fevers.
Remittent fevers seem to consist of a repetition of protracted diurnal paroxisms, or periodical aggravated exacerbations, nearly similar to the intermittent or primitive type; but without the latter’s complete intermission. Authors have described them under a variety of apellations; but they may be all comprehended as ramifications of one great trunk, or integral genus: they appear in essence the same disease, and are cured by similar remedies. In the medical nomenclature, they are denominated remittent, semitertian, hemitritea, tritophyea, double and triple tertian, putrid remittent, marsh, camp, ardent, bilious fevers, gall sickness: tertian fever obscured under a mist of one or more dangerous and prominent symptoms; hence named tertiana lethargica, vertiginosa, soporosa, apoplectica, paralytica, cataleptica, epileptica, convulsiva, phrenitica, hysterica, syncopalis, asthmatica, arthritica, cardialgica, singultuosa, rheumatica, pleuritica, dysenterica, atrabilaria, cholerica, emetica, diaphoretica, pituitosa, miliaris, scorbutica.
Exclusive of the symptoms common to such fevers, and partly delineated under the intermittent paroxism, remittent fevers are variously diversified by a rotine and medley of nervous, putrid, and inflammatory symptoms; but infinitely more of the two former. The climate, season of the year, remissions, and the notorious epidemick or endemick of that region or place, all contribute to their unerring detection. Sometimes they attack very suddenly and violently with delirium and inflammatory simulation; but soon afterwards, and at the interval of a few days, remissions are evident. Sometimes their approach is in appearance mild, but not less alarming. In general there are great lassitude, debility, anxiety, restlessness, severe headach, frequently delirium, especially at the exacerbations; disturbed sleep, and not refreshing; sickness at the stomach, nausea, bilious vomiting, or efforts to evacuate the ventricular contents; fecal excretion bilious with gripes; inextinguishable thirst; tongue dry and parched; quick hot respiration; skin sometimes dry. When bile is redundant, the intestinal excretion is often putrid and offensive, with bilious diarrhœa or dysentery, in repetition and quantity profuse, exciting tenesmus, and sometimes excoriation of the anus; to these may be added pain in the stomach and intestines, tension and elevation of the belly. According to Lind, the tropical remittents are the most virulent, yet are not contagious, unless accompanied with dysentery, or the sick crowded together; which, if an irrefragable fact, distinguishes this fever from the nervous and putrid: and besides, in those febrile epidemicks and endemicks, from marshy effluvia, the remissions are more perceptible and synchronous than in these from animal contagion. From the air, season, and medical treatment, the remittent may be converted into the intermittent or continued type; in the intermittent there is more security. In warm climates putrescency and death may ensue in a few paroxisms; in others, in all the intervals during three weeks: and usually the crisis is by some of the larger excretories.
Nervous and Putrid Fevers.
This febrile host are also widely dispersed over the earth; and probably are not so much governed or influenced as the preceding remittents by the climate, season, and sensible qualities of the atmosphere; but may originate in all countries, climates, seasons, and situations; and when extremely virulent, may, like the plague or small pox, be communicated by imperceptible emanation or contagion from one infected person to another; by personal intercourse, by the medium of polluted goods, furniture, apparel, cloaths, and houses; in all which the noxious miasma may be concentrated and lodged. Sometimes they harrass a nation or city in detachment only; and sometimes in formidable phalanx. Such fevers are frequently engendered in jails, crowded with filth and animal steams, and excluded from free ventilation: also in military hospitals, crammed with sick, with dysenteries, putrid sores, and mortifications: also in ships and large fleets, when hastened out in the hurry and spur of approaching hostilities: also in wet and stormy weather at sea, when the hatches are closed.
In cities, contagious fevers may be traced to prisons, perhaps sometimes to hospitals; certainly often to narrow courts and alleys, and small crowded apartments; to the houses of the indigent; to filth, rags, and squalid poverty, co-operating with foul unventilated air: and in the open perflated streets, are much less frequent. Cities, therefore, should be more infested with them than the country; and the poor more than the affluent. Children with adults are subject to them, but more of the latter. In London, perhaps, nine-tenths of the fevers, are of the remittent, nervous, and putrid type, and not of the simple inflammatory. But I exclude from this calculation the exanthematous order, and the topical inflammations. Some, not without argument, alledge, that slow nervous fevers are in general derived from the same origin; and that they differ from the putrid in degree only. Petechial spots are by no means constant symptoms of the putrid type; but when they occur, they point out the disease more unerringly, and its greater malignity. In many instances, their differences may be rationally imputed to climate, season, constitution, miasma, and medical treatment.
I meet with inextricable embarrassment, in endeavouring to draw the exact limits, not only between nervous and putrid fevers, but also between them and what some authors have termed the universal remittent of this island; and which is not limited to any season of the year. I take this opportunity, therefore, to avow, that in what proportion these very general fevers with remissions originate from marshy effluvia, from climate, and constitutional indisposition, from animal contagion, or from other occult causes, I am unable to decide: Their precise relation as to lineage and consanguinity, is beyond my penetration. Nervous and putrid fevers have been described under the following different names: slow nervous fevers, febricula, maligna lenta insidiose mitis, nervous and putrid fevers, putrid remittents, typhus castrensis, jail, hospital, infectious, putrid, malignant, continued, putrid, spotted, purple, petechial fevers; yellow fever of the West Indies, or typhus Icterodes.
Slow nervous fever frequently steals on with treacherous mildness; the sick are rendered unfit for business, but yet not confined to bed, and except to sagacious judges, the fever is not apparently alarming; and too often the sick and their friends are lulled into fatal security. The symptoms slight alternate chills and fugacious heats, especially in the evenings; heaviness, giddiness, and headach, particularly in the posterior and superior part, and the pain often descending down the spine; great debility and prostration of strength; and in both nervous and putrid, the functions of the brain, and of muscular motion, considerably weakened, and interrupted; also depression of spirits, sighing, restlessness, very little sleep and not refreshing; accelerated, weak, and small pulse; nausea, total inappetency; inconsiderable heat of the skin or thirst; dry tongue, a little yellow at the sides; pale urine, and without sediment; irregular sweats; sometimes pains resembling rheumatick. After a few days, the fever, stupor, delirium, and headach increase, with low muttering delirium, chiefly during the nocturnal exacerbation, and with noise in the ears, and universal debility of the corporeal and mental organs. The remissions are generally more distinct in the beginning, and, by degrees, more obscure.
Putrid fever sometimes creeps on with deceitful approach under the nervous cloak; and sometimes, with furious onset, counterfeits the inflammatory. The symptoms when radicated and inveterate are, unremitting headach, pain in the back and loins, and course of the spine; vertigo, throbbing of the temporal and carotid arteries, noise in the ears; delirium, extreme diminution of strength and despondency of mind, trembling of the hands and tongue when thrust out; anxiety, restlessness, or no refreshing sleep; intense burning heat of the skin, especially in the evenings; nausea, bitter taste in the mouth, vomiting of green or black bile: sometimes insatiable thirst; at other times the sick are insensible to thirst and heat, and only complain of universal languor and weariness; the tongue, teeth, and lips covered with a brown or black tenacious crust, with thrush and ulcers; the fecal excretion black, and fetid; the breath and perspiration offensive to the smell; the pulse progressively small, irregular, and quick, often 130 to 140 pulsations, even in adults, every minute; the eyes glazy, the vessels of the tunica albugina turgid with blood, and what is called blood-shot: in stages of still more virulency, petechial eruption sprinkled on the skin, with hemorrhages from the gums and nose, and hemorrhagick subcutaneous extravasations. In the yellow fever of the West Indies, there is a jaundice-colour of the eyes.
In the duration, crisis, and termination of nervous and putrid fevers, there is considerable diversity. Some may be suddenly stifled before they burst into a flame: some of inveterate malignity may prove fatal in a few days; others may terminate in all the intervals within three weeks, or even later. Some terminate auspiciously without any sensible crisis or evacuation: in others, there is more or less sensible defecation by some of the excretories, by perspiration and sweat; diarrhœa and fetid stools; turbid urine; exspuition and salivation; vomiting; tumor of the parotid glands; eruption about the mouth.
Miliary fever, febris purpurata, rubra and alba, is never epidemick, and is denied to be a primary disease; but is spurious, symptomatick, accessary, or fortuitous; it is very rare, and may be complicated with the nervous and putrid, and with small pox and measles. The miliaris alba is more frequent amongst the female sex, especially during the puerperal state, and in other females debilitated by fluor albus, and hemorrhages, of weak constitutions, delicate, prolifick. It sometimes exhibits previous symptoms of angina, pleurisy, catarrh, rheumatism, erysipelas. Its peculiar diagnosticks are extreme languor, anxiety, despondency, terror, sighing, prostration of strength, headach, delirium, restlessness, quick weak pulse, oppression of the breast and stomach, dry cough without expectoration; sometimes profuse sweats towards the third day or later, and the sooner the worse; inextinguishable thirst; urine and stools various. In different stages of the fever, after a few days, a cutaneous efflorescence is perceivable, from which the disease takes its name, preceded by and accompanied with itching and pricking heat of the skin, and eruption of diminutive pustules, the size of millet seed, and, by the fingers, may be felt prominent: they are rarely seen on the face; commonly on the neck, back, breast, and extremities; some of them change into small serous vesications, distinct or clustered, and emitting a peculiar sour odour: of these there is often a retrocession and new eruption, variously protracting the fever to a few days, or even weeks. It is distinguishable from measles by the pruriency and sour smell, and the absence of morbillous sternutation.
Inflammatory Fevers,
synochus continua non putris of Boerhaave. To this we may add the febris diaria. A different genus of fever, both in its nature and cure, from the remittent, nervous, and putrid, is the simple inflammatory. The frequency and the fatality of this fever, is infinitely inferior to the preceding groups; and in comparison, is as a wasp to a tyger; or a babe to Hercules. The false lights hung out successively by multitudes of authors, and transmitted, in some degree, through the Boerhaavean school, to steer with the antiphlogistick compass and lancet in each hand, in the generality of fevers, have been the cause of numerous shipwrecks. Inflammatory fever is frequently complicated with some local inflammation, and then is distinguished under a different name, and hereafter described. Pringle observes, that in military camps, pleurisies, and peripneumonies are the most frequent form of fever with inflammation; and next to these acute rheumatisms.
The predominancy and reign of inflammatory fever in northern latitudes, is in winter and spring, in cold climates and rigorous seasons, and where cold and moisture are combined. It commonly attacks the robust, strong, athletick, and those in the vigour of life: it is not contagious; and neither its remission nor exacerbation are conspicuous. Its assault is sudden and violent, with severe headach, quick laborious respiration, interrupted sleep and restlessness, or sometimes somnolency; sometimes delirium; but in general the mental functions are not greatly disordered, nor the muscular debility so great as in the nervous and putrid fevers: pulse accelerated, strong, full, and tense; commotion and throbbing of the temporal and carotid arteries; intense heat of the skin, dryness of the mouth, fauces, tongue, and nose; ingurgitation of drink with avidity; the urine somewhat crimson in tincture, and in small quantity; the belly generally costive; the blood drawn, forming a buffy incrustation on the contracted coagulum, complete its portrait. The natural crisis is various by nasal hemorrhage, by sweats, turbid urine, diarrhœa; and the duration of the fever from four to eleven days. The Febris Diaria of a few days continuance, is a sort of minor or infant species, an appendix of the inflammatory: it begins suddenly with nausea, vomiting, shivering, cold, headach, lassitude, heat of the skin, flushed face, restlessness, or disturbed sleep, strong quick pulse: and is rarely dangerous.
With respect to all the preceding confederate genera of fevers, we shall make the following general observation. In the preceding century, during the last thirty years, febrile mortality, by the London bills, is rated at 87,645: and the mortality of the present century is seen in the Chart. Formerly, in this metropolis and island, and probably throughout Europe, fevers seem to have been much more prevalent and fatal than at present: their essential nature and cure is now much better understood by physicians; and we are provided with far more powerful auxiliary remedies, and are more expert in their application. In this particular instance, modern medicine, especially of the century in which we live, is signalized, and may, without arrogance, claim triumphal honours. The supposed innumerable varieties of fevers, and from which perplexity Sydenham could not altogether extricate himself, is now disproved by repeated experience, and by the infallible efficacy of general remedies. It is, however, as yet impossible to fix any definite medium or average of mortality in the above genera of fevers, whether remittent, nervous, putrid, or inflammatory. We have modern authentick records, wherein, under judicious and skilful treatment, of 200 sick in remittent fevers only one died; and even in the nervous and putrid, the blanks were trifling compared to the prizes; whereas, under different and erroneous management, one half, and often the greatest part of the sick perished. The corroboration of these assertions may be seen in those learned authors, Lind, Millar, Robinson, Clarke, Lettsom, Sims, and others.
Throughout the intire morbid host of human foes, there is probably no such flagrant variation in the therapeutick barometer, or scale of mortality, as in that of the fevers hitherto described. Different curatory processes and remedies soon change the natural genus, symptoms, crisis, prognosticks, and event. No dangerous diseases almost whatsoever, are more successfully oppugnable under discreet medical regimen; and when entrusted to nature, from the days of Hippocrates to the present time, they have ever been extremely fatal. Sorry I am to add, that, perhaps in many instances, the errors and fatality of nature, have been less destructive than those of artificial and therapeutick mismanagement. Since the discovery of antimonials and Peruvian bark, few now, under skilful medical pilots, die, compared to the multitudes of sick: but still in the aggregate list of funerals, except perhaps pulmonary Consumptions, it may be doubted whether any other of the belligerent morbid foes commit such ravages amongst mankind.
Small Pox,
natural and inoculated. We have no vestiges, neither in history nor tradition, of this loathsome disease, nor of the measles, before the irruption of Mahomet and his followers from the Arabian deserts, about 1,300 years ago; and from whom this extraneous contagion was first transplanted into Europe. It is little more than 200 years since the exportation of this exotic poison to the American continent, where it had never before been seen nor heard of. The havock by this scourge of the human race, amounts, in London, to nearly a decimation of the inhabitants; or to about one tenth, or one twelfth. It is equally or oftener much more fatal throughout the torrid and frigid zones; and in the adult age is more violent than in childhood. It attacks the same person but once in life: had this not been the case, the human race must long since have been extinct. On a promiscuous average, one of every seven infected die of the natural disease; but under inoculation only 1 of 500. Besides, to the former deadly catalogue may be superadded a frightful train of mangled constitutions and countenances, of consumptions, abscesses, ulcers, opthalmias, blindness.
In every large metropolis, small pox is an annual epidemick. In country towns and open districts, its invasions are more distant; at uncertain intervals of some years, when numbers contiguous are attacked at the same time. In our climate, it is alledged to be most prevalent in spring and autumn. Very few of the human species escape the small pox, especially in populous cities and towns, wherein there is always lasting variolous fuel, or, lurking embers: a wooden horse with ferocious foes in ambuscade, tolerated within their walls, rioting in human slaughter, and infantile immolation. It might easily be demonstrated, that in London, and probably in all other large cities, variolous ravages are principally amongst children under five years of age. Without entering into any elaborate argumentation, or proofs of this assertion, the reader may, in some degree, be convinced, by only turning his eye to the first Chart, and to a small table of London mortality during ten years; wherein he will observe the trifling annual mortality in the interval between 5 and 20 years; before which last period, a mere handful of the native progeny of the metropolis can be supposed to have escaped an infection with which they are constantly enveloped. It is obvious that the total annual mortality by all diseases, inclusively, in London during this adolescent period of life of 15 years, is not equal to variolous carnage singly. As to inoculation, or artificial engrafting of the contagion, it is throughout the greatest part of Europe a modern practice of the present century, and is yet in its cradle. Even in the London small pox hospital, since its first institution, forty years ago, there have not been inoculated altogether 25,000.
The cruel carnage perpetrated by small pox throughout the earth; the rooted prejudices, and the insinuations urged to shackle the universal benefits of inoculation, and which pervade not only the ignorant mass of the community, but also the generality of the medical profession throughout Europe, would abundantly excuse and urge me to be more diffuse on this interesting and litigated topick. But having, some years ago, published a small Essay on Inoculation, and having now nearly finished a general treatise on the natural and inoculated small pox, I shall postpone the result of much reading and reflection to that republication. An acquiescence in neutrality or indifference, where it can be proved to mathematical demonstration that myriads of lives might be preserved, which are now sacrificed, would, at least in a moral sense, constitute an accessary in criminality.
Small pox, or variolæ, have been properly discriminated into several species: the distinct and confluent, or benign and malign; the crystalline, lymphatick, warty, petechial, and hemorrhagick; the inoculated; the spurious. The principal differences between small pox consist in the period of eruption, the number and form of the pustules, the quantity and state of the fluid contained in them, and the contumacious perseverance of the fever. The progress of variolous fever has been divided into four stages, that preceding the eruption; the eruption; the suppuration; and the exsiccation of the pustules. The first visible effects of the contagion and fever are nausea, vomiting, soreness at the stomach, drowsiness: before the eruption infants are prone to startings, and some even to epileptic fits; adults to sweats. The second stage of eruption is, from three to four days, from the first attack, of small red spots or pimples on the skin, resembling flea-bites, in number and quantity extremely various; from one or more, multiplied to many hundreds. The eruption is commonly first on the face, spreading gradually over the body and extremities, and is compleated about the fifth or sixth day from the febrile commencement: and on this eruption, the fever abates or subsides. In the third stage of maturation the pimples increase daily in size; are elevated into prominences inflamed at the base; and the suppuration is compleated between the eighth and eleventh day from the first attack: the pustules then detached from each other, have risen into small boils, the size of peas or larger, turgid with pus, gradually becoming opake, yellowish, and tenacious. In the fourth stage the pustules shrivel or burst, oozing out part of their contents, and a superficial incrustation is formed, which, after some days, together with the shrivelled pustules, scales off, leaving the subjacent skin of a brown red colour. This is the mild form of the disease; but we are next to describe it under more dangerous and fatal forms.
In the Confluent small pox, the revolutions are the same, but the symptoms more exasperated; the vomiting and the eruptive fever violent, frequently with coma, or delirium. The eruption protrudes earlier; on the second or third day, in congregated clusters, like measles, and more numerous on the face; the fever does not then subside, but increases towards the fifth or sixth day, and continues throughout the disease. The swelling of the face is commonly earlier and more severe: and both in confluent and distinct, when the pustules are numerous on the face and fauces, there is soreness and inflammation of the throat, hoarseness, and difficulty of swallowing; and about the eighth day, the eye-lids are closed up with temporary blindness. On the face, especially, the pustules are small, less elevated, coalescent; and it is often covered with a universal flat vesicle: the fluid is whitish or brownish, not yellow and tenacious, or of due maturation and concocted purulency. The pustular interstices, if any, are pale and flaccid. The facial intumescence subsides about the tenth or eleventh day: and during these stages of fermentation and depuration, a salivation commonly ensues, especially in adults; and in infants a diarrhœa. About the fourth stage the fever, called secondary, is often renewed with considerable vehemence, and with various duration and event. In the latter stages the pustules excite intolerable itching of the skin, and, if not prevented, incessant scratching and cutaneous denudation: the breath, exhalations and excretions are then offensive to the smell. In the mild distinct, the pustules commonly begin to dry on the ninth day, and continue to the fourteenth in a process of exsiccation; but in the confluent, this stage begins about the eleventh day.
The following are all unfavourable omens in small pox: Sudden and premature eruption of pustules. In this first stage, infants, especially before dentition, are sometimes snatched off in epileptick fits. The more small pox appear in the confluent, or in the distinct form, they are more or less perilous. It is only where the distinct are crowded with pustules on the face; or accompanied with fever and putrescency; or with pustules warty and lymphatick, that they are dangerous. Or, a natural mild small pox may be rendered malignant from confined air, heated room, and regimen. In the catalogue of unfavourable symptoms, are the fever continuing pertinaceous; and with putrescency it is still more dangerous: the pustules not sufficiently filled and distended, hard, or warty, or not filled with maturated pus; the top of the pustules depressed; pale interstices at their base; sudden retrocession or subsidence of the pustules during the stage of maturation: severe inflammation of the fauces; difficult deglutition; severe pain at the stomach. The secondary fever arising commonly about the recession and exsiccation of the pustules, or ebb of maturation, is the most dangerous period of small pox. The variolous crisis then is generally by diarrhœa, or turbid urine, or both conjointly, or by salivation. It is evident that, as the cutaneous pores are blocked up, the absorbed, and other floating pus, must be defecated by some grosser excretory. Additional symptoms of alarm, especially in the confluent, are, if the suppurating stage of the fever continues severe, the salivation ceases, and the hands do not then swell. When the putrescency is virulent, the disease sometimes proves fatal in a few days; but in most cases on the eleventh, and sometimes not until the fourteenth or seventeenth. Fatal symptoms of putrescency are petechiæ, and bloody pustules; putrid urine and stools; tumid emphysematous abdomen.
Inoculated Small Pox. Between seven and nine days, some slight fever succeeded by an eruption of pustules; in general not numerous, and the patients are very seldom confined to bed, or indisposed. In ninety-nine cases out of an hundred, inoculation produces a distinct small pox, void of danger. After inoculation from the maturated pustules of real small pox, and the usual symptoms of impregnation, mankind are ever after invulnerable by this contagion.
Chicken Pox. Bastard or spurious; and distinguished under the apellation of petite verole volante, stein pox, and swain pox. They are sometimes epidemick, but inoffensive; and have given rise to the supposition of a person’s undergoing the natural small pox a second time. The eruption forms very quickly into pustules, of which the pus is not concocted, nor tenacious; and after three or four days, incrustations.
Measles.
Morbilli rubeola. From 100 to 120th part of the community seem to be destroyed by measles. Morbillous mortality is to that of small pox in the ratio of one to ten or twelve; and consequently may be estimated at one of seventy-seven whom it attacks. Sydenham, long ago observed, that measles, if judiciously treated, are attended with very little danger; but he should at least have qualified the expression, by adding immediate and considerable danger; for both immediately, and in their future consequences, they are by no means so innocuous. Few escape this exotick contagion, especially in childhood and in cities. It attacks the same persons but once in life; and, with us, is said to be most epidemick in winter.
Morbillous symptoms are fever, impaired appetite, heaviness of the head and eyes, somnolency, catarrh, acrid defluxion from the fauces, nose, and eyes, with hoarseness, sneezing, and lachrymation; short dry cough, and some difficulty in respiration. Prior to the eruption, there is generally anxiety about the breast, palpitation of the heart, itching of the face, peevishness, and considerable fever. On the third or fourth day there is an eruption of small red spots first on the face, resembling the bites of ants or fleas, generally confluent and entangled, and broad on the trunk and extremities; but not elevated above the skin, nor rising into pustules, nor suppurating: the size and shape various and irregular. About the sixth day the eruption on the face begins to dry, and on the ninth, is totally obliterated with desquamation of the cuticle. With the eruption the fever frequently does not cease; and the cough and difficulty in respiration often continue beyond the eruptive limits and cuticular desquamation. The usual crisis is by scaling of the cuticle, turbid urine, or diarrhœa. Unfavourable symptoms are, too sudden or too tardy eruption; pale or yellow eruption; great debility; and above all, pulmonick inflammation. The last in the train of morbillous evils and consequences are, consumption, anasarca, ophthalmy. Sometimes, though rarely, measles have been seen in accompanyment with other eruptive fevers, as small pox, and gangrenous angina.
Scarlet fever.
Febris scarlatina, ignis facer, scarlatina anginosa. Its mortality in the London bills is added to the general febrile heap. This contagious epidemick is most frequent in the infant and adolescent age; it attacks families and schools about one time; and the same person but once in life; and is said to be most frequent in winter. It is generally accompanied with an anginous or ulcerous sore throat, but not putrid. That genus or species of scarlet fever which usually accompanies angina gangrenosa, and is extremely dangerous, is hereafter described. The symptoms of simple scarlet are the usual febrile precursors; on the second, third, or fourth day, an eruption of broad irregular redness and spots; general or partial only over the face, trunk, and extremities, and not elevated above the surface: sometimes overspreading the face with a crimson colour. Concomitant symptoms are, difficulty of swallowing, and uneasiness in the throat, redness, tension, and sloughs: commonly also nausea, sickness at the stomach, vomiting, vertigo, drowsiness, headach, difficulty of breathing, anxiety. After three or four days more; that is, between the sixth and ninth, the cutaneous eruption and redness disappears, with desquamation of the cuticle, and harrassing pruriency. The usual crisis is by sweats, urine, fetid stools, and exscreation of sloughs. Sometimes, a few days after the cuticular desquamation, an anasarcous swelling suddenly appears; and during the convalescent state, from exposure to cold air, or neglect of cutaneous and other expurgation, anasarca, hydrothorax or ascites have ensued.
There are two or three other febrile eruptions to which authors have appropriated distinct names, but by which very few of the human race are destroyed. These are febris urticata, bullosa, and pemphigodes. In general, they consist of red spots and serous vesicles on different parts of the skin, exciting heat and itching; the urticata resembling blisters from the burning of nettles. Some of these are mobile, receding and re-appearing, and prone to relapse. After a few days, however, or at the utmost a few weeks, they vanish: and are not contagious nor epidemick.
Plague.
Pestis. This febrile demon cannot now be called one of the mortal epidemicks of Europe, except in the south-east extremity, inhabited by the Turks. The two greatest pestilences on record, happened in the sixth and fourteenth centuries of our era; which, with more barbarous havock than that of Goths or Saracens, overwhelmed millions in three quarters of the globe in one indiscriminate massacre. In London, before the general conflagration in 1666, of one half nearly of the old city, the plague was very frequent: but since that event, or at the most two or three years after, it has been exterminated and banished from us. That fortunate disaster which consumed a magazine of putrefaction; together with widened streets, ventilation, cleanliness, and many other causes, have all contributed to the extinction of this exotick incendiary. For it is well known, that pestilential miasma has been preserved dormant many years in porous materials. From 1592 to 1665, the plague appears to have had annually more or less share in the mortality of the British metropolis; and adding together the different periods of its duration, amounts to twenty-five years. In 1665, which is the most furious pestilence in the London annals, the deaths amounted to 100,000; but in the eight preceding years, to only 113. Registers, in other parts of Europe, prove, that this disease has committed direful carnage since our emancipation. At Marseilles they can enumerate twenty general plagues, which have successively laid waste that populous city. Many other European cities and towns, during the last and present century, and especially those bordering on the Mediterranean, have, in a very short space of time, severely smarted by pestilence, and have been nearly depopulated.
At present, in all the Mediterranean ports they are, from fatal experience, scrupulously vigilant to guard, by a circumvallation of alarm posts, against the pestilential infection, and the clandestine entry of infected goods or merchandize. It rarely now gains admittance, by stealth into any of the European ports; (Constantinople excepted) or even if imported to our shores, the wise precautions and regulations, enacted by Quarantines, soon check its irruption and progress. This is a most interesting epoch and improvement in the police of modern states; for the original institution and rough draft of which, about 300 years ago, we are indebted to the Venetians. The political ordinances, however, enacted for the exclusion and suppression of pestilential contagion, were, until the present century, extremely erroneous and impolitick. Formerly, the plague in London, and in most other European cities, where it was permitted to sojourn, was rendered infinitely more terrifick and destructive by injudicious legislative regulations; especially by the barbarous sacrifice, and absurd policy of sick and sound immured together, with a forlorn motto on their doors, until all were dead or recovered. This was an effectual discouragement against an early alarm which, as in cases of fire, is of the utmost importance. It is evident, by the London bills, that a mere handful, at any time, died in the publick pest-house; consequently, every corner of the city was polluted with infection.
True plague is now chiefly chained down to Constantinople, and to Grand Cairo in Egypt, the two original, or at least one of the hotbeds and volcanos of pestilence; to several of the maritime towns of Asia and Africa situated on the Archipelago and Mediterranean; as Smyrna, Aleppo, Tripoli, Tunis, Algiers, &c. In many of these cities the pestilential miasma is hatched and accumulated into venomous malignity: it is in some nearly an annual, or triennial epidemick. At this day, plague almost solely wreaks its venom on the Mahometan nations, whose prejudices and ignorance, rivetted by religious and predestinarian absurdities, give licence and activity to its imperious domination. From such implicit and enthusiastick submission to the tenets of the Alcoran, joined to gross stupidity in science and philosophy, the Mahometans are encouraged, defenceless and rash, to brave this most malignant and terrible of the febrile host.
Fortunately for mankind, the pestilential contagion spreads to a very small distance through the air, without some contact or adhesion to infected goods and porous materials; or by personal communication and intercourse of the sound with the diseased. The atmosphere is not tainted to any considerable distance. A neighbour barricading himself within his house, at a few yards distance from infection, may escape unhurt. If pestilential contagion could be so suddenly and widely scattered over a kingdom as epidemical influenza, the earth, in a few months, would be converted into an enormous church-yard. It is not like some other exotick poisons of the exanthematous order, after enduring which once, mankind are rendered invulnerable: the plague, as well as putrid fever, may attack the same person repeatedly. What proportion die or recover, I cannot ascertain; and indeed the prophylactic or preventitive, is infinitely the most important indication. Its invariable characteristic features are buboes, carbuncles, and petechiæ. The general progress of the symptoms are, great abasement of strength and of spirits, apprehension of death, dejected countenance, and wildness of the eyes; nausea, vomiting of bile; headach, giddiness, delirium; weak irregular pulse; petechiæ, hæmorrhages; fetid breath and excretions; buboes or boils in the inguinal, axillary, or jugular lymphatick glands; and appearing early, or in the progress of the disease; besides gangrenous carbuncles in different parts. According to the virulence of the contagion, and other co-operating causes, the disease may be fatal in a few hours, a few days, or in one, two, or three weeks. The poison arrested in the lymphatic glands and suppurating, is a favourable presage. Domestick animals, as quadrupeds and fowls, are liable to the infection, and to be changed into carrion.
Sweating Sickness,
ephemera sudatoria et elodes, cannot now be considered as an epidemick cause of mortality. Somewhat more than 300 years ago, this singular contagious and vagrant disease burst out, for the first time, in the army of Henry VII. in his return to England from an expedition against France; and in four hours sickness, numbers were exterminated: but by keeping warm in bed, under profuse sweats, the dangerous whirlpool generally was escaped. The same infection was imported into England at several subsequent intervals; but happily, its greatest devastation was always of short duration; and this morbid meteor has long since disappeared from our island, and from Europe. Its symptoms were continued profuse sweats, extreme debility, fainting, anxiety, restlessness, pain in the stomach, thirst, vertigo, quick irregular pulse. Sometimes it was fatal in one day; and, if the sick survived to the seventh, they generally recovered.
Of the predisposing and occasional Causes of fevers,
intermittent and remittent, nervous and putrid, inflammatory, small-pox, measles, scarlet, plague, sweating sickness. The principal causes of the preceding genera of fevers may conveniently be presented at one view, in abbreviation. We throw to one side all that specious romance and sapient pomposity, strutting in the tinsel robes of proximate causes, and merely attend to the predisponent and occasional. Because, after diving and climbing as assiduously as many of our fellow-labourers in search of those arcana, we experienced reiterated retrogradation; and, as in metaphysicks, error supplanted by error. Neither do we attempt to pry into those latent predispositions in the human organization, which renders them susceptible to many various febrile impressions.
The predisposing and occasional causes of intermittent and remittent fevers are, cloudy winter and autumn: northern morasses: noxious miasma or emanation from morasses, from countries and soils low, damp, woody, uncultivated, especially in warm climates, weather, and seasons: atmosphere moist and hot: foggy atmosphere: unusual irregularity of the seasons and atmosphere: unusual continuance of cold rainy weather: damp night-air, especially in warm unhealthy climates: excessive heats: burning zones and regions: sudden vicissitudes from heat to cold of the seasons and weather: unusually excessive and long continued heats: also damp weather, particularly when unusually warm for the season and climate: damp ground-floors and habitations: damp sheets and beds: sleeping in the open air, and on damp ground: sudden stoppage of perspiration: bile depraved, redundant; septick miasma introduced from without, or generated within the body: efforts of nature to disencumber its functions and organs of some clogs or impurities. Perhaps rather contributing as exciting causes are passions of mind, fatigue, hardships, long watching, hunger, thirst, intoxication, venery, interruption of the excretions, &c.
The predisposing and occasional causes of nervous and putrid fevers are, many or perhaps all of the preceding causes: noxious miasma or contagion, engendered from human effluvia in cities, jails, hospitals, dirty, small, crowded houses and apartments, especially in unventilated alleys and lanes; accumulation of corporeal filth from want of cloathing, change of raiment, slothfulness; contagion concentrated in porous materials, furniture, raiment, and houses: cadaverous exhalations, effluvia from putrid carcasses of animals, and from both animal and vegetable heaps in a state of fermentative putrefaction: damp rainy seasons: bad harvest, and putrid grain; putrid diet animal or farinaceous: improper medical treatment of remittent fevers; corrupted bile, or other secerned and excreted fluids, noxious in quantity or quality: profuse evacuation, immoderate venery, desponding passions of mind, intemperance in food or drink, stoppage of perspiration, &c. Of miliary fever the causes are, estuation, hot regimen, and rooms, during fever or parturition, excessive evacuations, weak constitutions, debility, depressing passions, moist air, wet summer.
The predisposing and occasional causes of inflammatory fevers and diary are, cold climate and winter: cold winds: change of seasons: heat of the atmosphere: insolation: excessive labour, exercise, and fatigue: violent passions of mind: long watching: cold drink when the body is heated: intoxication with spirituous liquors: crude chyle: heating stimulating diet: disordered stomach, plethora: excess of coagulable lymph and its tenacity: menstrual, lacteal, hæmorrhoidal, arthritick: warm baths; excruciating pain.
The predisposing and occasional causes of small pox, measles, scarlet fever, and sweating sickness, are unknown, both as to their source and nature: the two first are exotick leavens. Of plague: venomous effluvia in certain hot climates, from putrid animal exhalations and filth, such as the stagnant canals and reservoirs of putridity in the city of Grand Cairo: putrid emanations from swarms of dead locusts. Predisposing causes to pestilential infection are, long watching, hunger, poor diet, intemperance, excess of venery, fatigue, terror, fear, debility, low spirits, &c.
With respect to the great sources of fevers, noxious miasma from morasses, contagion from human effluvia, and animal bodies, and that from specifick unknown origin, I shall make a few observations. Of what elementary nature miasma and contagion consist; the analysis of their minute atoms; whether animalculæ, or to us invisible emanations, I pretend not to decide. Of small pox, measles, scarlet fever, and sweating sickness, we are totally ignorant of their origin and essence. We, however, know to a certainty, and it is of infinitely more importance to the publick safety, that neither marshy miasma, nor those from human effluvia, spread to any considerable distance through the air. Even by the plague the atmosphere is tainted to a very inconsiderable distance; and mankind find an asylum and sanctuary within a few yards. Nor do marshy miasma emitted from the earth, mount or diffuse themselves to any considerable distance in the air: the inhabitants at the top of a hill have continued healthy, whilst those situated in a swamp at the bottom, have been infested with intermittents, and remittents. To what distance the contagion of small pox, measles, and scarlet fever extend through the air, I am ignorant: like the plague, the two former have been transplanted to distant regions, in animal bodies, or in polluted porous materials. Another important discovery of modern times is, that by fire and smoke, the heat of a baker’s oven, the most virulent contagion may be annihilated, when concentrated in apparel, spungy materials, ships, houses, &c.
Of Febrile Prognosticks.
The event of all the preceding fevers (intermittent excepted) is terminated with precipitancy in a few days, or, at the utmost, a few weeks in recovery, in death, or in some other disease. The predictions in fevers, and indeed in all diseases, should be deduced from the comparative mortality at different ages; the comparative mortality by different fevers; the symptoms peculiar to each genus, whether ominous or propitious; and the general symptoms applicable to an intire group or class. These enrich medicine with a rudder, compass and quadrant: in them consist the tactick and the sublime of medical divination. We have already treated of the three former, and have now only to add the general febrile predictions.
It is foreign to my plan, to squander time or words, in eulogy or censure of those elaborate treatises on the pulse and urine, and their presumed extensive application to the diagnostick and prognostick of diseases. Of strength and weakness, hardness and softness, fulness and inanition, slowness, celerity, velocity, saliency, intermission, irregularity, and a few other distinctions of the circulation and arterial pulsation, we are competent judges; and of the measurement of velocity to a still greater nicety with the stop-watch. But, with all due reverence to Galen and his copyists, down to De Bordeu, in discriminating the multitude and variety, if I may be permitted the expression, of complicated tones, combinations, divisions, subdivisions, chromaticks and chords in the arterial vibrations, we confess the bluntness and incapacity of our tangible organs. We have still fewer scruples to disclaim that affected sagacity and alchymistical intuition, of forming auguries from the urine; from its innumerable shades, intermixtures, pellicles, precipitation, and sediment. This is, even in our time, one of the decoys in vaticination to inveigle the ignorant and credulous; the stale manœuvres and chiromancy of vagabond empiricism and imposture.
A few words will finish our general remarks on the pulse. From physiology, we know that the whole mass of blood is circulated round the body from the heart, its lever and center, to the circumference, and back again, in the space of a few minutes. But in the velocity of the crimson torrent and arterial pulsation, prodigious variations ensue from age, sex, constitution, peculiar temperament, climate, season, food, drink, mental passions, exercise, rest, sleep, waking, health, different diseases, and different periods of the day. It is therefore, singly, a precarious sign; and did time permit, there would be no difficulty in demonstrating the urine to be infinitely more fallible. From infancy to old age, the velocity of the blood decreases, and is one half slower: in the adult and middle age, between sixty and eighty pulsations every minute is the usual natural pace: the febrile pulse is marked at 96, and is sometimes spurred to 130 or 140; and in infants sometimes outstrips the divisions of time or accurate mensuration.
All fevers with dangerous symptoms may be termed malignant; but in general, this term is appropriated to fevers, intermittent, remittent, nervous, putrid, exanthematous, and also to some of those complicated with topical inflammation. General prognosticks of danger are indicated by a concatenation of few or many of the following symptoms, which may, in some degree, be transposed to the intire febrile class; and to the phlogistick order not yet surveyed: as the brain, lungs, abdominal viscera, and organs indispensible to life, much deranged: debility in the executive and legislative functions; or vital, natural, and animal: signs of putrefactions.
We shall enumerate the principal of those in detail. The pulse weak, quick, fluttering, salient, irregular, intermittent, its systole duplicated, its velocity 130 or 140; tendency to faint or fainting in an erect posture; cold extremities: the respiration slow, laborious, quick, cold; all the subsidiary muscles of respiration labouring to distend the thorax; deep interrupted sighs, hiccup; particular noise in respiration, as if mucus plugged up the throat and lungs: the stomach very weak, with nausea, sickness, vomiting, desire of acids; deglutition difficult, struggling, and with noise; involuntary excretion of feces and urine; thirst; the tongue, teeth, and lips foul, and furred with a black gelatinous incrustation; the urine pale, red, black, fetid; intense burning heat in the abdomen; the belly tumid and puffed; fetid cadaverous smell and exhalations; clammy sweats, especially in the breast: the blood if drawn not coagulating: cutaneous petechiæ, like small bruises in different parts; subcutaneous effusions; hemorrhages: weakness, confusion, irregularity in the intellectual functions; the manners different from natural; in the speech or actions something unusual; loquacity; no sleep; coma or delirium furious, or low and muttering; in the countenance and eyes perturbation, agitation, amazement, despondency, despair, anxiety; attempts to rise out of bed; throwing off the bed-cloaths, incessant tossing about the bed; forgetfulness, loss of memory, so as not to know the nearest friend; refusing or exspuating food, drink, or medicines; moats floating before the eyes, and objects seen as through a cloud; total inattention to every object; twitching and spasms of the tendons at the wrist: catching and picking with the hands and fingers at the bed-cloaths, as if feeling for some object; starting of the muscles, convulsions; trembling of the hands and tongue when thrust out; supine posture; inability to support themselves erect or sitting; sliding down to the foot of the bed: livid nose; collapsed cheeks and temples; sunk and glazy eyes; dead, ghastly countenance, cold extremities.
It has been asserted by authors, that no certain febrile presages can be formed before the periodical crisis; but this is antiquated and erroneous. In tropical climates, the critical days are much more certain and evident than in northern regions: and as transmitted from the prognostical Alcoran of Hippocrates, are the 3d or 4th, 5, 7, 9, 11, 14, 17, 20; which amounts to rather more than one half critical, and the remainder non-critical. On such critical days the event is generally most decisive, whether salutary or fatal; in the non-critical it is a temporary respite. Besides, in tropical climates, the moon is observed to have considerable influence on febrile paroxisms, and crisis. As to the effect of febrile crisis on the human excretories, we have been sufficiently explicit. The favourable termination of fevers is chiefly discovered by cessation of delirium, abatement of the frequency of the pulse; mild sweats equally diffused; the urine depositing a sediment freely and copiously; coolness of the skin; return of natural sleep and appetite; and food recruiting the lost strength. The storm is then subsided, and the ship arrived at anchor.
The phlogistick group of febrile diseases
are now to be reviewed. The majority of these in their immediate causes and mode of cure, intimately anastomose; and the principal differences in the symptoms are to be ascribed to the different organs and parts enraged by inflammation. These are not like the generality of the preceding fevers, in which most of the corporeal functions participate: here, in many cases, one single portion of the human organization is originally transfixed with pain and commotion; and doomed to bear the brunt of the hydraulick torrent and inundation. After mature consideration, we imagined it would occasion less confusion and burthen to the memory, to detach a few diseases from the phlogistick legion. Inflammation of the ears, eyes, intestines, kidneys, and bladder, are incorporated amongst the other diseases by which those various organs are liable to be invested. I am aware that this does not quadrate with the stiff etiquette of nosological parade: but, without digressing into a critical disquisition on this subject, I shall content myself with simply acknowledging that I am no convert to any of those modern pedagogues in morbid arrangement and nomenclature. With similar and intentional omission, I avoid the technical subtilities of parenchymatous and membranaceous inflammation.
Inflammation of the Brain.
Phrenitis vera. As a primary disease, it is very rare in this kingdom. It is much more frequent in tropical and hot climates: and is the febrile calenture of those scorching regions. With us it is mostly symptomatick in different fevers: and may either affect the brain and medullary substance, or its investing membranes: and in the former case the delirium is said to be mild. Morbid dissections have proved, that when inflammation was believed to be present, none could be discovered; and in other cases, that the brain was inflamed, without expressing the usual symptoms. Of idiopathick phrenzy, the symptoms are, fever, excruciating and deep seated headach, restlessness, and want of sleep; intolerance of light and noise, with acute sensibility and irritability; red, prominent, ferocious eyes; audacious, and flushed countenance; contracted and languid pulse; throbbing of the temporal arteries; noise in the ears; change in the voice; impetuous delirium, and the patient, with difficulty, restrained in bed; dry parched tongue, but sometimes no complaint of thirst; costiveness; limpid urine. It is extremely dangerous and precipitate, terminating in a few days in recovery, death, or some other disease; and is rarely protracted beyond a week. The favourable crisis is various: by nasal hemorrhage, sweats, diarrhœa, turbid urine: but on any irregularity or intemperance, convalescents are prone to relapse. The predisposing and occasional causes are, warm climate; insolation, especially with the head uncovered; sudden suppression of the puerperal lochia; intoxication; violent passions of mind; ambition, anger, grief, profound contemplation, unremitting study; long deprivation of sleep; external injuries; erysipelas, or scald head prematurely repelled; violent exercise; symptomatick.
Angina:
cynanche, quinsey; and distinguished into the inflammatory; and into the putrid, gangrenous, or malignant. The mortality by quinsey and sore throat, appears in the London bills inconsiderable; and without discrimination of the inflammatory and putrid. Inflammatory angina is a general and frequent affliction in both sexes, and especially in ours and some northern regions. Adults more than infants; and some individuals more than others, are obnoxious to it: its reign is in spring and autumn, on the change and vicissitudes of the seasons, or of heat and cold. In that very different species, the Gangrenous Angina, the ancient authors are nearly barren of information: some years this is epidemick and contagious in different parts of our island; and is much more inimical to childhood and adolescence than to adults; discharging its venom on schools, and the younger branches of families.
The principal differences in inflammatory angina are in the parts affected, and the degrees of inflammation; which may be in one or in both sides; and variously extended over the mucous membrane of the fauces, tonsils, velum, uvula, pharynx, and larynx. The usual symptoms are difficulty and pain in deglutition, and sometimes in respiration; internal intumescence and redness of the fauces, stiffness of the neck, and the lower jaw moved with pain; frequent and difficult in excreation of viscid mucus and saliva, and clamminess of the mouth and throat; impediment in the distinct articulation of words and speech; noise and darting pain in the ears; flushed face, prominent eyes; quick, strong, and hard pulse; anxiety, restlessness; sometimes considerable contiguous tumor externally; and in violent inflammation, necessity of an erect posture of the head, to prevent suffocation: the more the pharynx is affected, deglutition is proportionally interrupted; and some cannot swallow food or liquids during several days. The crisis is in a few days, at the utmost in a week or two, by resolution, or by suppuration; seldom or ever by gangrene. Resolution or discussion is accompanied with copious excreation and salivation; and frequently with critical perspiration, sweats, urine. Suppuration may be artificially discharged, or may spontaneously burst internally or externally. With judicious and opportune assistance, there is trifling danger. When fatal, it is by suffocation. The predisposing and occasional causes are cold air inspired cold and moist air: perspiration suddenly checked, especially on the neck; cold water drank when the body is heated: epidemical influence of the air and seasons.
Inflammation principally attached to the muscles of the os hyoides, glottis, larynx, and trachea, is fortunately far less frequent than the former. In this, the current of air being intercepted, there is necessarily difficulty and pain in respiration, quick short breathing, sense of strangulation, great anxiety and restlessness; acute squeaking or ringing sound of the voice; quick and irregular pulse. Of that disease, which at least in symptoms has considerable analogy with the present, and called with us the Croup, we are hereafter to treat. We may here, however, with propriety, subjoin two other inflammations, the Angina Parotidea, and the Glossitis. The Angina Parotidea is often epidemick, but not dangerous. It commences as a glandular tumor externally, at the articulation of the lower jaw, becoming gradually more enlarged and unequally diffused, increasing to the fourth day, and from thence declining: and often is succeeded by swelling of the male testicles, or of the female breasts. The Glossitis is rarely a primary disease; but mostly complicated with angina, or venereal salivation. Its symptoms are obvious; pain and swelling of the tongue; speech and deglutition exercised with difficulty, headach, restlessness, flow of saliva. If violent in the extreme, there is danger of suffocation or starving.
The strong cardinal outlines in the features of Angina Gangrenosa are, symptoms of nervous and putrid fever, with ulcerations in the tonsils. Upon these we shall enlarge in their rotine and detail: soreness or uneasiness in the fauces and throat; stiffness of the neck; headach, nausea, and vomiting; the fauces and tonsils inflamed, but seldom in any considerable degree, of a shining crimson colour, with ash-coloured spots on the tonsils, and sloughs, forming soon into corroding ulcers; some pain is felt in deglutition; there is sudden prostration of strength; depression of spirits; anxiety and oppression at the breast; small, quick, and fluttering pulse; dizziness in the head; slight delirium, especially at the nocturnal exacerbation; heavy, red, and watery eyes; the tongue foul at the root; in some the voice hoarse; and in most the nostrils excoriated by a sharp defluxion; the breath unusually fetid, and generally the fecal discharge: the external tumor of the fauces, when visible, which, so far as my experience reaches, was rarely the case, is edematous, indenting by pressure. In most cases there is a cutaneous efflorescence overspreading the face, neck, and other parts of the body, in small points, scarcely eminent, or in confused and confluent blotches: the period of this eruption and of its duration varies; and with its recedence there is desquamation of the cuticle.
This is infinitely more dangerous than the inflammatory angina, terminating salutary or fatal from the third to the seventh day, according to the degrees of virulence and medical aid. Alarming symptoms are, great debility; cutaneous petechiæ; the internal functions of the brain much deranged; weak, quick, fluttering, and irregular pulse; livid colour of the ulcers; refusal of drink and medicine; together with the other inauspicious symptoms enumerated under febrile prognosticks in general. I have seen not only petechiæ, but also putrescent hemorrhages from the nose and gums in this disease. At the crisis there are often fetid stools; but whether critical, or from the acrid matter swallowed, may be disputed. General sweats and excreation of the ulcerous sloughs are favourable omens. By the speedy and judicious assistance of remedies and regimen, very few, compared to the sick and infected, sink. It is epidemick and contagious: but of the source or nature of the contagion, we are unacquainted.
Inflammation of the Lungs and Organs of Respiration,
is a frequent inflammation in northern climates; and most so in spring, autumn, and winter; when the body, hydraulick canals, and blood are in a state of inflammatory diathesis: it generally encounters the robust vigorous constitution, those of strong muscular fibre, and dense rich blood; the athletick rustick, manufacturer, and artizan; those in the prime, and in all the intervals between twenty and the decline of life: it is very rare in infancy, as in idiopathick disease, and seldom under puberty, or in old age. It is most universal amongst the male sex; and in all probability, both more universal and destructive amongst the necessitous laborious mass of the community. We also read in authors, of spring pleurisies as no unusual affliction in some climates considerably nearer to the equator than ours. I apprehend, that in the London registers the mortality by pulmonick inflammation is under-rated, and perhaps delegated to imposthume and consumption.
Nosologists have enumerated several extraneous symptoms as complicated species of pleurisy and peripneumony; such as bilious, erysipelatous, catarrhal, rheumatick, intercostal, arthritick, verminous, flatulent, scorbutick, putrid, and malignant: most of which are merely symptomatick: for neither rheumatick pains in the intercostal muscles, nor flatulence pent up in the intestines, can impose on medical discernment as genuine pleurisy. The primary seat of pulmonick inflammation, whether in the parenchyma or internal viscus, or in its investing membranes, is not clearly established in medical diagnosticks; and therefore we comprehend pleurisy and peripneumony under one genus: in most cases they are complicated; and it is now doubted whether any pure peripneumony occurs without the pleura also participating in the affliction. The inflammation confined to the pleura alone, was described as unaccompanied with expectoration; hence the distinction of dry and humid species; and in genuine pleurisy the pain was represented as more acute than in peripneumony.
The symptoms of pulmonick inflammation are fever, darting pungent pain fixed like a dagger in some part of the chest, the side, breast, or back; and sometimes shooting to the scapula and clavicle: sometimes the pain is more dull and obtuse; and its situation oftenest in the side, about the middle of the ribs, between the sternum and spine; and commonly confined to one lobe. At the invasion there is shivering, restlessness, anxiety, succeeded by heat: hot accelerated laborious respiration; load and oppression at the breast; urgent, short, and painful cough; and very early in the disease more or less expectoration, streaked with blood; the pain is exasperated by inspiration and coughing, and mostly fixed, but sometimes veering or shifting: the pulse quick, full, hard, and tense, like a stretched chord; the blood drawn forms a buffy tenacious crust on the coagulum; the urine is of a florid colour: from the violence of pain, patients are often unable to lay on either side, but compelled to recline half-erect on their backs: when the inflammation is violent, or both pulmonick lobes assailed, there is inexpressible anxiety and struggle in respiration, florid countenance, prominent eyes; with other symptoms of obstructed circulation, and return of blood from the head, and menacing suffocation. In the advanced or dangerous stage of the disease, the pulse is weak, soft, and irregular. Sometimes there is nausea of the stomach; and sometimes delirium.
The termination of pulmonick inflammation is by resolution, by suppuration, by gangrene, by fatal effusion of blood, or exudation of coagulable lymph into the cellular texture. Favourable symptoms are, as in anginous excreation, facility in expectoration, without much exertion or coughing, copious, of due consistence, a little yellow, white, thick, slightly streaked with blood; the sooner this is concocted and excreted, the sooner is the crisis; less urgent and painful cough; freer breathing; abatement in the heat of the body and velocity of the pulse; general perspiration; deposition of sediment in the urine; nasal hemorrhage; dispersion of the pain, hitherto fixed in the thorax, about the shoulders, back, or arms; erysipelas in some external part; pustular eruption about the breast, neck, and scapulæ; abscesses in different parts. A crisis, when favourable, always ensues within seven, or at the utmost fourteen days; and after such crisis, expectoration may continue copious several days.
Inauspicious symptoms are, the respiration struggling and laborious in the extreme; dry pertinacious cough; no expectoration, or with difficulty; suppressed expectoration; obtuse pain, with difficult respiration; frequent violent cough exasperating the pain; the pain changing from one side into the other; the pulmonick lobes in both sides inflamed; the breathing intolerable and suffocating, except in an erect posture, and even then with laborious anxiety; the face turgid and florid, or pale, with features of consternation; violent headach; delirium; remission succeeded by relapse; excessive sweats; dry skin; weak, soft, and irregular pulse; sudden cessation of pain; grumous livid expectoration; rattling noise in the thorax, as if plugged up by phlegm; dejected countenance, squalid sunk eyes; great prostration of strength; cold clammy partial sweats; limpid urine; florid blood coughed up, or white and glutinous matter resembling the branches of blood-vessels. Effusion of blood, and exudation of coagulable lymph into the pulmonary cellular texture, bronchial vesicles and air-pipes, is more frequently than gangrene, the cause of suffocation and death. The occurrence of either is seldom later than fourteen days. There is also great danger of pulmonick inflammation, persevering beyond seven or, at the utmost, fourteen days, and without any considerable remission or signs of resolution, terminating in suppuration; of which the diagnosticks are hereafter marked. Authors have likewise described a malignant peripneumony, which seems to be a complication of the preceding deleterious symptoms, and of putrid fever.
There is, however, a species of pulmonick affliction, the specifick diagnosticks of which it would be unpardonable to omit; because it has often and fatally been either confounded with, and treated as genuine pulmonick inflammation, or slighted as a catarrh. This is named Peripneumonia Notha; whose symptoms, at the onset, are ambiguous. It is most frequent in persons old, phlegmatick, fat, weak, emaciated, subject to catarrh, addicted to fermented and spirituous liquors; and in foggy weather and rainy winters. It appears in the same seasons with genuine pulmonick inflammation, and with catarrh; that is, in spring and autumn; and frequently under the veil of a violent catarrh. The fever and heat are inconsiderable; the pulse not hard nor tense; but there is straitness and difficulty of breathing, and load at the breast, with anxiety and gasping for breath; urgent violent cough, with some expectoration, and sometimes exciting vomiting; giddiness of the head; rending headach; sometimes drowsiness. It is sometimes suddenly and unexpectedly aggravated, and suffocates the patient.
The predisposing and occasional causes of pulmonick inflammation are, epidemick state of the air; sudden vicissitudes of the seasons and weather from heat to cold; sudden suppression of perspiration, or of pulmonary exhalation; inspiration of cold air; sudden exposure to keen cold air, especially after breathing in a warm room, or drinking warm liquors; cold liquors drank when the body is heated; intemperance and sottishness, particularly in spirituous liquors; dry cold winds; strong muscular exercise, or manual labour; repulsion of cutaneous eruption, febrile or chronic; exsiccation of old ulcers; suppression of habitual evacuation and eruption; translation to and deposition of morbid matter on the lungs; consequence and dregs of small pox and measles; symptomatick from some other diseases.
Inflammations of the heart, mediastinum, and diaphragm, as solitary, are very rare diseases. The symptoms of Carditis are severe fever; pain and anxiety in the region of the heart; difficulty of breathing; cough; irregular pulse; palpitation, syncope. Inflammation of the diaphragm, paraphrenitis: the symptoms are, acute fever, intense pain in the breast darting to the back, and increased by inspiration, coughing and sneezing, and by natural exertion at stool and urine; restlessness, anxiety, dry cough, quick convulsive breathing; sneezing, hiccup, nausea, vomiting; compulsive painful grin on the countenance, delirium. When it occurs, it is generally complicated with inflammation of the adjacent organs, in either the thorax or the abdomen. As the heart is the main spring of the blood’s circulation, and the diaphragm the principal agent in respiration, it is evident that inflammation in either must be extremely dangerous.
Inflammation of the Liver,
hepatitis, acute and chronic. Both species are much more frequent in tropical climates and warm regions, than in northern and cold; and more so in the former during the hottest seasons of the year. The sensibility of the liver being dull, its inflammation is less painful than that of any other viscus. The symptoms are, fever, pain in the right side under the false ribs, and felt at the corresponding clavicle, scapula, and hand; sensation of heat and heaviness in the hepatick region; difficulty of breathing, more especially when the inflammation invests the superior convex part of the liver; there is often dry cough; nausea, bilious vomiting, and diarrhœa; the urine of a fiery or saffron-colour; and generally, but not always, the eyes, countenance, and skin more or less of a jaundice tinge; the pulse not remarkably disturbed; but thirst. Sometimes hepatick inflammation is entangled with that of some contiguous organs of the lungs or abdomen, and with their respective features. The acute hepatitis, but not the chronic, is usually terminated in a few days, at the utmost fourteen or twenty-one, by discussion, suppuration, or gangrene. Critical resolution may be variously accompanied with bilious diarrhœa and urine, nasal or hemorrhoidal hemorrhage, copious bilious sweats. Suppuration is not an unfrequent termination: after which many survive, but with difficult and slow recovery. The purulency may be expurgated by absorption, by the biliary ducts, by erosion of the abdominal muscles, or by an artificial opening when the abscess is perceptible externally; and sometimes it erodes the diaphragm and lungs.
The predisposing and occasional causes are, burning climates; acrid viscid bile; the blood tenacious and glutinous in consistence; calculi, steatome, worms in the biliary ducts; bilious vomiting; sudden refrigeration of the body when heated, and obstructed perspiration; thirst, and not sufficient dilution of the blood; intoxication and abuse of spirituous liquors; poisons; external injuries; violent exercise; passions of mind; inveterate hypochondriasm; translation of purulent matter to the liver; symptomatick.
Inflammation of the Spleen is a rare occurrence: schirrus of that organ is far more frequent. The Peritonitis is also an uncommon inflammatory vagrant: it will be revived hereafter under Puerperal Fever.
Inflammation of the stomach,
gastritis. Notwithstanding the incessant irritation and distinction of this sensible organ, by innumerable varieties of food and drink, yet its inflammation is a rare event. The symptoms, acute fever; fixed burning pain and heat in the region of the stomach, aggravated by pressure; frequent nausea and vomiting after taking any nourishment; anxiety, restlessness; weak, hard, intermittent pulse; frequently delirium; universal debility. It may prove fatal in the space of a few days, or even of a few hours: there are different gradations of severity and danger. The termination is by resolution, suppuration, gangrene. The predisposing and occasional causes are, all the causes of topical inflammations in general; poisons swallowed; cold water, ices, and fruits swallowed when the body is much heated; repletion from food and gormandizing; crude and difficultly digested nutriment; violent agitation of body or mind; external injuries: from repelled gout very rarely.
The three succeeding genera of the phlogistick tribe, so far as respects mere inflammation only, affect the external parts and circumference of the body, and do not suppurate. In other respects there is a distinct tripartite separation, both as to general outlines and minuter shades.
Erysipelas,
ignis sanct. antonii: gutta rosacea, zoster, zona, herpes. Some trifling pillage by this disease is noticed in the London bills. To adults it is most hostile. The symptoms are, more or less fever; superficial inflammation of some portion of the skin and cuticular membrane, with pain, tumefaction, burning heat, redness, and pruriency, like that from nettles; and variously, in different persons, assailing the face, the neck, the trunk, or one of the extremities: the eruption seldom appears until after the commencement of the febrile commotion; and often from a small point spreads gradually: it never rises to any conical eminence, nor suppurates, but often excites vesications; and if on the face and violent, blocks up the eyelids: the pulse is frequently full and hard; and with the eruptive expulsion the fever and heat do not cease. It is sometimes critical and salutary: the favourable crisis is usually in a few days, or within nine, by perspiration, urine, and desquamation of the inflamed cuticle; and sometimes without any perceptible revulsion to the excretories. Some have this cutaneous inflammation annually, or oftener, or at wider intervals; and those once affected, are more obnoxious to its returns. Presages of danger are, violent inflammation and intumescence on the face, or sometimes even on the legs, particularly in old age, or unsound constitutions; premature retrocession of the eruption; pale colour; frequent return, and repetition of the inflammation; delirium; coma; gangrene. On the legs it sometimes leaves behind a chronic enlargement. The zoster and zona is a species of erysipelatous inflammation, a hand’s breadth or more, affecting the breast, sides, or abdomen, and various in length.
The predisposing and occasional causes of Erysipelas are, epidemick influence of the air; obstructed perspiration; sudden refrigeration of the body when heated; plethora; suppressed evacuations, natural or artificial; luxurious living and indolence; intemperance; spirituous liquors in excess; poisons; unsound constitutions; contusions, wounds, burns, punctured nerves, blisters, acrids; dregs of fevers; scorbutick; lunar influence; passions of mind.
Rheumatism, acute and chronic.
From the Chart of diseases we may rank rheumatism as an inferior piratical foe amongst the morbid host; or rather as a scourge and instrument of torture than of execution. In the acute or chronic form, multitudes are molested by it, especially in this island, and in northern regions: and more so in winter, in spring, and autumn, and the interchanges of the seasons: it seldom molests very young or aged persons: adults are most annoyed by it; the male more than the female sex; the poor and indigent more than the affluent; and those most who are exposed to the inclemency and vicissitudes of the seasons and weather: hence, during war, soldiers and sailors are much more afflicted with it than in peace.
In the acute rheumatism, fever may commence before or after the pain, which variously and alternately seems to dilacerate different parts, especially about the joints of the ancles, knees, hips, shoulders, elbows, and wrists, sometimes the trunk; but rarely the small joints of the toes or fingers: and commonly succeeded by swelling and redness of the distracted joints, and with restlessness: at night the pains are exasperated, and often suddenly abating in one joint, seize upon another; thus harassing the body with a war of posts. In its diagnostic train also are, hard quick pulse, sizy blood, inflammatory urine; sweats sometimes copious, but not critical. Its continuance may be one, two, or three weeks; by which time the fever, if not mismanaged, abates with the pains: it very rarely terminates in suppuration, and in this instance resembles erysipelas and gout. The crisis of the acute is generally by sweats, cuticular efflorescence, nasal hemorrhage. It may terminate inauspiciously in chronic pains, or in consumption: indeed, emaciation is always a consequence.
Chronic rheumatism may occupy all the stations of the acute: in the hips it is called ischias, morbus coxendicis, and sciatica: in the loins, lumbago. In this there is no fever, redness, nor swelling, only pain and often inability to move the affected joints; and this aggravated by change of weather and cold. In the lumbago there is direful pain about the loins, with difficulty in erecting the trunk; but not, as in the nephritis, accompanied with nausea or vomiting, nor pain of the ureters, testicles, or thighs. In the ischias there is severe fixed pain about the hips, os sacrum, and pubis, and often extending down the thigh and leg along the fascia aponeurotica; with difficulty or incapacity of moving the thigh; and sometimes atrophy of that extremity, or sciatic tabes. Chronic rheumatism may harass months, years, with various degrees of severity and exacerbation, and interludes of ease; and is often extremely obstinate and difficult to be dislodged. In many instances also, we observe a contrariety and dilemma whether to affix the name of chronic rheumatism or gout to such pains. In general, rheumatic aches are not so periodical in their returns; and in several other features the two diseases divaricate.
The predisposing and occasional causes of acute and chronic rheumatism, idiopathic and symptomatick, are, sudden suppression of perspiration; sudden heats and colds; cold damp night air, beds, houses, habitations, want of sufficient warm cloathing and fuel in rigorous seasons, or during the interchanges of the seasons; wet cloaths; exposure to heats and colds; sudden vicissitudes of heat and cold; change of winds and weather; one part of the body exposed to cold whilst the other part is heated; sleeping on damp ground; plethora; impure blood; repelled eruption; suppressed evacuations; habitual intoxication; intermittent; dregs of fever; arthritic; hereditary; scorbutick; hysterical; venereal; noxious exhalation from lead or mercury; excess of venery; tabes dorsalis; aneurism of the descending aorta near the loins; lifting great weights; internal abscess and scirrhus; abscess, and caries at the upper articulation of the thigh-bone; sprains; luxation and fracture of its neck; diseases of the coverings of the nerves, or of their medullary substance, or of the muscular fibre.
Gout,
arthritis, podagra; acute, chronic, regular, and irregular. Here we have no foundation to accuse the elements, or the invisible demons of disease: this malady either immediately, or by hereditary descent, is too often the natural castigation and penance of voluptuousness and sensuality. In the preceding century it was confounded with sciatica in the London bills. During the present century, there is a considerable increase in arthritic mortality; but, compared to some other of the morbid host, it is a mere buccanier. Arthritic piracy must solely be imputed to the assaults of chronic gout, either gradually breaking down the fabrick, or storming some of the internal organs essential to life. It attacks principally the male sex; sometimes, but rarely, females; and of the latter those of robust full habits, the viragines, luxurious, indolent, corpulent, and generally after the final menstrual cessation: the majority, from the peculiarity in the female constitution, and from superiority in temperance, are exempt. It seldom attacks before middle age; generally in the decline of life: the few exceptions of its earlier occurrence are rare; and in them it is usually by co-operation of hereditary, and of remote exciting causes: in adolescence, and before puberty, it would be numbered amongst the medical miracles. It harasses most those of robust, full, corpulent, large frame and temperament, the voracious, gormandizing, affluent, and pampered; more of the patrician than the plebeian orders; more of the literary and sedentary professions; and, according to Sydenham, those of an acute genius and intellectual eminence. The active and industrious orders of every community; those who are exercised in daily corporeal labour, or who, from necessity, design, custom, or religion, do not indulge to excess in animal food, or in wine and fermented liquors, are seldom arthritick martyrs. Compared to the number afflicted, very few die of gout; it has even been by some considered as an omen of longevity: many, subject to it, have reached the Mosaick goal. It has been alledged, to render men more secure from other diseases; and in some few instances to expurgate and renovate a disordered constitution. These observations, however, must be restricted to regular gout only, and recurring at distant intervals.
That periodical local pain and inflammation called the regular arthritic paroxism sometimes invades suddenly, without any warning; but in general there are presages of its approach, one or two days, or even weeks; by ceasing of usual moisture on the feet; coldness, numbness in the feet and legs, enlargement of their veins, muscular cramps; general torpor and languor; restlessness; headach; depression of spirits; impaired appetite; flatulence, indigestion, cardialgy; costiveness. But frequently one or two days preceding the paroxism, the appetite is keener than usual. The regular and recent paroxism commonly invades by nocturnal surprize in bed, with pain in one foot, usually the ball of the great toe, accompanied with shivering, heat, and shortly after, conspicuous glossy redness, tension, and spreading tumor. The pain becomes often so intense as to be compared to premeditated dislocation, or to a dog tearing the flesh and ligaments: and such is the exquisite tenderness in the inflamed part and foot, as not to be able to tolerate the slightest touch or even weight of the bed-cloaths. In this way there are more or less diurnal remissions and exacerbations of pain; which, after one, two, three, or four weeks, recedes gradually and insensibly, together with the redness and swelling; leaving the patient who had been chained to a bed or couch, in perfect health; and soon after, the foot in the exercise of its former suppleness and strength. Throughout the paroxism the corporeal agony renders the mind more irritable and irascible: the urine is acrid, hot, turbid, and fabulous; in many, the perspiration is fetid; and with both general and local sweats, and desquamation of the inflamed cuticle, the paroxism finally evaporates. In vigorous constitutions the paroxisms are sooner terminated: indications of which are, sudden tumefaction, throbbing pain, and frightful sleep. In recent gout the pain is more severe than in chronic; the paroxisms shorter, with longer intervals; and vice versa. Pustular eruptions on the foot sometimes carry off the arthritic fuel.
At the beginning, the paroxisms are shorter, and the periods more regular and distant; at intervals of three or four years, or longer: by degrees the intervals are progressively reduced to two, to one; to two paroxisms annually about the equinoxes and solstices, and during the autumn, winter, and spring; at the same time the paroxisms are protracted to two or three months. At length, in the chronic inveterate stages of the disease the patient enjoys a very short respite; some few of the enervated, perhaps only two or three months during the summer: the pains in the extremities are then indeed less violent; but the stomach is more disordered. In recent gout, one foot only is assaulted; by degrees both feet, one after the other: and in the rooted state of the disease it not only torments both feet in succession, but capriciously deserts and re-attacks various parts; the ancle, knee, elbow, wrist; darting often with electrical velocity and shocks through the nerves and muscular fibres: thus, in a circle of torture and litigious warfare, teazing the arthritick victim.
When either the inflammation of the joints has commenced in the usual manner, but without an adequate degree of pain and inflammation, or at least without continuing the usual time, and precipitately recedes, some internal organ is exposed in its retreat and rebound. Or when the arthritick fuel is occluded, and not ejected to the feet, it will, according to the various parts and organs affected, excite corresponding vibrations and symptoms in the natural, vital, and animal functions; as inappetency, indigestion, nausea, vomiting, flatulence, ventricular eructation, colick, diarrhœa, nephritis, and urinary obstructions; difficult respiration, asthma, palpitation, fainting, general debility, low spirits, hypochondriasm, cramps and spasms in the muscles, apoplexy, palsy. In dubious cases from what source to derive such irregular alarms and minatory explosion; if they happen about the usual arthritic periods, and in such temperaments, their origin may be suspected: and it is of the highest moment to know that they are rarely of an inflammatory nature. After the disease has continued many years with frequent reiterated paroxisms the joints do not soon recover, but continue weak and stiff. In many cases, chalky and calculous concretions are formed in the joints of the extremities, and in the kidneys and urinary passages. Racked by those combined tortures, the patient requires the auxiliary aid of stuffed chairs, flannel, and crutches.
The predisposing and occasional causes are hereditary; inactive sedentary life, with luxurious living and gormandizing, especially on animal food; intemperance in wine, spirituous or fermented liquors; early or intemperate libations to Bacchus and Venus; unremitting application to study or business; sedentary life; nocturnal lucubrations; disturbed sleep, cares, misfortunes, vexation, depressing passions; ceasing of usual exercise or labour; sudden transition from an active to a sedentary life; coaches, dissipation, luxury, effeminacy; sudden violent changes in diet; plethora; suppressed evacuations; profuse evacuations; various causes of debility; indigestion from quantity or quality of aliment.
Of internal suppuration
in the lungs, liver, stomach, intestines, kidneys. Pulmonick suppuration, empyema, or vomica, may be predicted from preceding inflammation, without considerable remissions, the neglect of effectual remedies, and no signs of resolution by the efforts of nature or art, and by remission of acute pain; the difficulty of respiration and also cough continuing; with frequent horrors and shivering, heat and hectic, weight and throbbing in the side, laying on the diseased side painful; dyspnœa aggravated by a recumbent posture; disagreeable taste in the tongue; thirst; fetid breath; emaciation. It may burst in all the intervals between fourteen and sixty days, and either relieves or suffocates, or is gradually expectorated: and sometimes, after absorption, may be evacuated by diarrhœa or urine: the purulent contents may also be discharged upon the diaphragm, or between the pleura and intercostal muscles. Sometimes there are several small abscesses; and too frequently the final termination is ulceration and phthisis. Suppuration in the Liver is a frequent consequence of previous inflammation, and is not altogether so fatal as some other internal abscesses. Its symptoms are those in common with internal formation of pus, horror and chilliness, hectic heat, thirst, weight and load in that region, jaundice-colour of the eyes. Sometimes the purulence erodes the external integuments; sometimes the diaphragm, lungs, or stomach; sometimes is discharged by the biliary ducts into the intestines, or absorbed and washed away with the urine. Suppuration in the stomach and intestines is rare. In the kidneys, the general symptoms, with purulent fetid urine: it may also burst externally; or by slow ulceration and hectic, undermine the constitution.
Of Internal Gangrene in the lungs, stomach, intestines, kidneys, liver. Pulmonick gangrene from inflammation, is predicted by sudden cessation of pain, without any benign crisis: expectoration either suppressed, or yellow, green, black, and fetid; hollow noise in the breast during respiration; dejected countenance; red and heavy eyes; foul and black tongue; quick, languid, and intermittent pulse; fetid urine, stools, and sweat; hiccup; cold sweats; universal debility and sinking of the vital powers. From the preceding symptoms, from those enumerated under general febrile prognosticks, and from the functions peculiar to the different diseased organs, internal gangrene in whatsoever part may be comprehended; and a minute detail would be superfluous.
Diseases of the Lungs and Organs of Respiration,
what extensive ruin do they yet spread! In commenting upon these, I shall, in a trifling degree, invert the prescribed order and arrangement. Into this group are concentrated pulmonick hemorrhage, pulmonary phthisis, the various species of hectick, atrophy and tabes, nervous, sciatick, dorsal, and icterick; also asthma, dyspnœa and cough, catarrh, hooping cough, croup. Inflammation of these organs and spurious peripneumony, have already been described. These, therefore, constitute nearly the whole combined pulmonick host, and likewise some of those diseases closely connected with the pneumonick machinery, or with several of its general morbid symptoms.
Behold here one of the great caravans of dead to the stygian ferry; and tottering myriads crowding to the same shambles. View the innumerable multitude of fable mourners and weeping relations attending them in the last melancholy offices of friendship, to that eternal bourn, the grave! Every introspection of general morbid registers, and the unanimous observations of the medical profession, concord in proclaiming the notoriety of the consumptive throng, and their ruinous uncontroulable domination. Notwithstanding the prodigious improvement in the alphabet, subordinate rudiments, and appendages of the medical science, consumption as yet is one of the great oligarchy of morbid and remorseless tyrants. He would be intitled to every terrestrial honour, and to posthumous apotheosis; he would rival and eclipse the most celebrated tyrannicides, and expurgators of monsters, whether demi-gods, heroes, or saints, who could dethrone or controul this stationary monopolizer of human sacrifices, and sheathe his deadly sword.
From one fifth to one sixth of all the mortality in London, is from consumption; which is nearly double to that even of small pox. But consumption is a term too lax and indefinite. Into this gulph, no doubt, are thrown many febrile and slow hectick emaciations, from infancy to old age, in both sexes; and there are few diseases from acute and chronic sources, especially in their fatal termination, without emaciation. Consumptions and dropsies are the final wreck of a great variety of human maladies. In no two other diseases are, what pathologists term Morbi a Morbis, more apparent: and in multitudes of such cases, morbid dissections often detect the effect, and not the original cause. How many of the genuine pulmonary phthisis are consociated with this miscellaneous crowd, is difficult to guess; but, from the concurrent testimony of physicians, and of experience, we may safely affirm a very large proportion. There are few families in this kingdom whom it has not, one time or other, plunged into tears. Physicians on the continent alledge, that phthisis is more prevalent in Britain than in any other kingdom of Europe.
The next inquiry is, in what age, sex, rank of life, season of the year, and whether in city or country is consumption most predominant? It has been, from the earliest chronology, the universal echo and monotony of medical writers, to mark the principal consumptive age between 18 and 35. But, with submission, I would considerably enlarge its limits, including from birth to 5, and from 20 to 60. No age or stage of life is exempted; but we might “a priori,” and from viewing the great and general scale of mortality, assert, that between 5 and 20, a considerable number cannot possibly be swept away in the phthisical torrent. Nor do we mean to invalidate the general aphorism, that in the blossom and full maturity of vigour and comeliness, phthisis is superlatively deleterious. Between the sexes no distinction seems to be made. I conceive, however, that amongst the lower orders universally, and more especially those penned up in the foul atmosphere of cities, that phthisis is more fatal than amongst those who browse in the pure air of the country. In accommodation, cloathing, noxious trades, &c. the indigent have the disadvantage; and during sickness, from the same causes, their recovery is more desperate. With respect to seasons, winter and autumn in our climate is the most pernicious to pulmonick maladies.
Pulmonary Hemorrhage,
hæmoptysis, sputum sanguinis. The lungs spungy pneumatick and hydraulick organs, in themselves passive; but by the contraction of the diaphragm and intercostal muscles enlarging the capacity of the thorax, this ventilator is alternately distended with atmospheric air, and this sonorous fluid again quickly expelled, with either some noxious emanation from the body, or decomposition of its own vital principle. Half the blood of the human body circulates thro’ this organ: its blood-vessels are numerous and large, and rise immediately from the heart; and it is incessantly in motion and agitation. When the body has nearly attained its ultimate extension and altitude, pulmonary hemorrhage is most predominant; more especially in those of narrow thorax, prominent scapulæ, red cheeks, and acute tone of voice. Before the hemorrhage, there are shivering, horror, heat, fever, weight, oppression, pain and heat in the breast, difficulty of breathing, titillation of the fauces, dry cough, exspuition of florid blood in various quantity, and slowly or suddenly, from ounces to many pounds, or even quarts, in a few days; but the latter is rare. It may soon totally cease, or only intermit, and again return at irregular intervals. Relapses are frequent on any irregularity or intemperance; on acceleration of the circulation, or expansion from heat.
This hemorrhage is very seldom in such quantities to prove precipitately fatal, unless mismanaged. From Bleeding, at least in the London registers, there is petty spoliation. Pulmonary hemorrhage is more frequently the consumptive precursor. Malign omens are an eruptive torrent; ulceration in the lungs; fever renewed; pain in the breast; difficulty of breathing; cough, hoarseness; night sweats; peripneumony; visceral obstructions; cachexy; old age; relapses. But pulmonary hemorrhage from temporary obstructions of the menses, or in pregnancy, or periodical, or without load in the thorax, or fever, are much less mischievous.
Pulmonary Phthisis.
Not one hundredth part of pulmonary consumptions commence with hemorrhage. Phthisical lineaments are emaciation, diurnal hectic fever, obstinate rebellious cough, difficulty of breathing, and usually some change in the voice. In the beginning, phthisis often resembles a catarrh, or stubborn cold; and in this insidious disguise is too frequently slighted, or neglected: but continuing longer than the usual catarrhal period, without any considerable intermission, and especially if in summer, are sufficient grounds of alarm. In that, from tubercles, there is frequent teazing dry cough, exasperated at night; some difficulty of breathing, and panting on ascending any eminence or stairs, or on exercise; some emaciation and weakness. By degrees, there is more or less expectoration of viscid, yellow, greenish purulence, intermixed, however, with natural mucus, and in the progress streaked with blood. Sooner or later, uneasiness in the breast, inability to lay on one side, pain in the side, or under the sternum, and aggravated by inspiration and coughing.
The consuming hectic fever has generally two exacerbations during the twenty-four hours, about noon and night; with some degree of chilliness and shivering, and increased sensibility to cool air, notwithstanding the skin is preternaturally hot; the palms of the hands and soles of the feet burn; a florid redness, or circumscribed spot is perceivable in the cheeks; the other features are partial sweats about the neck and breast, particularly in the morning; disturbed sleep; slender, hoarse, and obscure voice; quick pulse; sometimes vomiting after meals; thirst; salt taste in the mouth; cough and expectoration, in frequency and quantity, varying in different persons; in some, there is a very considerable discharge of purulency from the lungs. Various ordeals have been proposed for the distinction of mucus from pus, or pulmonick ulceration. Mucus is naturally more transparent, viscid, and cohesive: pus always opake, more yellow and greenish; the odour more disagreeable, and the expectoration accompanied with a hectick fever. The sinking or swimming in water of the expectorated matter, is a precarious symptom, as it depends on the quantity of entangled air.
In this island, phthisis, especially from tubercles not suppurated, may continue one, two, or more years; appearing during the winter and spring, and disappearing during the summer. Other consumptions are much more rapid; in the vernacular phrase, galloping the patient to a skeleton in a few months. Phthisical patients are rarely confined to bed, until near the deplorable stages and fatal termination. Some have even a tolerable appetite; and the generality are cheered with adulatory hopes of recovery to the last extremity. The progressive encroachment is evident, by increased debility, emaciation, and partial sweats; edematous ancles; diarrhœa; depilation; consumption and melting away of the fat and muscular flesh: at last sapless, and macerated into ghosts, the twinkling vital snuff is extinguished. It is, as yet, impossible for me to apportion the comparative mortality and recovery in real confirmed phthisis; nor could I depend upon any of the general registers which I carefully consulted with this view. We may, however, venture upon a gross estimate, by negative proof. Exclusive of individual evidence, and medical attestation, we might, by a simple algebraic process out of any specified number, with their mortal diseases, and probable proportion of sick in each, sift out the consumptive. At all events, it cannot possibly be thought exaggeration to alledge, that not one out of seven consumptive recover. From hereditary entail, or tubercles, it is still more desperate.
Species of Consumption
are, hectick fever, atrophy and tabes; nervous; icterick; dorsal. Hectick fever and atrophy is described as a very frequent and fatal disease of infants, especially in cities; accompanied with emaciation, often short dry cough, hot skin and palms of the hands; quick pulse, thirst, diurnal exacerbations, sickly countenance: in some the abdomen is tense, tumid, and considerably enlarged. In simple atrophy the fever is not so acute; with tumid belly, irregular fecal discharge; voraciousness, indigestion, thirst, nocturnal sweats, unhealthy countenance. Atrophy and nervous tabes are confounded in medical diagnosticks: in both there is emaciation; but no considerable fever, cough, or difficulty of breathing; impaired appetite and digestion; leucophlegmatic sickly appearance, partial sweats; general debility, and proneness to faint on any exertion. Sometimes atrophy is circumscribed to a particular part or member. The icterick tabes is accompanied with symptoms of jaundice; and probably, under several disguises, is more frequent than medical authors have represented.
Dorsal, or spermatick, is a particular tabes; miserable spectacles of which are recorded by the celebrated Tissot. Its symptoms are, emaciation, yet good appetite; pain and weakness in the back and loins; disturbed sleep, and frequently interrupted by nocturnal dreams and pollution, either with or without pleasure; weakness of the knees and trembling of the muscles on the least exercise; sometimes a sensation as of thorns pricking the skin, and descending down the spine; pale sickly countenance, livid circle under the eye-lids; the feces and urine excreted with some difficulty, and often either with semen or prostate liquor. By degrees, the appetite decays with indigestion, hypochondriasm, melancholy; pains in various parts, headach, lumbago, universal debility, wasting of the penis, impotency and blight of future progeny. Females are not exempt from this disease; but it is much more frequent amongst the male sex, from the age of puberty through various adult stages of life: the foundation of it is often laid at schools; and in those seminaries of vice, large cities: and in some countries it is a more general habit of licentiousness than in others.
Of the predisposing and occasional causes of pulmonary hemorrhage, pulmonary phthisis, hectick, atrophy and tabes. Of pulmonary hemorrhage; hereditary; narrow thorax; weak pulmonary blood vessels, small capacity; plethora; suppressed natural or habitual hemorrhage, as nasal, hemorrhoidal, menstrual; amputation of a considerable extremity; luxurious living and indolence; violent exertion and exercise of the lungs and voice in various trades and professions; also violent efforts to cough, to exonerate the excretories; parturition; lifting great weights; violent exercise; furious passions of mind: external injuries on the thorax; wounds; confining the thorax by writing-desks, by strong whalebone stays; suppressed perspiration and exhalation of the skin and lungs by cold; light atmosphere, especially on high mountains; pulmonick inflammation; scrophulous lymphatick glands and tubercles in the lungs, or calculous concretions; polypus concretions in the large pulmonary blood-vessels; schirrus and obstruction in the abdominal viscera.
The predisposing and occasional causes of pulmonary phthisis are all the preceding causes of pulmonick hemorrhage; hereditary; scrophulous tubercles; suppuration in the lungs, and not with laudable pus; calculi in the lungs; consequence of pulmonick inflammation and suppuration, of small pox, measles, hooping cough, rickets; and of various acute and chronic diseases; venereal, icterick; chlorosis; worms; rheumatism; chronic asthma; internal abscesses and ulcers; catarrh and neglected colds; sudden suppression of perspiration, especially when the body is heated; pulmonary exhalation suppressed, and cold damp air inspired; irregularity and coldness of the climate joined to moisture; various noxious trades and occupations; noxious fumes and effluvia inspired; foul atmosphere of cities, coal fires; broken ribs and blows on the thorax; indigence; cold habitations; want of sufficient cloathing and fuel in rigorous seasons.
The predisposing and occasional causes of hectic, atrophy and tabes, are many of the causes just now enumerated: scrophulous obstructed mesenterick glands, and course of the chyle; colds; damp habitations; foul atmosphere of cities; moist cloudy atmosphere; unwholesome air; coagulated milk in the stomach and intestines; foul stomach; diseased stomach and abdominal viscera; improper diet; gluttony, sloth, uncleanliness, bad nursing, insufficient exercise; worms; repelled cutaneous eruptions and ulcers; cachexy; intoxication and intemperance; depressing passions of mind, cares, and vexations; intense study; insufficient nutriment, poverty, and want of food; frequent vomiting of food; faults in the organs of digestion; digestive fluids defective or depraved; profuse evacuations, as hemorrhages, diarrhœa, diabetes, fluor albus, salivation, seminal emission; delicate women suckling; sweats; rupture of the thoracick duct; diseases of the spinal brain; weakness of the solidum vivum; general defect of fluids, or of oil in the cellular texture; fever and absorption of the subcutaneous oil; old age and contraction of the small vessels; broken constitution, from various causes; frequent manustupration; libidinous books, prints; consequence of venereal gleets, and improper treatment.
Asthma.
In the London bills, Asthma and Tissick are forced into a connubial link: formerly it was consumption and tissick, the Italian name for consumption, and without any mention of asthma. It would appear by the London registers, that about one fortieth part of the memento mori’s in church-yards is from asthma; and its proportion to consumptive mortality as 1 to 8. I have every reason to believe that the funeral catalogue in London is not, in any outrageous degree, preternaturally overcharged with consumption or asthma. As both these diseases are properly excluded from in-patients of our hospitals, I applied to one of the largest dispensaries in London, the Aldersgate; in which there is necessarily an overflow of both these distempers; and with the intention of confronting and irradiating the bills of mortality. Almost every page of these books presented Asthma in no inconsiderable number; and above all, Phthisis, phthisis, phthisis, towering with gigantic bulk.
There is, unfortunately, in medical books such an exuberance of postulata, that I endeavoured to ascertain from facts and numbers, the sex and age in which asthma is most predominant; and also its absolute mortality. For this purpose I extracted and winnowed out of all the patients in the Aldersgate Dispensary during seventeen years, from 1770 to 1788, all the cases of asthma and dyspnœa: the result is as follows. Out of 70,000 patients, asthma and dyspnœa were 3,192; or one twenty-third of all the diseases; of which there were of males, 1613; females, 1536: dead, 169; relieved, 575: discharged, 569: cured all the remainder. The sundry ages of these were,—From birth to 10 years, 36; from 10 to 20, 25; from 20 to 30, 161; from 30 to 40, 429; from 40 to 50, 882; from 50 to 60, 949; from 60 to 70, 596; from 70 to 80, and upwards, 114.
From the preceding valuable records, and which, in this instance, happen to chime with the gross of medical observations, we may draw the following inferences: That in infancy and adolescence there are very few cases of asthma and dyspnœa: that these diseases chiefly occur in middle age and the decline of life: that more than one half of them are reported as cured; the relieved and discharged forming a neutral list, numbers of whom were either surfeited with medicines, or were discharged by their physicians when despairing of a radical cure, or fearful of their swelling the dead catalogue: in sinking of which there is a universal rivalship throughout our dispensaries and hospitals. Some of them, probably, were palliated, vamped, and amended; and indeed many were aged, for whom it would be unreasonable to expect a radical cure. I conceive, that with a part of them we may venture to double the dead list; which would raise asthmatick mortality to one of ten. But in the above estimate, what proportion legitimate periodic asthma bears to the other anhelations I could not fathom.
The term Asthma has been misapplied to every species of dyspnœa: it strictly denotes a chronic periodic difficulty of breathing, recurring and exasperated in paroxisms; and, at least in the intervals, without fever. Authors have subdivided it into several species; the spasmodic, convulsive, and periodical; the dry, humid, continued, flatulent: and from the gradations of difficulty in respiration, dyspnœa, orthopnœa. The periodick and spasmodick is the true disease. Generally, the day preceding the paroxism there is fulness of the stomach, impaired appetite, flatulence, eructation, tightness, and stricture about the breast, and difficulty of respiration; sometimes dry cough; the diaphragm descends with difficulty in inspiration: these are all increased by wine, fires, bed, and heat: the head is stupid, heavy, with slight pain, drowsiness, languor, yawning, restlessness of spirits; profuse excretion of colourless urine.
Asthmatic paroxisms commonly invade suddenly, or are greatly aggravated during the night, with constriction in the breast, anhelation and struggling in breathing, so that all the muscles of the thorax and shoulders are roused into action to enlarge the capacity of the lungs: this difficulty is greatest in inspiration: the patient is compelled to sit erect, or recumbent in bed, panting for breath, cool air, and drink; and can with extreme difficulty cough, expectorate, or speak: the respiration is slow, laborious, wheezing, and sonorous; with painful propensity to cough: from the interrupted circulation of blood through the lungs, the face and eyes are turgid and livid, in some the face is pale and bloated; with headach, somnolency; palpitation of the heart; weak and intermittent pulse; internal burning heat, and often cold extremities; eructation and flatulence, sometimes vomiting; difficult and sonorous deglutition; sweats; limpid urine; restlessness, or disturbed sleep. Some lay easier on one side than on the other. Many are under the necessity to sit erect in a chair during several days and nights, gasping for breath, not daring to repose in bed. Should both lobes of the lungs be equally constricted, the compound offices of this pneumatick and hydraulick organ will be obstructed, with more threatening symptoms of suffocation and strangling. A loaded stomach, close chambers, fires, beds, wine, noxious smells, all aggravate the paroxism.
In the duration, recurrence, intermission, and remission, asthmatic paroxisms vary. A few hours, or a few days, are the usual limits of this pulmonick tumult. In the beginning it continues only a few hours, with a diurnal remission and nocturnal renovation: in the chronic state, from two to five days is the usual duration. As the paroxism mitigates, there is flatulent explosion upwards and downwards, often with fecal discharge, and expectoration of mucus. The intermissions are proportioned to the duration of the paroxisms: the longer the paroxisms the longer the intervals, and vice versa: with a copious expectoration they sooner terminate, and are less severe. Some have had as many paroxisms in winter as in summer; and in the country as in town. Floyer had sixty in winter and twenty in summer: the latter, as usual, were more violent, and longer. During calm frosty weather asthmaticks are most secure; but at all points of the compass the paroxism may invade. Some find more ease in the city than country; others, in low ground than mountainous. Some are never entirely liberated from dyspnœa, and with periodical aggravations. Few, comparatively, die immediately in the asthmatic paroxism: numbers survive many years, even to the goal of longevity, and, emaciation excepted, without considerable diminution of strength, spirits, or appetite. After long continuance, it seldom admits of a radical cure; but only alleviation and respite. Its fatal terminations are suffocation, apoplexy; pulmonick inflammation; consumption, cachexy, partial or general dropsy; polypi in the heart and the large vessels.
The predisposing and occasional causes are hereditary; original structure of the pneumonick organs; narrow thorax; plethora; suppression of habitual or natural evacuations, and cutaneous eruptions, as menses, piles, old ulcers, sweat of the feet; consequence of catarrh and colds, and sudden suppression of perspiration: serum, pituita in excess; cachexy; dregs of fever, small pox, measles, and pulmonick inflammation; pulmonick tubercles; spasmodic stricture of the diaphragm and bronchiæ; smoky rooms and houses, especially with wood fires; noxious mineral and metallic fumes, arsenical, nitrous, sulphureous, saturnine; smoky atmosphere of cities; pulverulent trades, as stonecutters, lapidaries, millers, flax-dressers, chimney-sweepers; fetid offensive smells; sudden changes of weather and winds from heavy to a light atmosphere, portending storms, and especially snow; easterly winds; fogs, with unsteadiness of weather and seasons; possibly some secret alterations in the electrick fluid, and affecting electrometers; warm and moist air; errors and intemperance in food and drink, and ingurgitation; violent motion and agitation of body and of mind; symptomatick in various diseases, as hystericks, hypochondriasm, gout, pectoral dropsy, empyema, polypi in the heart or aorta; wounds of the lungs; diseases of the liver and spleen.
Dyspnœa and Coughs
are symptoms of many diseases; and they are also primary, and very general maladies, especially in this island. It is true, we have here no compass to steer by: these are an exploded banditti; a sort of rebels to the symmetry of system, whose diagnosticks and therapeuticks are as yet slovenly and imperfectly noticed by medical authors. From the universal connection of the organs of respiration, their functions are more or less interrupted by and warped with other diseases and morbid symptoms. Many of the chronic impediments in breathing, and the broken-winded, may be called asthmatic excrescences, without its periodical paroxisms, exacerbations, and remissions; and without any rapid emaciation or hectick: they are spurious asthmas and chronic catarrhs. All the parts about the fauces and pharynx are crowded with mucous glands, from which, as in angina and catarrh, there is often a profuse secretion. Many persons advanced in life, and the aged, have a large discharge of mucus, variously, from the fauces, pharynx, larynx, lungs, stomach; all requiring frequent expectoration or hawking. The predisposing and occasional causes are many of those already enumerated under consumption and asthma. To these may be superadded cold pituitous temperament; air hot, cold, weighty, light, moist, impure, stagnant; changes and vicissitudes of the winds; cold moist climate and atmosphere, and especially in winter, autumn, and spring, and interchanges of the seasons; sudden vicissitudes, disorders and inconstancy of the surrounding elements; suppressed perspiration, and pulmonary exhalation; catarrhal defluxion on the lungs, larynx, fauces; mucus in excess, tenacious; faults in the mucus glands and ducts; trachea too sensible or irritable; calculi, chalky concretions, and inspissated mucus in the larynx; vascular or parenchymatous diseases of the lungs; original faults of the lungs, bronchiæ, larynx; wasted lungs; extravasated air; spasm of the respiratory muscles; flatulent farinaceous food, slimy food, and drink; weak or foul stomach, voraciousness; infants swallowing saliva; symptomatick in various diseases of the thorax, as consumption, asthma, empyema, polypus, aneurism, cum multis aliis: symptomatick in various diseases of the abdomen interrupting the play of the diaphragm; as full stomach, flatulence; pregnancy; dropsy; enlarged spleen or liver; tympany; nephritis; worms; injured abdominal muscles.
Catarrh,
colds, influenza, coryza, gravedo. In our irregular climate, during the annual revolution of the seasons, few escape slight catarrhs and colds, to which all ages are liable. That particular epidemick species of erratick catarrh, called Influenza, has sometimes spread suddenly over a kingdom, and some the greatest part of Europe. In no other epidemick do so few die in proportion to the number infected. Its continuance is generally short; and the little depredations committed during its itinerant incursions, are principally upon declining, consumptive, asthmatick, those of diseased lungs, worn out constitutions, and aged. In such forlorn complaints, catarrhal influenza has hastened the final dissolution sooner than it would otherwise have happened. In some, from neglect or irregularity, it has excited consumption, or pulmonick inflammation: in others, recovering from fevers, and convalescents of various descriptions, it has occasioned relapses. These observations are also applicable to simple catarrh skirmishing in less formidable inroads. Frequent relapses, from imprudence, in persons of phthisical or asthmatic constitutions, may expedite the inflammation of latent tubercles; or in aged persons subject to pituitous coughs, spurious peripneumony.
Catarrhal symptoms are increased secretion of mucus, from the membrane of the nose, fauces, and bronchiæ, with slight fever. It generally begins with some difficulty of breathing through the nose; dull pain and weight in the forehead; oppression in moving the eyes; distillation from the nose, sometimes from the eyes, of a thin fluid, often acrid, and exciting frequent sneezing; lassitude and languor of the body and spirits; sometimes shivering and heat, and increased sensibility to cold air; hoarseness, soreness of the trachea and fauces, with some difficulty of breathing, frequent cough and irritation at the glottis, at first dry; sometimes slight inflammation or angina, and pains resembling rheumatic about the neck and head. In some, the appetite is impaired, but not considerably; but in all the smell and taste. By degrees, the cough and sternutation are accompanied with a copious excretion of mucus, progressively incrassating, with less laborious efforts of coughing and hawking. Some catarrhs or colds, affect principally the membrane of the nose, and the different sinusses or cavities communicating with that emunctory; wherein stagnating mucus becomes more tenacious: others are lower situated in the fauces, pharynx, and trachea. Catarrh seldom continues beyond a few days, or weeks: that from contagion is more febrile and chronic. The predisposing and occasional causes are, cutaneous perspiration and pulmonary exhalation suddenly checked; cold moist atmosphere; sudden atmospheric changes; cold habitations and beds; wet feet; head or breast exposed or naked, thin ragged clothing; excessive effeminacy and warm rooms; epidemick state of the air.
Hooping Cough,
chincough, tussis convulsiva, epidemick, and contagious: is generally prevalent in infancy and adolescence, and but once in life: adults are rarely afflicted with it; and it is not confined to any particular season of the year. In the London registers, hooping cough and cough are confounded, and conjointly make no inconsiderable augmentation to the funerals. By the records of Dr. Armstrong in the dispensary of infant poor, of 732 cases of hooping cough, only 25 died; that is, about 3½ per cent. or 1 of 33. But this is too favourable a representation as a general scale of mortality. Its beginning resembles a slight catarrh continuing some days, or one, two, and three weeks before the formation and maturity of the convulsive paroxisms. These consist of many successive expiratory motions, so as to exhaust the lungs of air, succeeded by a full inspiration and pulmonick gulp, which rushing thro’ the glottis, makes a particular loud hooping sound. The duration of these pneumonick convulsive paroxisms, is from one to several minutes, in which the child’s face is turgid with blood, tears trickle down the cheeks, and it seems almost in the agony of suffocation and strangling. At the termination of each paroxism there is usually some mucus expectoration and excreation: this, at the beginning, is thin and not considerable; but by degrees increases in quantity and tenacity; and frequently at the same time, the contents of the stomach are evacuated. The pneumonick convulsions vary in their recurrence: they often return, frequently in the course of twenty-four hours, especially during the night: and thus may continue to persecute from one to three months, and sometimes a much longer space. Throughout, the senses are not injured; nor in the beginning the appetite; and in the intervals, children return to their amusements as if nothing had happened.
The younger the child there is more danger; as also in those born of phthisical or asthmatic parents, or in a state of debility, when seized with the hooping cough. When it begins in the form of catarrh, and is attended with fever, difficulty of breathing, and little expectoration, it may prove fatal in the early immature stages, unless the convulsive cough supervenes, and with copious expectoration. After some continuance of the disease, fever, with nocturnal exacerbation and difficult respiration, sometimes occur, and always with danger. Some fall down in the paroxisms; others have convulsions: violent paroxisms of coughing have excited epilepsy, apoplexy, or suffocation; but fever, dyspnœa, and pulmonic inflammation are to be most dreaded. With moderate expectoration the paroxisms are neither frequent nor violent: but expectoration in either extremes of scantiness or excess are both unpropitious, more especially with dyspnœa. Paroxisms terminated by vomiting, and succeeded by craving for food, are favourable omens; and recovery may be predicted by longer intervals from coughing, and shorter paroxisms; by restitution of natural appetite and respiration, of tranquil sleep, of fecal excretion, by evanescence of fever, and recruit of strength. The predisposing and occasional causes are, a certain epidemick state of the air or specifick contagion, the nature of which, and in truth of the disease beyond empirical observation, are as yet very imperfectly understood.
Croup,
suffocatio stridula. This disease has been particularly discriminated by modern authors. It is principally inimical to children, seldom until after ablactation; and never after the age of twelve, or of puberty at the utmost: it may attack the same child more than once: it is most frequent in winter and spring; and is not contagious nor general amongst the community. It commonly invades like a catarrh; and sometimes with its own permanent features, which are sudden paroxisms, as in spasmodic asthma, of laborious struggling respiration, and wheezing, as if the air-passage was straited; hoarseness, and shrill ringing sound, both in coughing and speaking, as if the voice came through a brass tube; cough, if any, dry, or with excreation of membranous fibres; thirst, quick pulse, anxiety, restlessness; and during the intervals, the senses and appetite are unimpaired: sometimes there is appearance, sometimes none, of inflammation in the fauces. It is always dangerous, infinitely more so than the preceding disease: death may suddenly ensue on the third, fourth, or fifth day, and perhaps when no such event was suspected: the impending hurricane may be prognosticated by laborious struggling in respiration, and symptoms of strangulation; with anxiety, restlessness, quick weak pulse.
The predisposing and occasional causes are yet the subject of litigation; whether inflammatory, or spasmodick, or a combination of both. On dissection, mucus accumulated has been found lining the larynx, by degrees incrassating, and interrupting the air from entering the lungs. We require same additional illumination on this subject.
A Miscellaneous cluster of diseases
are now to be developed. In the majority of these, however, some few general features of affinity may be traced: such as their affecting, directly or collaterally, the head, the brain, or its numerous diverging chords, the nerves; or the inherent muscular energy. But in many other circumstances of cause, diagnostick, prognostick, and therapeutick, they are disunited. And in every possible arrangement such defects are irremediable.
Headach.
No parts of the human organization are more prone to transitory interruption and disorder than the head and stomach: between the two there is a close connubial sympathy: to these two important centers many other maladies and remote perturbations converge, or reverberate their affliction. We here treat of headach as a primary disease; or at least as the principal symptom. From this calamity, in the extreme, the lives of many are rendered wretched. The London bills neither convey an adequate representation of cephalgick fatality, and far less of its general contentious torture of the human species. Headach has been subdivided by authors into the idiopathick, symptomatick, general, local, internal, external, chronic, periodic, and temporary; into cephalea, cephalalgia, hemicrania, clavus, megrim. In the seat, duration, recurrence, and pain, there are many varieties and gradations. Trespassing on the throne of sensation, it is evident the corporeal and mental functions must lament the subjugation.
The predisposing and occasional causes are, hereditary; sanguineous plethora; suppression of habitual hemorrhages, as menstrual, hemorrhoidal, nasal; perspiration checked; cold feet; cutaneous pores blocked up, and not sufficient perspiration; stomach foul, disordered; food or drink disagreeing; gluttony; ebriety; unwholesome quality of fermented or distilled liquors from accident or design; costiveness; violent exercise of body or mind, voice and lungs; immoderate determination of blood to the head from causes corporeal or mental; much stooping of the head; disagreeable passions and anxiety of mind, exasperating or depressing; study in excess; state of the winds and weather; of the points from whence winds blow; the variations in the barometer and electrometer; the muddiness and fogs of the atmosphere; cold; heat; foul air; crowded rooms, theatres, and other assemblages of mankind for amusement or business; offensive smells and vapours; fainting; inanition; excessive evacuations; intermittent; rheumatick; arthritick, hysterical; nervous; scorbutic; impure blood; cachexy; venereal; lunar; caries of the skull; diseases in the diploe; abscess, insects, or inflammation in the frontal, ethmoidal, or sphenoidal sinusses; first branch of the fifth pair of nerves particularly affected; carious teeth; various diseases within the brain; external injuries: symptomatick in fevers; hydrocephalus; and many other diseases besides those above enumerated.
Night Mare,
incubus, ephialtis, pavor nocturnus. Oppressed breathing during sleep and sensation of load in the breast, and of suffocation; terrifick dreams, fantasies, apparitions, visionary encounters, and dangers; by which the person is at length awaked in agitation, palpitation, and sweats. It attacks generally the dormant in a supine posture. Some infants and children, during sleep, are also disturbed with anxious groans, and exclamation. The predisposing and occasional causes are, plethora; heavy suppers; ventricular crudity, indigestion, gluttony, flatulence; worms; head laid low in bed; intense application of mind, and various passions: symptomatick in some fevers, in hystericks, hypochondriasm, hydrocephalus, hydrothorax, aneurism, and polypi; sometimes is a prelude of apoplexy, epilepsy, &c.
Apoplexy.
Under this we shall aggroup several inferior species of vortex and stupor in the imperial seat of reason and motion; as lethargy, coma, carus, cataphora, vertigo. By apoplexy and suddenly, in the London registers, between one eightieth and ninetieth part of the community seem to be destroyed: and this mortality would be magnified by the addition of many who are reported as found dead. In the last 30 years of the preceding century, apoplexy and suddenly stands at 3010: Lethargy at 488: and megrims now omitted at 45. This thunderbolt of death, or in the phrase of one of the British poets, “that knocketh man down as butcher felleth ox,” is principally hostile to those advanced in years, and the aged: to those more especially of large heads and short necks, of corpulent habits, indolent life; to the full feeders, or the addicted to frequent intoxication. Medical observations also represent it as affecting more of the male than the female sex; as more predominant in winter and spring, especially on vernal heat succeeding winter cold; or moist rainy weather supplanting cold, and vice versa. It is also said to be more general and fatal in the city than the country.
Apoplexy may attack suddenly; in other cases it is preceded days, weeks, or even months before the shock by vertigo, obscure vision, noise in the ears, dullness of memory, faultering in the tongue, difficulty of articulation; in some the mouth is distorted, with transient torpidness or tremor of different muscular parts, headach, drowsiness, night mare, nasal hemorrhage, flushing of the cheeks, lachrymation, decay of strength, alteration of countenance and voice. In the paroxism the patient, instantaneously stunned, falls down, with suspension of the functions of the external and internal senses, of voluntary motion, and of voice and speech; and with muscular relaxation; at the same time the pulse and respiration remain nearly in the natural state, excepting that there is generally a stertor in breathing, resembling a profound sleep from gross intoxication; and also, as in most soporous diseases, the circulation slow. These unmolested functions of the heart and lungs distinguish it from syncope. In the duration and severity of the symptoms, there are different gradations. Some lay in this lethargic state insensible to every object and impression: some when spoke to, only groan or make dumb signs: some, after a short time, are able to articulate: in some, there is froth at the mouth: the colour of the face is various, sometimes flushed, sometimes however pale; and the signs in authors between the sanguine and serous apoplexy are extremely ambiguous.
It often proves fatal at the first stroke; few can survive many attacks. Death, recovery, or transition into palsy, are generally decided within seven days. In magnitude of danger, perhaps no other disease can contend with this formidable antagonist: but I shall leave it to others to graduate the apoplectick scale. Some recover; in others it ends in death or hemiplegy, which is but a sad alternative and capitulation for life: and too frequently is accompanied with some lesion of the mental functions. Even of those who recover, they are in danger of relapses from intemperance, and errors in the non-naturals. The violence and contumacy of the symptoms indicate the degrees of peril: the less the functions of internal and external sense, and of voluntary motion are injured, our hopes are more flattering; whereas total insensibility, froth at the mouth, cold sweats on the breast and face, cold breath, involuntary excretion of feces and urine, are harbingers of impendent wreck in the apoplectic whirlpool.