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.
Of lethargy, coma, carus, cataphora. These denote different degrees of
profound deep sleep without delirium. Authors have often confounded
them with the febrile class, especially the “_lusus naturæ_” of
remittents. To this irresistible torpor and drowsiness, even at meals
or in conversation, many corpulent and fat persons are subject. We
also read in authors of some extraordinary instances of profound long
protracted sleep, from which it was impossible effectually to rouze the
person. The vertigo has also been distinguished into simplex, scotomia,
caduca. In this disease all objects, although at rest, seem to whirl
round; sometimes with headach, flushing of the face, noise in the ears;
and if not supported, the patient often falls down. It is commonly
fugacious, and momentary; seldom above a minute; and in some diseases
is symptomatick. The prognostick may be deduced from that of apoplexy.
Of the predisposing and occasional _causes_ of apoplexy, lethargy,
coma, carus, cataphora, and vertigo: hereditary; short neck; plethora,
general or partial, sanguine or serous, especially sanguineous
plethora in the vessels of the brain; tight neckcloaths; pressure
on the descending aorta, cava; serous or sanguineous exudations or
extravasations in the brain; compression of the medullary substance,
or of the origin of the nerves; suppression of habitual evacuations or
hemorrhages, nasal or hemorrhoidal; habitual venesection neglected;
old ulcers dried up; full and long continued inspiration loading the
vessels of the head; blood forced on the brain by violent efforts of
coughing, vomiting, fecal expulsion, exercise, venery, stooping the
head; salivation suddenly suppressed by cold; foul stomach, gluttony,
surfeits, luxurious living, and sedentary life; fatness, corpulency;
intoxication, sottish potations; violent passions of mind irascible
or stimulating, and also depressing, as anger, ambition, chronic
melancholy and cares; intense meditation and study; intemperate lust in
old age; noxious vapour from liquors in fermentation, from charcoal,
quicklime, and new-plastered walls; particular effluvia and odours
concentrated in large quantity; crowded rooms filled with animal
steams from the lungs; thunder; sometimes epidemick state of the
air and elements, or perhaps celestial influences not yet explained;
intense cold; warm baths; blood rarified and expanded; insolation; some
narcotick poisons, as opium, hyoscyamus, cicuta, laurus, belladonna,
and some fungi: obstructed circulation through the lungs and heart,
from asthma, polypi, ossifications of the large blood vessels or
valves, and particularly of the right ventricle; external injuries
of the head; concussion, fractures. The most frequent cause is,
accumulation and congestion of blood in the brain: but sometimes, on
dissection, no disease is discernible; and effusions in the brain do
not always inflict apoplexy.
Of vertigo, the causes are several of those just enumerated: the
principal, plethora, suppressed hemorrhages; suppressed perspiration;
luxurious diet, gluttony, somnolency; foul or disordered stomach;
costiveness; intoxication; narcotick and tobacco fumes; unremitting
attention of mind to study or business; restlessness, mental distress;
hunger, inanition, debility; obstructions and diseases in the retina or
optick nerves.
_Palsy._ Paralysis, hemiplegia, paraplegia. During the last thirty
years of the preceding century, paralytick mortality is only 630 in
the London bills; but in the present century is doubled and trebled;
and some part of this surge can be readily accounted for by the
multiplication of the mechanical arts, in which lead and quicksilver
are employed. At present, its mortality seems to stand in the
proportion of one third or fourth to that of apoplexy. Of 310 patients
afflicted with palsy and hemiplegy, and admitted in the course of 10
years into the Bath hospital, 57 were cured; that is, 7 _per cent._
or 1 of 15; there died 15, or 5 _per cent._; and the remainder were
found incurable and discharged, or received some trifling relief; and
several of these might be added to the dead list. I doubt whether by
the artillery of the shops we are so successful against this crippling
foe. A considerable number of the community are rendered helpless and
decrepit from this disease; to which some trades, more than others,
are obnoxious; and adults and aged infinitely more than the young and
adolescent.
Palsy and apoplexy often alternate, and may then be termed one
bicipitous disease. Severe apoplectick strokes, if not immediately
fatal, frequently remit, and pass into palsy: or the catastrophe may
originate in hemiplegy, which is the most frequent form of palsy; and
when fatal, it is through the apoplectick explosion. In palsy there is
more or less diminution or privation of muscular motion and feeling,
without pain or fever, or injury of appetite. This may affect the
muscles of voluntary and of involuntary motion; the whole, or only a
portion of each: as muscular impotency of one side, or half of the
body; of one or both of the lower or upper extremities; of some smaller
portion of the face, eyelids, tongue, œsophagus, stomach, intestines,
the sphincters of the bladder and anus, the penis, bladder, kidneys,
heart. Under this deplorable calamity many linger years; some confined
like a shellfish, and motionless; others crawling upon crutches. Tremor
may be ranked as an inferior vassal of palsy.