scirrhous testicle, and venereal induration. Indurated and scirrhous
testicle is rounder, harder, painful, and the spermatic chord
distinguishable at the rings: it has, however, frequently a quantity
of extravasated and surrounding fluid. Besides, scrotal hydrocele and
hernia, hydrocele and scirrhous testicle, hydrocele and encysted dropsy
of the spermatic chord, have been seen combined. Some hydroceles are
several years collecting: others are very suddenly formed, especially
from extravasated blood, external injuries, violent muscular exertions;
these likewise have been mistaken for ruptures. Hydroceles vary in the
quantity of fluid and magnitude, containing from ounces to several
quarts; some are enormous in size, reaching half-way down to the knees,
and occasioning great load, and pain in the back. The colour of the
extravasated fluid is also various; clear, limpid, pale, straw, yellow,
grumous, dark, bloody. Many, from choice or necessity, are contented to
drag on life, not chusing to risk what is termed the radical operation
and cure; but merely by frequent repetitions of the scrotal puncture
or palliative remedy. Sometimes the skin and cellular membrane of the
scrotum, in inveterate hydrocele, is prodigiously thickened.
The predisposing and occasional _causes_ of Dropsies, comprehending
all the preceding genera, are in consequence of various acute and
chronic distempers; broken constitutions, cachexy; intermittent,
remittent, and scarlet fevers; repelled erysipelas; rickets; jaundice;
biliary obstructions; suppression or repulsion of habitual or wholesome
evacuations, as menses, hemorrhoides; general debility from various
causes; atony of the sanguinous vessels, and of the exhalents,
and transudation of serum through them; excessive evacuations by
hemorrhage, diarrhœa, perspiration, or other excretories; sudden and
large draughts of cold water when the body is much heated, especially
if not discharged by urine or sweat; excess of fluids, of spirituous
liquors; languid circulation; sedentary life; watery trades; moist air;
suppressed perspiration, and watery excretions; tenuity or impurity
of the blood; tenacious adhesion and agglutination of the coagulable
lymph; increase of serous fluid in the blood; diseases and also
ruptures of the lacteals and lymphaticks, and of the kidneys, ureters,
and bladder; defect of lymphatic absorption; obstructed and scirrhous
viscera, mesentery and lungs; asthma, polypi, ossified arteries,
excessive fatness, and other causes intercepting the circulation of
the blood: diseases of the stomach and digestive organs, and those of
sanguification; laxity of the external subcutaneous cellular membrane;
debility of the muscular solids and fibres, and of the tela cellulosa;
hereditary; hydatides; violent muscular exertions, external injuries.
_Tympany._ There are two species; that where air is confined within
the intestinal tube; the other, where it is extravasated between the
intestines and peritoneum: this last species very rarely occurs,
and only from an erosion or hole of the intestines. The symptoms of
Tympanites are, tumour and tension of the abdomen, and compared to
the stretched head of a drum, without fluctuation or thirst; and not
altered by a change of posture, nor is the body increased in weight:
there is inappetency, indigestion, colick pains, eructation, and
explosion of fetid air by the mouth and anus; costiveness, sallow
complexion; and, from the distension of the abdomen, difficulty in
breathing: in the inveterate stages of the disease, ischury, dysury,
emaciation, hectic, and atrophy. Its increase is generally quicker
than ascites; it is also chronic, and contumacious to medicine.
Tympany of the womb is also mentioned by authors; but is a very unusual
occurrence: it is described by local heat, pain, tenesmus, tumour,
discharge of fetid air. The _causes_ of Tympanites are, atony and palsy
of the intestinal tube; excessive purging; chronic colick, dysentery
and diarrhœa, or their premature suppression; suppression of the lochia
or menses; the consequence of rickets, intermittent fevers, asthma,
hypochondriasis; diseased abdominal viscera; excess of pituita, or
bile; complicated with ascites, and the intestinal tube debilitated by
soaking in water.
_Excess of Fat_, obesitas, polysarcia; including anasarcous obesity,
abdominal corpulency, and their complication. This is a frequent malady
of adult age in this island. Those, unfortunately for themselves,
thus stuffed and loaded with grease, are clumsy, unwieldy, inactive,
lethargic; on any exercise or motion, they are panting for breath; and
may be compared to cumbrous hulks. The _causes_ hereditary; laxity of
the cellular membrane, or tela cellulosa; esculent luxuries, sensual
living, epicurism, malt liquors, excess of oleaginous secretion from
the blood.
My original intention was to have proceeded to the next group, as
arranged in the medical catalogue: but whether we enter upon their
discussion now or hereafter, is a matter of no moment. However modern
nosologists may plume themselves on classification, it appears to me as
attended with no difficulty, nor requiring any exertion of genius: we
may with as much facility as shuffling a pack of cards, throw diseases
into endless arrangments and associations.
* * * * *
_Female Diseases_, including obstructio-mensium, chlorosis, profluvium
mensium, fluor albus, hystericks. These derangements of the human
machinery, which, from the days of Hippocrates, have been discriminated
by specifick morbid names, are notwithstanding unnoticed in the London
registers; unless perhaps rising of the lights, spleen, and vapours
are substituted as a portion of hysterick mortality. This formidable
phalanx, whose frequency and fatality are of universal notoriety,
must be mustered amongst the chronic host of diseases. From about the
period of puberty, seldom earlier, they begin to infest numbers of
the female sex. On a careful perusal of nearly one half of the books
of the Aldersgate Dispensary in London, and before mentioned, during
six years, I found the total sick and diseased amounted to 29,511:
by far the greater proportion of which were adults, and more females
than males. Of this twenty-nine thousand, the numbers afflicted with
different female complaints were as follow: Obstruct. mens. and
chlorosis, 254; profluvium mens. 270; fluor albus, 446; hysteria, 1104;
total, 2074. Here it is worthy of observation, that four only of the
principal female infirmities constituted nearly one fourteenth part
of all the diseases in that dispensary, which is open to afflicted
patients of every description and age. I should, however, not omit to
add, from the information of one of the learned physicians of that
charity, that under Fluor Albus, a few cases of venereal gonorrhœa
were concealed; and that under Hysteriæ, were arranged all female
and nervous complaints, without strictly attending to its generick
symptoms. We have here likewise, one proof that uterine relaxation is
a more frequent female malady than obstruction in London: it is more
so in warm than in cold climates: and probably, all these four female
diseases are more prevalent amongst the higher and luxurious ranks; and
in city than in country.
Hippocrates has truly said, “Uterus sexcentarum œrumnarum mulieri
auctor merito dicatur.” Great and important changes ensue at puberty
amongst the two sexes, especially the female, affecting their future
health. In both, the organs of generation are then evolved, and the
sexes first capable of procreation. The semen in males about this
period, begins to be strained through the generative organs, the beard
to sprout, and the countenance to assume a more masculine appearance.
That periodical discharge of red blood from the female womb, called
Menses, the index of womanhood, begins in this island to gleet monthly,
about the age of 14, 15, or 16: but its first eruption and final
cessation, as well as its periodical returns, are sometimes extremely
variable; from 11 to 20 years of age; and its final ebb between 30
and 50; generally, however, between 40 and 50. In warm climates, the
menstrual commencement is earlier, and more profuse. This discharge
is not suddenly in a full stream, but continues oozing from 3 to 5
days, and even longer; the whole quantity in healthy women amounting
to 4 or 6, and in others, to even 12 ounces: but the first efforts to
menstruation are commonly scanty and irregular. The quantity of blood
evacuated, the duration, the intervals, periodical returns and effects,
are various; and are diversified by climates, seasons, constitutions,
mode of life, habit, and by numerous other accidental circumstances.
In different women the menstrual intervals are from 2 to 6 weeks,
or longer; but when strictly regular, or the woman not pregnant,
every lunar month. The first periods of menstruation, and the final
cessation by age, are two very important epochs in female life, on
which much of their succeeding health and longevity will hinge. But,
without entailing diseases, many women are liable to some menstrual
irregularity, with respect to the periods, duration, and quantity.
_Morbid and Irregular Menstruation_, under the different heads of
scantiness, chlorosis, or morbus virginius, retention, partial
obstruction, and total suppression. The menstrual eruption is generally
and naturally preceded by heat of the loins, and weight about the
uterine region, frequently with pain and cholick, lassitude, headach,
dulness of vision, disturbed sleep, inappetency, and nausea, pain
and load about the breast: all which, with many other troublesome
symptoms, usually disappear on the establishment of this salutary and
critical evacuation. But where the menses do not flow at puberty,
or afterwards become obstructed or suppressed, a numerous train of
morbid symptoms and fatal diseases often ensue; such as inappetency,
indigestion, colick, palpitation of the heart, difficulty and labour in
respiration, pulmonary consumption, hectic, dropsy, fluor albus, low
spirits, fainting, hystericks, insanity, apoplexy, general bad health,
barrenness. Indeed, those women who have passed the stage of puberty
some years without menstruation, are generally barren.—The Chlorosis
appears about puberty, sometimes indeed earlier; and is more frequent
amongst indolent and luxurious females. The complexion is pale, sallow,
of a green sickly tinge; the lips pale, with aversion to motion, with
debility, muscular flaccidity, inappetency, indigestion, craving for
unusual and unnatural food, flatulence, palpitation of the heart,
laborious and quick respiration on exercise or ascending any eminence;
pain and weight about the loins, night sweats, hectic and emaciation,
œdematous ancles, crude urine, usually obstructed menses, unusual bad
health, and derangement of the animal, vital, and natural functions. It
is seldom immediately dangerous to life, but often lays the foundation
of some of those diseases above enumerated.
The predisposing and occasional _causes_ of scanty menstruation,
obstruction, and suppression, and of chlorosis, may be comprehended
under the following: general bad health, debility, and unsound
constitutions; partial weakness of the uterine vessels; too great
resistance and rigidity of the uterine vessels; want of sufficient
momentum in the sanguineous circulation; scarcity of florid blood; not
sufficient motion nor exercise of the body; sanguine plethora; sizy
blood; spasmodic constriction of the uterine vessels; sudden passions
of mind, especially the depressing passions; cold wet feet; cold
liquors and various cooling luxuries drank or eat at the menstrual
period; crude watery diet; worms; celibacy; love; salacity stifled; lax
fibre; severe parturition, and local diseases inherent in the womb and
vagina.
_Uterine Relaxation_, including excessive menstruation, fluor albus,
leucorrhœa. There is a great similarity in all their causes. We here
treat of menstrual excess in the unimpregnated state; reserving for
pregnancy that uterine hemorrhage, vulgarly denominated Flooding.
Menstruation may be morbid from frequency in the returns, from
duration, and from quantity. It has already been said, that the
quantity of the menstrual flux, the recurrence, and the duration,
vary in different women: the immoderate discharge is determined not
altogether by the absolute quantity, but by the effects: such as
languor, debility, pale countenance, weak pulse, palpitation of the
heart; depression of spirits, pain in the back and loins, inappetency,
coldness of the skin and of the lower extremities; in the evening
œdematous ancles. Excessive menstruation may either be sudden and
within a few days, or chronic and persevering a long time beyond the
natural period. There is also erroneous menstruation from various parts
of the body; of which many extraordinary and monstrous examples may be
seen in the records of medicine. Menstruation in excess, especially if
chronic, is often accompanied with fluor albus; and may terminate in
consumption and dropsy, and in many of the diseases enumerated, under
obstruction and suppression.
The Fluor Albus often succeeds or accompanies excessive menstruation.
It is a dripping discharge from the womb and vagina, and from the same
vessels which exude the menses, sometimes pale and serous, or often
variously intermixed with yellow, green, and red tinges; sometimes
fetid and acrid, and either constant or irregularly intermittent. At
the commencement, the usual concomitant symptoms ascribed to this
disease, such as pain and weakness in the back and loins, indigestion,
&c. only occur when the discharge is excessive, or long continued. It
is then attended with a pale sickly colour and countenance, dejection
of spirits, palpitation of the heart, lassitude and debility, pain
in the stomach, loss of appetite, indigestion, flatulence, acrid and
turbid urine, hectic. But notwithstanding the heat and acrimony of the
excretion in many instances, especially when chronic and inveterate,
yet it may easily be distinguished from venereal gonorrhœa. Women of
various ages after puberty, married and unmarried, some even after
the final menstrual cessation, are obnoxious to this gleet, which is
not infectious. The fatal termination may be in some of the different
diseases consequent of obstructed and excessive menstruation; such as
barrenness, diseases of the womb; colick, piles, strangury, hystericks,
low spirits, consumption, dropsy.
The predisposing and occasional _causes_ of excessive menstruation and
of fluor albus, are, many of the general causes of hemorrhages, already
enumerated; plethora, sedentary, luxurious life, stimulating and
nutritious diet; too long indulgence in warm soft beds; warm chambers;
suppression of usual and habitual evacuations; weakness and laxity of
the uterine vessels from abortion, violent evulsion of the placenta, or
other injuries during parturition; difficult and lingering, and also
frequent parturition; general relaxation, and delicate constitution;
weak nerves; violent exercise, especially in hot climates and weather;
excessive heat of the season or climate; moist watery climate; violent
efforts of the body or muscles, or straining of the body and loins;
external injuries, or falls near the uterine region; excess of venery
and salacity, manustupration; spirituous liquors and drunkenness,
intemperance, immoderate use of tea, and other warm fluids; immoderate
use of warm baths or stoves; neglect of cleanliness and abstersion;
passions of mind, frights; impeded perspiration; excess of serum in
the blood; scorbutic habit and acrimony: purulent translation to and
deposition upon the womb from other parts of the body; polypi, fungus,
scirrhus, cancer, ulcers in the womb or vagina; procidentia uteri et
vaginæ, emmenagogue medicines.
_Final Cessation of Menstruation_ from years. This is a dangerous
period to women; more so, perhaps, than any other stage of maturity.
In this island the menses usually cease about 48, 45, or sometimes at
41, and earlier; especially after frequent parturition. The springs
of life, or generative powers, then become effete; but in the male
sex, the faculty of procreation continues ten, twenty, and in some
thirty years later. In most cases, women do not conceive before
menstruation, nor after its cessation. Towards the final drain, women
commonly are irregular in the recurrence, duration, or quantity of the
discharge; which is often excessive. The longer or shorter duration
of menstruation depends, in some degree, on its earlier or later
commencement. Women who never had children, nor enjoyed sound health;
those whose constitutions have been impaired by frequent parturition
and miscarriages, and others of delicate nerves and structure, all
these are frequently obnoxious to complaints and diseases at the final
uterine ebb. As infirmities and bad health are frequently removed on
the first flow of the menses, such are also again prone to relapse in
this autumn of life, into nervous complaints, hystericks, consumption,
dropsy.
_Hystericks_, uterine suffocation, and female nervous diseases. This
morbid Proteus rarely attacks before puberty, most frequently between
puberty and middle age. Married and single women are obnoxious to it;
but more so the latter and widows, and those barren, or irregular in
menstruation. It is not so frequent amongst the laborious class, or
those of clumsy organs, as in the higher ranks, and particularly in
those constitutions strung to a morbid extreme of nervous and muscular
sensibility and irritability. It may also affect females of robust
muscular constitutions. It very rarely attacks the male sex; the
only disease in them, somewhat analogous to it, is hypochondriasm.
The regular hysterick paroxism generally attacks by surprize, with a
sensation of some pain and fulness, and of a convoluted ball or lump,
rising up from the lower part of the belly to the stomach and throat,
where it seems to stick, and excites efforts to cough it up, or to gulp
it down; with difficulty of swallowing and sense of strangulation, and
often suspension of the functions of voice and speech. In others, the
ball, without ascending, rolls tumultuously and convulsively round the
abdomen. The paroxisms are preceded and accompanied with palpitation of
the heart: the patient often falls down in a fainting fit, turns cold
and pale, and the breath and pulse are scarce perceptible. Sometimes
the paroxism deviates into immoderate laughter or tears; sometimes into
muscular convulsions and distortions, resembling epilepsy; or into
stupor and insensibility; and there is usually a profuse secretion of
limpid urine; sometimes there is vomiting. After some remission and
exacerbation, the paroxisms cease, the patient recovers, stupid, and
seemingly dozing, with repeated sighing and sobbing; and generally
with some remembrance of the paroxism. The form, duration, violence,
recurrence, and repetition of the hysterick paroxisms are various,
not only in different women, but even in the same at different times;
and, however alarming in appearance, are seldom immediately dangerous
to life: but by continuance, may derange the machine, and lay the
foundation of diseases. They sometimes occasion, symptoms of dyspepsy;
but oftener the appetite and digestion are unimpaired.
The prolifick brood of what may be termed Nervous symptoms, or
irregular hysterick paroxisms, in their turn interrupt and disturb most
of the important functions and organs of the human body; the brain and
nerves; the heart, blood vessels, circulation, and respiration; the
stomach and intestines. Amongst this medley of afflictions are nausea
and vomiting, flatulence, coldness of the stomach, depraved appetite,
indigestion, unusual cravings, colick pains, sudden flushes of heat and
cold, formication, transient fugacious pains, fixed spasms, fainting,
convulsions, headach, general or partial, and fixed like a nail in
a small compass; vertigo, drowsiness, lethargy; alarm, trembling
and starting at the least noise or surprize; the spirits sometimes
exhilarated to excess, at other times plunged into despair: to these
may be added timidity, capricious temper, palpitation of the heart,
resemblance of spasmodic asthma, flow of limpid urine, or of saliva,
difficulty of urine, night sweats; “cum multis aliis.” If the symptoms
of each are properly understood, hystericks cannot be confounded with
syncope, epilepsy, and apoplexy; to all which it has some resemblance.
The predisposing and occasional _causes_ of hystericks are, excessive
delicacy, sensibility, and irritability of the nervous and muscular
fibres, and laxity of the muscular solids; retention and suppression of
usual evacuations, especially the menses; scantiness and also excess in
menstruation; fluor albus; profuse hemorrhages, and other evacuations
by stool and urine; sanguineous plethora; hereditary; obstructions in
some of the abdominal viscera, or in the circulation of the vena porta;
scirrhous abdominal viscera; flatulence in the stomach and intestines;
tough phlegm and sordes in the stomach and intestines; weak stomach;
worms; improper food; drunkenness; indolent, luxurious, voluptuous,
sedentary life; valetudinarian regimen; irritability of mind; passions
of mind, particularly the disagreeable and depressing, as cares,
grief, disappointed love, jealousy, frights, intense fixed mental
application to one object, religion, envy, anger, grievous misfortunes,
joy, concealed uneasiness of mind; celibacy; salacity; sudden and
great changes in the constitution from menstruation, generation,
pregnancy, and parturition; impure blood, its acrid tenuity; repulsion
of cutaneous eruptions; general bad health, and diseased state of
the fluids or solids; irregular gout. It is often difficult and
impracticable to dive into the real efficient causes.
_Childbed_ Mortality in London is nearly one eightieth part of the
whole funeral catalogue. It is in storms and hurricanes; or within
a very short space of time. The mortality of this group must occur
between the two extremes of 16 and 50 years of age. Or, as marriages in
this island, one with another, are computed to commence on the side of
the woman at 25, we may, with safety, rate the principal mortality in
the stage of life between 20 and 50. On this interesting subject there
are several curious and useful propositions, which I have attempted
to establish by demonstrative proof. These are, 1st, The number
of women who, on an average, die in childbed: 2dly, The proportion
between natural, laborious, preternatural, and complex labours: 3dly,
The number of abortive and stillborn infants to those brought forth
alive: 4thly, The proportion of twins and tergemini to single births:
5thly, The diseases principally fatal to women during pregnancy and
parturition, and afterwards, with the arithmetical ratio and fatality
of each, and also of labours. To the investigation of these corollaries
I proceed in a regular order.
From twenty-four years of the London, and from several country
registers in England and Germany, Dr. Short calculates, that on an
average, 1 of every 60 women die in childbed: others rate the decrement
at 1 of 66, or 3 in 200. Upon a much broader basis I formed a puerperal
estimate. From the year 1700 to 1776, the christenings in the London
registers amount to 1,220,656; and the abortives and stillborn in
the same interval, to 46,831. The sum total therefore of the births,
including the christenings and abortives, amounts to 1,267,487. During
the above period of 76 years, the deaths in childbed are 17,057;
which number employed as a dividend to the former, makes about 1 of
74 pregnant women to perish in childbed. But as a considerable number
of infants, after being brought into the world alive, die before
baptism or christening, and consequently are excluded from the publick
enrolment of births and christenings, this is an additional reason for
believing that the perils of childbed are not rated by us too low.