apoplexy; various diseases of the cerebrum, cerebellum, and medulla
oblongata; diseases of the inherent muscular power; vapours from lead,
mercury, arsenick; colica saturnina; compression of nerves; abscesses
in the lumbar vertebræ; falls, external injuries, blows on the head
or loins, luxations or sprains of the lumbar vertebræ; spinal dropsy;
fractures; venery. Of Tremor many of the causes of apoplexy and palsy;
hereditary; old age and decay of the inherent nervous and muscular
energy; compression or obstruction of the nerves; poisons; opium;
employments in lead and mercury; ebriety; suppressed evacuations;
sanguine plethora; repelled cutaneous eruptions; lurking gout; general
debility; external injuries; warm fluids; strong tea; excess of venery;
long watching; anxiety; passions of mind; sedentary life; excessive
evacuations.
_Epilepsy._ Morbus sacer, demoniacus, caducus, falling-sickness. In the
last thirty years of the preceding century, thirty-five deaths only are
marked in the London bills to epilepsy; and in the first forty-five
years of the present century, they dwindle to thirteen: at present the
title and disease is omitted. Medical men know, that no inconsiderable
number of the community are tormented with this frightful convulsion,
which the ancient Jews could only ascribe to the malicious rancour
of an infernal devil. In this instance also, professional experience
and erudition must interfere and correct the omissions of the publick
registers. We are certain, that epilepsy is much more destructive to
the springs of life: perhaps it is cast by the reporters into either
the apoplectick or convulsive abyss. It is alledged to be more frequent
amongst the male than female sex; and in infancy, in those of delicate
constitutions, lax habit, acute, nervous and muscular irritability.
_Vid._ Convulsions.
In many cases there is no previous monitory of the impending paroxisms;
in some other cases the lowering storm is portended by lassitude,
headach, giddiness, dimness of sight, broken sleep, frightful dreams,
restlessness, terror, noise in the ears, palpitation of the heart,
unusual smells, murmuring of the intestines, yawning, luminous flashes
before the eyes, profuse urinary excretion, sense of the disease
ascending from a particular part to the head. By the epileptic
whirlwind the patient is suddenly and precipitously thrown down,
with suspension of the internal and external senses, and universal
convulsions of the external muscles, or those of voluntary motion: the
muscles of the head, face, eyes, and mouth, are particularly agitated;
the head is tolled in every direction, the teeth grind against each
other, the eyes roll, the mouth emits froth and slaver; the tongue,
thrust out of the mouth, is often wounded and lacerated by the teeth;
the respiration is as if through a noose on the neck; the fingers are
clinched into the hand; there is perpetual involuntary deglutition,
palpitation of the heart, and sometimes involuntary excretion of
urine, semen, or feces; the motions of the heart and of respiration
are hurried, but not otherwise interrupted nor injured. Such is the
powerful coercive muscular contractions and convulsions, that several
strong assistants are requisite to secure each member. Some, at the
first struggle and uproar, emit hideous groans or yells, resembling the
bellowings of a wild beast; others, a more still and savage murmur. In
most, the aspect is horrible: nor does any other disease exhibit such
truculent spectacles of terror and abhorrence.
After some few minutes, very rarely hours, a pacification ensues, and
abdication of the epileptic demon; and the patient liberated, rises up
of his own accord, languid, dejected, and ashamed, with but few traces
on the memory of the preceding tragedy; and nearly in the exercise
of all his usual faculties; which is not the case in apoplexy. In
the severity and duration, but still more in the repetition of the
paroxisms, there is prodigious variation: in some they are erratick and
irregular; in others, they are periodical; and at various intervals
in diurnal paroxisms, synchronous with the tides; monthly with the
lunar revolutions; equinoctial; annual. It is often a chronic disease,
and then, much less inimical to life than might be expected from such
a universal commotion. But in infancy, epilepsy and convulsions are
the most atrocious of the morbid murderers. Sometimes it ceases after
puberty. In old persons, or where there is no previous warning of
the approaching paroxisms, the prospects are deplorable: reiterated
epileptic bombardment often makes breaches in the internal recesses
of the senses; hence insanity, apoplexy, palsy, idiotism. Authors have
attempted the diagnosticks of epileptic origin: thus, in the brain, or
its spinal elongation, it is represented as invading with stupidity, or
hebetude of the internal and external senses; headach, disturbed sleep,
pale face; with suddenness in the assault, without previous warning,
and a sort of sensation of distillation from the head to the breast and
stomach: from nervous sympathy of the stomach and intestines, and of
the extremities, it is preceded by disturbance of those parts at the
approaching paroxism; by an aura epileptica, and ascending vapour, or
extraordinary sensation originating from some fixed point. To conclude,
this convulsion is sometimes feigned by begging impostors.
The predisposing and occasional _causes_ are, hereditary, peculiar
original organization, especially of the brain and its appendages:
plethora, fright, terror, horror, anxiety and passions of mind, excess
of venery, study; passionate drunken nurses; foul stomach; acidity,
acrid bile; worms, dentition, scald head, or ulcers rashly dried up
or repelled; external injuries of the head; various diseases within
the brain, or in the nervous chords; ebriety; difficult parturition;
hystericks; cachexy, dregs of intermittent fevers; irritability and
sensibility in morbid extreme; nervous sympathy and motory vibrations;
force of habit; offensive odours; poisons, narcoticks. In those of
epileptic temperament and predisposition, paroxisms are liable to
be recalled by heat, ventricular crudity, intoxication, anxiety and
passions of mind, terror, prospect of precipices, &c.
_Tetanus_, emprosthotonus, opisthotonus, locked jaw, trismus. This
is not a frequent disease in this island, nor in Europe: it is far
more universal and fatal in the tropical regions, and in the warmest
seasons of those zones. In such climates tetanus, and all the train of
spasmodick and convulsive diseases rage with more inveterate rancour
and devastation: there the slightest wound or scratch will frequently
occasion a locked jaw. It afflicts more adults than youth; and, as
is reported, more males than females. The emprosthotonus, or head
bent forward on the breast, is much less frequent than the reverse.
Its assault is sometimes sudden and violent; but generally by slow
approaches; and with stiffness of the muscles of the back, neck, and
occiput; difficulty in rotating the head; sense of uneasiness about
the root of the tongue; difficulty of swallowing, painful spasm at
the lower part of the sternum darting to the back; spasm and rigidity
of the muscles of the neck and occiput pulling the head backwards;
and also of the muscles of the lower jaw, locking the teeth together,
so that by the utmost force they cannot be separated: the muscles
also of the face, eyes, and nose, are often violently distorted with
a hideous grin. By degrees, this spasmodic conspiracy becomes more
universal, communicating to the spine, abdomen, and extremities; and
the contracted abdominal muscles feel as a hard-board. In the spasms
there are repeated exacerbations, with excruciating pain; followed by
remissions or transitory reprieves; but the latter seldom an hour in
duration: and sometimes with these paroxisms, internal murmuring of the
voice.
Seldom any fever accompanies this spasm, unless from cold; and in this
case the disease commences a few days after such accident: but if from
wounded nerves, frequently not until some days after the lesion, and
even when the vulnerary pain and uneasiness was removed. The external
and internal senses are seldom interrupted until the last and perilous
stages, when the brain shares in the general disorder. But the natural
functions and also those of respiration and circulation are unmolested.
It may prove fatal in a few hours; generally, if not relieved, in a few
days; and rarely is protracted beyond fourteen. Until of late years,
and the discovery of more effectual remedies, few recovered. Its danger
is increased by the sudden impetuosity of the assault; or from wounded
nerves: the final tragedy is closed by convulsions.
Authors describe a spasm of the lower jaw and tetanus of infants, which
they term Trismus: this is most frequent and dangerous early after
birth: the aperture of the mouth and gums is contracted, and with
difficulty separable: its lips and mouth remain nearly motionless,
with contention or impracticability in suction: and sometimes the spasm
becomes general amongst the muscles. I read in authors the diagnosticks
of another species of tetanus, which they represent as not unfrequent
in the European regions, and especially amongst infants; the symptoms
agitation, trembling, convulsions, distortion of the lips, grinding
of the teeth, difficulty of suction and deglutition, regurgitation of
milk by the nose; the jaws locked together; spastic respiration, and
with groans; the muscles of the neck rigid, with flushed face, tumid
abdomen, vomiting, fetid stools. This, in some features, resembles what
we term Inward Spasms. In fact, the history and accurate diagnosticks
of infant diseases are as yet imperfect.
The predisposing and occasional _causes_ of tetanus and its species,
are wounds, particularly of the fingers and toes; surgical operations,
fractures, luxations, burns, injuries of a nervous tendinous and
sensible part, bruised testicle; suppuration, abscess; cold and
moisture applied to the body when heated; sudden suppression of
perspiration; sudden vicissitudes of heat and cold; repletion, foul
stomach and intestines in infants; dentition; bile in the stomach;
worms; poisons; ebriety; excessive evacuations, hemorrhages; suppressed
salutary evacuations, exanthemata and cutaneous eruptions; abortion;
difficult parturition; violent mental emotion; angina; lurking gout;
hemorrhoides; hypochondriasm, hystericks, melancholy. In many of these
it is merely symptomatick.
_Spasms and cramps_ are idiopathick as well as symptomatick; fugacious,
or more fixed and constant; and may affect various portions of the
external and of the internal muscular fibres; of the head, neck, face,
eye, lower jaw, lips, arms, hands, fingers, thighs, legs, feet, penis;
the tongue, fauces, pharynx, œsophagus, lungs, stomach, intestines,
kidneys, ureters, bladder. Fugitive cramps in the legs excite
excruciating pain, tumor and rigidity of the muscle.
_St. Vitus’s Dance._ Chorea sancti Viti. This very uncommon disease
may afflict either of the sexes about the period of adolescence and
puberty; rarely afterwards. Its symptoms are lameness of one leg,
which, when attempts are made to walk, is dragged as if paralytick;
and is then, more or less, convulsed: at the same time, whenever the
patient attempts to convey any food or drink to the mouth with the
corresponding arm, it is incessantly convulsed, with a rapid succession
of gesticulations. Some are even compelled to dance, leap, run, sing,
or laugh. The paroxisms vary in duration and frequency: sometimes they
are terminated in half an hour: sometimes they continue several days,
rarely a week, without intermission: sometimes they recur several times
daily, leaving behind debility and weakness. Delirium and a degree
of fatuity are not unusual in the paroxisms. The predisposing and
occasional _causes_ are mostly unknown: sometimes worms.
_Catalepsis, and extasis._ It falls to the lot of very few physicians,
at least in this island, to see a single instance of this phenomenon,
a living statue fixed in whatever situation and posture they happen
to be in when seized: the legs and arms flexible, remain sometime
in whatever posture they are placed by a spectator: the functions of
internal and external sensation are suspended; the eyes are open; the
countenance and colour are nearly natural; the pulse and respiration
alone continue in motion, but obscure. The duration of the paroxism is
from a minute to hours, very rarely days: and the recovery as if from
a profound sleep: in some with confused ideas of surrounding objects
during the chasm. In the extasis strange visions are seen: and of
these trances there are extraordinary instances on record. It may be
complicated with somnambulismus, and hystericks. The _causes_, deep
meditation, fanaticism, mental passions, intense cold, worms, foul
stomach, suppressed evacuations: it is feigned by impostors.
_Fainting and asphyxy:_ syncope, leipothymia, asphyxia, idiopathick,
symptomatick. In syncope the action of the heart and of respiration
become considerably weaker than usual, or for a short time suspended:
the pulse and breathing are sometimes so weak as to be imperceptible;
the countenance pale and cold, with a clammy sweat, especially on
the forehead; the functions of external and internal sense, and
of voluntary motion, during this vital chasm, are interrupted or
suspended. It sometimes arrests suddenly, sometimes with preceding
languor and anxiety about the heart, giddiness, and dimness of sight;
objects are seen as through a mist, sounds are scarcely audible; and
there is confused noise in the ears. In the gradation and duration
of vital suspension, there are diversities: after the lapse of a
few or more minutes they gradually revive, yawning, sighing; some
with vomiting; and some without vestiges of reminiscence during the
temporary interreign. This partial cessation of the vital functions
distinguishes it, at the first glance, from apoplexy. Asphyxy is only
a more violent degree of syncope in which the intire human machinery
is stopped: the counterfeit of death; but in which there are embers
capable of being fanned and vivified into vital renovation. The first
exertions towards a restitution of the vital energy when suspended, are
sometimes with symptoms of epilepsy and convulsions.
The predisposing and occasional _causes_ of syncope and asphyxy,
idiopathick and symptomatick are, profuse evacuations and hemorrhages;
venesection; tapping the abdomen in ascites; strong emeticks and
purgatives; exhausted strength; violent exertions of strength, or
muscular action; excessive fatigue; venery in excess; sudden terror or
joy, or other mental emotions; intense anxiety; severe pain; offensive
smells; foul air; close rooms and crowds, and the air contaminated with
their breath, and effluvia; charcoal fumes; foul stagnant confined air,
and gas of old damp pits, wells, subterranean caverns, mines; mephitick
vapours from fermenting liquors in considerable quantity; lightening,
thunder-shocks; excessive heat; excessive cold; sanguineous plethora;
various diseases of the stomach; poisons, narcoticks; repelled
cutaneous eruptions; hysterick, scorbutick, arthritick, febrile; wounds
or blows on the head, spine, or stomach; severe labour and parturition,
in which the infant’s head and brain is compressed, injured, or
mouldshot, or the navel-string compressed, and the circulation
interrupted; hydrocephalus; internal aneurism, polypi of the heart, or
large arterial trunks; rupture of large blood vessels, or of internal
abscess; palsy of the heart, dropsy of the pericardium; gangrene;
drowning; hanging.
_Palpitation of the Heart._ Chronic is here meant, not transitory,
which may occur on every sudden emotion of body or mind. In this the
contraction of the heart is with preternatural outrageous rapidity
and force, and often with audible strokes against the ribs, and
intermittent pulse. It is generally periodical; and by continuance, it
is evident that, from the convulsion of this important motory pendulum,
the entire subordinate series of hydraulick offices, together with
those of sense and motion, must share in the disorder. The predisposing
and occasional _causes_ are, plethora; repletion, intemperance in food
or drink; suppression of habitual evacuations; excessive evacuations;
inanition; passions of mind; long continued grief, terror, venery,
pain, anxiety, thirst, immoderate exercise; light cloathing; extreme
irritability, peculiar irritability of the heart, and debility,
spasm; pressure on the aorta; aneurism; ossification and straitness
of the aorta; tumors about the great vessels; polypi; dropsy of the
pericardium; impeded respiration and circulation through the lungs;
broken ribs; weak disordered stomach, flatulence; diseases of the
abdominal viscera; sweat of the feet, ulcers, scabs prematurely
repressed; cachexy; hysterick, hypochondriack, melancholick,
scorbutick, arthritick, atrabilarious, inflammatory.
_Polypi of the Heart, internal Aneurism, and Ossification._ Polypi are
solid coagulums of blood, of a firm or fleshy consistence: aneurism
a distention and weakness in some portion of the arterial coats, and
partial enlargement or bulge in the sanguineous canal; the usual seat
of the first is in the auricles and ventricles; of the second, in the
large trunks, and more about their origin: ossification of the valves,
and of the aorta, or the smaller branches, is more frequent in old age.
The symptoms of polypi and aneurism are often ambiguous; most of them
are common to some other diseases; such as difficulty of breathing,
violent palpitation of the heart, and anxiety aggravated by the least
motion, with propensity to faint, intermittent pulse, pain under the
sternum, torpor of the arm, pale face, edematous ancles, frightful
dreams, timidity to walk alone without support. These, together with
syncope and asphyxy, no doubt make a part of the sudden deaths, and
some other casualties in the London bills.
I had nearly omitted the description of two diseases in which we
are not personally interested; the Berbiers of Indostan, and the
Raphania, once a European meteor. In the berbiers there is chronic
tremulous motion of the hands and feet, sometimes of the whole
body: at the same time pricking and formication, and some degree of
insensibility; weakened voice; anhelation: it usually originates from
suppressed perspiration. The raphania was once a transient epidemick,
and principally noxious to infants; the symptoms stupor of the
spine, sensation of pricking pain in the muscular fibres; the lower
extremities rigid, sometimes convulsed; eyes rigid and distorted;
pharynx constricted; tongue retracted.
_Hypochondriasm_, hips, spleen, and vapours, imaginary maladies. This
chronic valetudinary infatuation is very frequent in our island:
it occurs principally in the adult and middle age; seldom early in
life; in the male more than in the female sex, especially in those of
melancholick temperaments; and much more amongst persons of independent
fortunes, and amongst literary and sedentary professions, than the
exercised and industrious. Vapours are often complicated with diseases
of the stomach, hystericks, melancholy. But in the true hypochondriasm,
the valetudinary dyspepsy, and diseases of the digestive organs, seem
rather a natural consequence and sequel of the lugubrious mental
temperament: besides, in dyspepsy the mental perturbation is slight;
it is also a far more universal disease than hypochondriasm, affecting
equally both sexes; and the young as well as the old.
Hypochondriacks feel, or imagine they feel, all diseases; against
these they combat with a thousand remedies, and exhaust the whole
pharmaceutical rotine. They exaggerate with minute narrative these
morbid phantoms, which no other person can perceive, nor account for;
examining their pulse, fatiguing and harassing their physicians,
visitors, and domesticks; on the slightest grounds haunted with
apprehensive forebodings of misfortunes, misery, and death; and in the
utmost anxiety about the event, at the time perhaps that the appetite
is not much impaired: in most things, however, their judgment is
correct; their health and diseases excepted, which are the constant
objects of their fears.
By such anxious solicitude, and passive submission to fanciful and
imperative chimeras, a luxuriant brood of symptoms, like irregular
hysteria, are engendered: they at length convert, or at least
aggravate, accelerate, and multiply imaginary into real evils,
deranging the complicated offices of digestion and circulation:
hence flatulence, eructation, indigestion, nausea, acid bilious
vomiting, exspuition of watery fluid, irregular appetite; profuse,
irregular excretions and secretions by urine, perspiration, saliva,
mucus, diarrhœa, or its reverse costiveness; with palpitation of
the heart, flushing of heat and cold, fugacious spasms, anhelation;
obscure vision, vertigo, noise in the ears, headach, disturbed sleep,
frightful dreams; slothfulness, pusillanimity, want of resolution and
activity, disposition to seriousness and sadness, shyness, suspicion,
peevishness, moroseness: the mind often dejected and in despair, so
as not to be solaced with hopes of relief. It sometimes ceases, or at
least abates weeks and months, recurring in periodical exacerbations on
any exciting cause or mental distress, intemperance, or vicissitudes
and irregularity of the seasons. Costiveness and hardened feces
indicate the obstinacy of the disease. It is not immediately dangerous
to life; but when of inveterate continuance, may terminate in insanity,
cachexy, jaundice, dropsy, tympany, consumption.
The predisposing and occasional _causes_ are morbid extreme of
sensibility; hereditary; various depressing passions of mind; studious
sedentary life and abstruse meditation; retirement to an inactive
after a bustling busy life; excess of venery, manustupration;
wealth, indolence, transient, unsatisfactory amusements; revelling in
pleasures, and cloyed with satiety; November fogs, easterly winds,
sirocco winds; intemperance in food or drink, suppression of usual and
solitary evacuations, as menses, hemorrhoids; repulsion of cutaneous
eruptions; obstruction in the circulation through the vena porta and
liver, and in the biliary secretion; obstruction in the abdominal
viscera; debility in the stomach and intestines, and consequently
vitiated chyle; pituita in excess; worms; irregular gout; hystericks;
intermittent fever.
_Insanity_, lunacy, mania, melancholia, and complex insanity. During
the preceding century, distracted and lunatick was the term in the
London registers; and in the last thirty years of that century,
amounted in the funerals to 544; but in the present century, are
quadruple. We must reflect, that two of the largest lunatick hospitals
in Europe are erected in this metropolis, exclusive of several
large private madhouses; all of which are of late years enlarged
and multiplied in London and its suburbs. Into these publick and
private receptacles many lunaticks, from sundry parts of the kingdom,
are congregated; amounting in all, by the nearest calculation which
I can form, to upwards of one thousand. Perhaps those whom nature
originally, or disease branded as idiots, are also included in the
lunatick catalogue of mortality. The coroner’s inquest generally
returns suicides as lunaticks, after reciting the mode of their death;
but the searcher’s reports in the bills of mortality, have invariably
ranged lunatick and self-murder under two distinct heads. I have reason
to believe that many lunatick deaths in London are not reported, from
their being interred in dissenting and unregistered burying grounds,
or in other places of interment without the verge of the bills; others
intentionally suppressed, and a considerable remnant sunk amongst the
suicides and drowned. It is probable, that in lunaticks and suicides,
this island may challenge any other in Europe, whether in modern or in
ancient times.