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.