The chart of London diseases demand some criticism on that inextricable miscellany surfeits, stoppage of the stomach, vomiting, cholick and gripes, bloody flux. In the last century, surfeits make a monstrous article in the chronicle of deaths, amounting in some years to four hundred; whereas, during fifteen years of the present century, they sink down to only fifteen. Yet all are witnesses that good eating and gormandizing are not worn out of fashion in this metropolis. Medical men know that surfeits and intemperance are often merely predisposing or occasional causes of diseases: they may rouse latent disorders, or dispose the body to receive noxious impressions externally. The searches therefore formerly, as I suspect, made many of these reports from the ostensible cause which they imagined gave birth to the disease and mortality. At the same time, I am not contending for the delicacy and moderation of our forefathers appetites. They were unquestionably in the last century, and partly indeed from the cheapness of flesh-meat, and scarcity of vegetable nutriment, more carnivorous in their diet than the present generation.
Stoppage of the stomach also, is a morbid centaur in the last century. It would baffle the ingenuity of an antiquarian to decypher the true import of this term: severe sickness, or the word Abracadabra, would be full as intelligible. It is a vulgar name for rejection of food; and there are few diseases in which the stomach does not sympathize. What proportion of the mortality of infants, adults, or the sexes, are crammed into this absurd article, I submit to the reader’s criticism.
An important circumstance, and overlooked so far as I know, by all the calculators and criticks on the rise and fall of infant diseases in London, and especially of convulsions, is this. In the first column of 15 years, at the beginning of the present century, colick and gripes of the guts amount to 13668, but continue through every succeeding column to diminish; and in the last or fifth, dwindle to 769 only. What is meant by this complaint, colick and gripes? was it dysentery? We observe that bloody flux makes a separate, though small group, through all the five columns. Were these two diseases confounded in the annual reports? or may it not be alledged, that many infant diseases and deaths, which were formerly crowded into colick and gripes, are in modern times transferred to the vortex of convulsions? I am aware that, in reply, it may be suggested that drains, sewers, drier lodgings, less damp, alteration in diet, and the more plentiful use of vegetable and fermented liquors, have decreased dysenteric complaints in this city; and also, that Dr. Sydenham, in 1670 and 71, describes an autumnal dysentery as annually prevailing in London, and about two months in duration. Turning the subject into every possible view, I continue to suspect that numbers of infant diseases, and commonly terminating fatally in convulsions, were formerly heaped into gripes and colick; for during the last thirty years of the preceding century, they amount to the enormous number of 69,799.
Diseases of the Stomach
are idiopathick and symptomatick. Under the present head we shall include inappetency, indigestion, nausea, vomiting, eructation, acidity, cardialgy, heartburn, regurgitation of bile, pica, soda, pyrosis, hiccup, rumination. Several of these are obvious symptoms, and are often complicated. Inappetency is generally accompanied with nausea. Foulness or feculence in the stomach, is indicated by weight and load in that region, anxiety, nausea, eructation, disagreeable taste in the mouth, foul tongue: the state of the gustatory organ is some index to that of the stomach. Acidity in excess will excite eructation, flatulence, heartburn, gnawing pain in that part, irregular appetite and craving, colicks, gripes, diarrhœa, vomiting. In infants, acidity is very frequently predominant; hence acid eructation, restlessness, gripes, green curdled feces, tumor of the abdomen, dyspnœa, sometimes costiveness, or diarrhœa, and sometimes dry cough, and muscular paleness and flaccidity. Of bilious regurgitation there are various gradations: with severe sickness at the stomach, nausea, bilious vomiting, bitter taste on the tongue, and its surface furred; inappetency, frequently colick; sometimes temporary jaundice. The cardialgy is a severe pain, threatening syncope. The pica an aversion to natural aliment, and craving for unusual. The bulimy is a monstrous appetency for food. The heartburn denotes a sensation of uneasiness, heat, and acrimony: the soda, or water-brash, a burning heat in the stomach and fauces, anxiety, acid eructation, exspuition of lymph, and fretting the edge of the teeth.
The pyrosis, or cardialgia-sputatoria, is more frequent and endemic in some countries than others; and, it is alledged, more amongst the poor than affluent, and amongst females than males; and of the former, the single and barren: it rarely occurs in puberty, or in old age. The pain at the stomach and back is often very severe, and with anxiety, until the torrent of watery fluid bursts forth, which, after continuing one or two days, intermits: but relapses are frequent, and the disease is contumacious. The hiccup, or sudden convulsive inspiration, is a complicated affliction of the stomach and diaphragm. Of rumination in the human species, there is scarce an instance in a generation.
The predisposing and occasional causes of the preceding diseases of the stomach are in general, weakness of the muscular coats; diseases of its nerves; small omentum; the digestive menstrua as bile, saliva, mucus, defective or depraved; frequent exspuition and waste of saliva; slow digestion, and food corrupted in the stomach; crudities in the stomach; vitiated chyle; excess of pituita, acidity, bile; relaxed pylorus, large stomach, calculi in the biliary ducts; scirrhus stomach, pancreas, liver, spleen, duodenum; mucus of the stomach abraded; ulcers, cancer, depression of the xiphoid cartilage; frequent emeticks and purgatives; valetudinarian regimen, too much physick, quackery, and care about health; gluttony, epicurism, pampered indulgence of that passion and appetite; frequent surfeits; dram-drinking; malt liquors in excess; the aliment in quantity or quality, or in multiplicity at one meal, injurious; ravenous ingurgitation at meals, and imperfect manducation; fat, rancid, corrupted, salted, and indigestible farinaceous food; tea, tobacco, watery liquids: in infancy, acid milk, sucking to excess, curdled milk in the stomach; superfluous acid generated in the stomach; too violent agitation in the nurse’s arms; passions of the nurse; too tight bandages; saliva swallowed in excess during dentition; too much vegetable diet and milk: to the catalogue of general causes may be added various depressing and cankering passions of mind; cares and troubles; want of sleep, intemperate study, sedentary life, unremitting application to sedentary business; moist cold air, foul air of cities; leaning forward on the stomach, and improper postures of the body; costiveness; suppression of salutary evacuations and cutaneous exanthemata; sanguineous plethora; conference of hereditary infirmity, bad health, old age, chlorosis, worms, gout, rheumatism, intermittent and remittent fevers, and of various other acute and chronic diseases; poisons; extraneous substances swallowed, contusions on the head; external injuries; blows and falls.
Cholera Morbus
is much more frequent in tropical and warm climates; and in northern regions in the summer and autumnal seasons; especially in unusually hot summers. The disease is not unfrequent in this island and metropolis; nor is it entirely restricted to the warm season only. The symptoms are sickness and nausea, succeeded by violent vomiting and purging, of a bilious nature, with gripes, tenesmus, tension of the abdomen, anxiety, great prostration of strength, intense thirst, cardialgy, and sometimes muscular spasms in the lower extremities. The vomiting and purging either commence about the same time, or alternate with each other: and throughout its rapid race there is seldom any fever. It is often a salutary effort of nature, by which a superfluity of bile is disembogued; and in cases of ordinary violence, may continue a day or two, and then cease. In more tremendous assaults it sometimes proves fatal in twenty-four hours; portentous omens of which are violent vomiting and purging, sudden prostration of strength, quick weak pulse, hiccup, fainting, cold sweats and extremities. The predisposing and occasional causes are, hot climate and seasons; in warm climates extreme heat and dry weather, succeeded by a fall of rain and coolness of the atmosphere; sudden changes of weather; increased secretion of bile and corrupted bile; surfeits, intemperance, accumulation of feculence in the intestines and liver; excess of food or drink without sufficient exercise; indolence, luxurious living and sedentary life; malt liquors; passions of mind; repulsion of cutaneous eruptions; gout; poisons; worms; symptomatick in intermittent and remittent fevers.