Some adult mortality, but in all probability a very inconsiderable portion, is included in convulsions: infants are the principal victims. The convulsive list diminishes during the latter half of the present century: but to unravel the problem respecting convulsive increase or decrease, requires more elaborate investigation than preceding calculators and criticks seem to have suspected. It is necessary to contrast the deaths by convulsions and teething with the christenings; for if more are born, more should be expected to die in infancy. We must also take cognizance of some other titles of London diseases, particularly stoppage of the stomach, colick and gripes of the guts; both which have already been under review. Besides, chrysoms and infants, an obsolete term, denoting the deaths in the first month after birth, is long exploded from the bills, and probably ingulfed in convulsions.
Dentition.
It is probable that the mortality under this head is exaggerated enormously in the London registers, amounting to one fifteenth part of the annual burials. Dentition usually commences about six or seven months after birth; sometimes not before ten, twelve, or eighteen months, and, in some extraordinary instances, not before two years of age. These sharp bones, in piercing the tender gums, often excite exquisite pain, restlessness, fever, flow of saliva; the infant’s hand is frequently thrust into its mouth; it bites the nipple; sometimes the gum is swelled at the jutting of the tooth, and a pale spot appears at the part where it endeavours to protrude. When dentition is out of the natural order, it is generally painful: in the natural progress, the two foreteeth of the lower, then those of the upper jaw; next, the two adjacent of the upper, and afterwards of the lower jaw, cut their way. After the eye-teeth, or canine, in the upper, and those two opposite to them in the lower jaw are protruded, the danger of teething is generally escaped. It is only in the first dentition, that is, under two years of age, that mortality ensues from this source: the fatal and most frequent transition is into convulsions. About two years of age, infants are generally provided with twenty teeth for the purposes of mastication: and this number remains stationary until after seven years from birth, when all the first set are gradually and successively thrust out by others deeper seated in the jaw bones; about the age of fourteen all are excluded; and in adults the number is increased to thirty-two.
Rickets.
Notwithstanding the omission of ancient authors to discriminate this disease, we cannot believe but that, in this instance, the same causes would in all ages have produced the same effects. Rickets would seem by the London registers to decrease; for in our last group of fifteen years they shrink to 104; whereas in the thirty last years of the preceding century, ricketty deaths are numbered at 11,415. To what cause is this decrease to be ascribed? Does it indicate more maternal attention, and also more propriety in suckling and rearing of infants? Is implicit faith to be placed in the London registers, and crimination of diseases?
Rickets, one of the chronic diseases, seldom commence before three, six, or nine months after birth, generally between nine months and two or three years of age, and seldom or ever after five. The progressive symptoms are aversion to motion, and to put the feet to the ground, decrease of strength, paleness and flaccidity of the muscles, wasting of flesh, although in many the appetite is voracious; enlarged belly, liver, spleen, head, and joints; tumid and tympanitick abdomen; laborious respiration; dentition later or slower than usual; carious teeth; fetid breath; premature acuteness of genius and reason than is natural to the years; the countenance serious and ancient; the infant waddles in its gait, the spine and bones of the lower extremities become crooked and deformed, the breast prominent. The earlier rickets commence, they are more contumacious; and when chronic or fatal, are frequently accompanied with hectic fever: they may continue several years, and at length terminate in general bad health, atrophy, dropsy. Should they not be checked before the fifth, or at the utmost, the eighth year, irremediable deformity must ensue, which in females is often the cause of distorted pelvis, and difficult labours. The predisponent and occasional causes are hereditary; weak diseased parents or nurses; negligent nursing; not sufficient exercise nor cleanliness; improper diet and gross food; worms; foul stomach and intestines; scrophulous obstructed mesenteric and lymphatic glands; diseased liver; general bad health, with hectic fever; various causes of atrophy; difficult dentition; faulty state of ossification; deficiency in the ossious rudiments; faults in the organs of nutrition.
Thrush.
In the preceding century, Canker was often joined together in the London registers with Thrush; but whether it should be coupled with this or with gangrene, or with both, I cannot determine. Thrush is principally a disease of early infancy: it is likewise often a concomitant symptom of some febrile and acute diseases of adults. It infests not the young alone, but also aged persons, especially in cold northern and moist climates, in damp situations, and in warm rainy seasons. As an idiopathic disease of adults, it is rare in this island. The disease generally appears first on the tongue and roof of the mouth, in small superficial red specks, and ash-coloured ulcers, spreading gradually over the palate, fauces, cheeks and lips; with anxiety, restlessness, pain, difficulty of suction and deglutition, fever, nausea, vomiting. After some time, the ulcers form thick, tenacious incrustations, shining like lard, ash-coloured, brown, rarely black: these crustaceous layers scale off, but, not unfrequently, after the interval of a few days, are again renewed: the oftener the worse: and in such cases they may be protracted weeks. When the raw skin appears dry under the crusts after desquamation, they are reproduced; moisture there indicates a speedy and favourable termination: diarrhœa frequently supervenes.
In order to prevent the superfluous multiplication of symptoms and diseases, and which are common to all ages, I have, under the respective titles of Vomiting and Acidity, Colick, Diarrhœa and Watery Gripes, diseases so frequent and harassing in infancy, added the discriminating marks and peculiarities in those early years. Small pox, measles, hooping cough, croup, dropsy of the head and spine, phthisis, hectic and atrophy, scald head, rash, worms, have each been the subjects of preceding investigation: ruptures make a part of our subsequent inquiry.