to the sudden and violent changes after birth in its tender machinery;
to weakness and injuries from tedious and laborious parturition;
delivery before the end of the ninth month; hereditary debility;
diseased parents; foul air of cities; improper food and drink; scarcity
of food and milk; ill formed nipples; the tongue tied or retracted;
errors in quantity or quality of nutriment; too long continuance of
vegetable and acescent food; foul stomach and intestines; acidity
in its stomach; errors of the mother or nurse in food, drink, rest,
exercise, excretions, passions of mind, ill temper, passionate,
hysterical, addicted to raw spirituous liquors and drunkenness;
diseased; fasting too long before the infant sucks; unwholesome milk;
adulterated milk and bread; neglect of cleanliness, and suffering the
infant to lay too long in wet cloaths; insufficient exercise, and also
too violent agitation of the infant; the ligatures, bandages, and pins
too tight, and tormenting the infant; improper positions and postures;
cold cloathing and habitations, beds, and scarcity of fuel, especially
in northern regions, and in winter; infants excretions, and especially
by the anus, defective or excessive; improper treatment and quackery
of old women and nurses, and other such medicasters, during its
illness. It is but candid also to confess, that, in numerous instances,
the causes of infantile maladies are not yet sufficiently established
nor explained.
_Convulsions, Inward Spasms, and Tetanus._ From the exquisite
tenderness and irritability of its frame, most diseases of infants,
when fatal, seem to terminate in spasms, epilepsy, and convulsions;
with which they are infinitely more afflicted than adults, and often
endure better. Inward spasms are amongst the first of infantile
maladies: it appears as if slumbering; the eyelids are not perfectly
closed, and the white bulb of the eye is partly turned upwards, and
exposed to view; the eye-lashes twinkle; there is a tremulous motion
of the muscles of the face and lips, sometimes resembling a smile or
laugh: as the disease increases, the breath seems frequently to stop;
the tip of the nose is then contracted, with a pale, sometimes ghastly
and livid circle around the eyes and mouth; it starts on any motion or
noise; sometimes it seems falling into convulsions, but on discharging
flatulent air upwards and downwards, it recovers, and relapses again
into a lethargic state. By continuance, these spasms often terminate
in some of the following diseases; hectic fever, thrush, vomiting,
diarrhœa and green feces, watery gripes, convulsions. Infants also are
sometimes subject to a locked jaw; which we have already noticed under
Tetanus.
The predisposing and occasional _causes_ of convulsions and inward
spasms are, acrid stimulus of food, acidity, or bile, or inflammation
in its stomach or intestines; general debility; the brain compressed
during parturition, hence mould shot, horseshoe head; water in the
brain; teeth cutting the gums; passions and frights of the nurse
affecting her milk, or drinking raw spirituous liquors; improper
food of the nurse or infant; scald head, excretion behind its ears,
and cutaneous rash repelled; they are usually imputed to fulness and
foulness of the stomach and intestines. Lastly, Derangements in its yet
crude machinery.
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.
* * * * *
A Miscellaneous group of diseases are here associated: several of them
unconnected in symptom, cause, or cure: others are of exotic origin,
and transplanted amongst us. Mankind left exposed, without defence or
remedy, against even this small morbid host, would soon be sensible of
the calamities and scourge of medicinal ignorance: and they would be
less surprised at the incorporation of medicine with divine worship in
ancient times.
_Venereal Disease._ Three hundred years have not altogether elapsed
since the discovery of America, and the importation of the venereal
disease into the old world. Before the discovery of its antidote,
mercury, and in some inferior degree of the native Indian remedy, the
decoction of guiacum, Europe was alarmed with universal confirmation at
the rapid inroads of this disease: multitudes, of all ranks, perished
in lingering torture, under its corroding ulcers, presenting before
death hideous spectacles of cadaverous corruption and deformity.
In the last thirty years of the preceding century, 2360 deaths are
recorded under French pox, in the London bills; and even at this day,
the chart of diseases demonstrates its fatality to be infinitely
greater than medical men could suspect.
It would, in this disease, be ridiculous to inspect hospital registers,
for the purpose of either ascertaining the ages wherein venereal
ravages prevail, or the proportion of cured and incurable. Its ravages
cannot be in infancy, nor in adolescence, nor in the decline of life.
The merest smatterer in medicine knows the infallible remedy and cure I
except that in the application to particular cases, some more judgment
and dexterity is necessary. The multitudes who now perish in these
battles of Venus, are so many sacrifices either to negligence or to
indigence; or to the grossest ignorance and empiricism of licenced
murderers. There is no other disease wherein professed quackery is so
generally resorted to, or wherein its decoys are so pernicious to the
community. The great majority of these victims to seduction, pleasure,
and necessity, are in all probability amongst the swarm of wretched
and unfortunate female prostitutes; and in the male sex amongst the
lower orders: for in those of less straitened circumstances, a small
bribe to the searchers would conjure venereal mortality into sores
or ulcers, or into consumptions. Besides, were we to add to venereal
carnage the shattered constitutions, in consequence of these wounds and
scars, it would appear an object of sufficient magnitude to attract the
attention, interposition, and regulation of the legislature. In every
metropolis, especially amongst the unmarried, and in armies and navies,
it is without doubt, much more fatal to the community. Indeed, in
cities, few of the male sex, arrived at adult years, can boast of not
having been, in some giddy moment, fascinated into impure embraces.
There are two distinct genera, or species, of the venereal disease;
the Local Gonorrhœa, and what is called Confirmed Pox. The gonorrhœa
generally begins from two to six days after the infection, with
titillation of the glans, redness of the orifice of the urethra, and
oozing of mucus; which tinges the linen in spots and hardness. These
symptoms are daily aggravated with strangury, dysury, involuntary
painful priapism, and nocturnal pollution. Sometimes, though rarely,
gonorrhœa is confined to the external mucous glands about the neck or
ring of the glans. In females, the gonorrhœa affects principally the
vagina, with pain, heat, and mucous discharge; but no considerable
dysury. The lues venerea confirmata, or syphilis, commonly begins
with either one or more ulcerations of the penis, or vagina; or with
inflammation in the glands of the groin. The ulcer or chancre appears
as a red spot on the glans, or prepuce, is hot, prurient; in a few days
the top changes into a white speck, ulcerates, and, if not prevented,
gradually spreads and corrodes all around. Inflammation, or bubo in
the lymphatic glands of the groin, may either originate from previous
chancre, or without it. In this a tumour and pain is felt in the groin,
with enlargement of the glands; this tumour and inflammation, if not
checked, increases to a boil, and suppuration; but often with tedious
subsequent ulcerations, fistulas, and sanious discharge.
These are the two usual and slight appearances of gonorrhœa, and of
confirmed pox, when the infection is first applied to the genitals;
and frequently these two genera are complicated. But in both genera,
from various causes, originating from the virulence of the disease,
the intemperance of the patient, or mismanagement of his medical
pilot, many adventitious and aggravated symptoms are superadded; in
number and severity varying in different persons; several of them,
when violent and precipitate, requiring speedy alleviation; and often
to be treated as separate diseases. In the malign train of gonorrhœa
are violent inflammation and constriction of the prepuce, before or
behind the glans, or phymosis, and paraphymosis; dysury, strangury,
priapism; painful and inflamed testicles; scirrhous and indurated
testicles; chronic gleet; stricture, caruncles, and obstructions in
the urethra. Confirmed pox, in its inveterate and chronic stages,
contaminates the whole constitution; erodes the genitals, or anus;
ascends to the throat, and excites callous ulceration and dilapidation
in the uvula, tonsils, fauces, palate, nose; hence hoarse, guttural
voice, fetid breath: the patient is variously tormented with gnawing
pains in the legs, shoulders, and hand bones, which are exasperated in
bed; with chronic headach; with cutaneous eruptions on different parts
of the face, trunk, or extremities, and dry, scaly, humid, ulcerated,
red, yellow, or purple; with ophthalmy; with nodes and tumour of the
forehead, exostoses and caries of the bones; atrophy. Chronic warts
about the genitals and anus, and called by different names, porri,
crystæ, condylomata, rhagades, thymi, moræ; are generally innocuous.
The _Causes_. Infection by contact with the genitals: or the pox, when
inveterate, may be communicated by the mouth and nipples; by drinking
out of the same vessels, by touching any diseased or ulcerated part.
When inoculated by suction, it begins first in the mouth or nipples.
_Scurvy._ True scurvy is seldom or ever mentioned by any writer, before
the long voyages, first began three centuries ago by the moderns;
that is, on the discovery of the passage to Asia by the south cape of
Africa; and the discovery of America. Then, in consequence of living
long on salted and gross diet, and the want of fresh vegetables or
fruits, together with their ignorance of the cause and cure, this
disease made dreadful havock amongst naval squadrons, and the other
busy hive employed in nautical commerce. The ancient navigators, who
seldom ventured out of sight of land, or capes; and who probably
were not under the necessity of subsisting long on salted food, do
not appear to have suffered by, nor even to have known, the disease.
Hippocrates is by some supposed slightly to allude to scurvy, under the
name of large spleen; accompanied also with spungy putrid gums, and
offensive breath: it is also, though indistinctly, noticed by Pliny, as
affecting a Roman army encamped on the banks of the Rhine.
Through all the northern kingdoms of Europe, particularly in the winter
season, and in Holland, amongst those who fed chiefly on salted fish
and gross diet; who drank bad waters, and dwelt either in morasses, or
near the sea coasts, and were exposed to cold and moisture, scurvy in
the two last centuries made cruel ravages. Several armies and besieged
garrisons in Germany, intercluded from fresh vegetables; and numbers
of the new settlers in the northern colonies of America, and who
were in nearly the same predicament, were cut off by the scurvy. The
North Americans were at last taught by the Baltickers and Swedes the
sovereign benefit of substituting spruce beer, when fresh vegetables
cannot be found. The industrious Dutch made drains and canals to carry
off water, and trusted the rest of the cure or prevention to pickled
cabbages or sour crout. In the northern parts of Russia, where scurvy
is very universal, they found a particular acidulated bread and sour
drink, powerfully to resist this disease.
By these and other precautions, the scurvy is now much less formidable
on land; but at sea no other, the nervous and putrid fever not
excepted, is so inimical to navigators. On that element it is yet the
devouring monster and tyrant. In the first voyages of our East India
Company’s ships, nearly one fourth of the crews died at sea. Nautical
records teem with tragical narratives of scorbutic ravages. But at
present, the causes and the effectual antidotes, and the cure, are so
well known, that the greatest part of the lives now lost by scurvy at
sea, are either sacrificed to gross negligence, or to impolitic and
inhuman economy. The temperature of sea air is more equal than that on
land: and that it is not pernicious, we have an undoubted proof in one
of the late Captain Cooke’s voyages; wherein, with a company of 118
men, during a voyage of three years, and through all climates, from 52
degrees north to 71 south, he lost only one man by sickness.
From 1671 to 1686, the deaths by scurvy are in the London bills
9,451; but in the succeeding fifteen years, decrease to 569 only:
and throughout the present century, continue progressively on the
declension. Even of this trifling number, what proportion was
engendered at sea, or whether they all died of genuine scurvy, I cannot
decide. The theory of the last century imputed many diseases to this
specific cacoethes, as they called it; which would have some influence
on the searchers reports. In London, the lodgings are now warm and
dry, and the people in general tolerably well cloathed: animal meat
is eat fresh; vegetables, though perhaps not universally consumed in
sufficient quantity, are certainly in much greater abundance than
formerly: beer, fermented liquors, and tea, are drank by all ranks. All
these, in conjunction with exercise, powerfully resist the tendency to
scorbutic corruption.
The progressive gradations and virulence of scurvy, are distinguished
under the three following stages: the countenance becomes pale, sickly,
and bloated, with lassitude and aversion to motion, and debility, on
any exercise. But the cardinal symptom is red, spungy, enlarged gums,
from which, on being rubbed, blood issues, and the teeth begin to
loosen and fall out; the breath and urine are fetid; and, by degrees,
bruises and black spots are seen in various parts, especially the legs.
In the next more aggravated stage, the tendons at the hams begin to
contract and swell; there are pains in different parts; disposition
to salivation and hemorrhages from the gums and nose, with increased
debility and proneness to syncope. In the last and most inveterate
stages, putrid ulcers are formed, particularly in the legs, which
are swelled and enlarged; or old cicatrices of former ulcers are
dissolved, and again break out, from which issue a sanious and fetid
discharge; and within them is generated fungous flesh, in confidence
resembling a bullock’s liver. Throughout there is no fever; nor is
the disease contagious; neither are the appetite and senses impaired,
except that there is great despondency and melancholy. The predisposing
and occasional _causes_ are cold and moisture, and subsisting long on
dried, smoked, salted flesh meat or fish, without vegetables, or these
in small quantity; putrid, and also gross diet difficultly digested,
not perspirable; corrupted stagnant water; low marshy damp situations;
cold situations; the winter season of northern climates: wet cold
cloaths, beds, houses; insufficient or suppressed perspiration,
hence the corrupted animal juices are not carried off; indolence,
sedentary life, confinement, dejection of mind, melancholy; bad health;
impurities of the blood; diseases of the spleen.
_Scrofula_, Struma, King’s Evil. In the last thirty years of the
preceding century, the mortality by evil is only 2,126, in the London
bills; and throughout the present century continues decreasing. This,
however, is a very partial representation of its fatality, which in its
consequence is far more destructive. The disease seldom appears under
two years of age; commonly between three and seven, and sometimes not
until near puberty; after which its evolution and first appearance is
very rare. The children of fair hair, rosy cheeks, smooth skin, soft
delicate complexion and temperament, are more obnoxious to scrofula
than those of an opposite temperament. It is sometimes introduced by
a tumid upper lip, and chop in the middle of it; at other times the
first appearance is oval moveable tumours in the lymphatic glands
of the neck, under the chin, or below the ears. These tumours often
continue inert one, two, or more years, and without pain, until they
tend towards suppuration; and are various in size, from a walnut to
an egg, or larger. At length there is some fluctuation, ulceration,
and exudation of viscid serum, but no concocted pus; the ulcers spread
unequally; their edges are not callous; yet they are very tardy in
cicatrizing. In this way there is a succession of tumours and ulcers
during several years; the former alternately subsiding whilst the
ulcers are open; some cicatrizing, and others breaking out; and most so
in the spring season.