Chapter III: Part 3

-----------------------+-------+-------+-------+------+------+------------ |Fifteen| From | From | From | From | Total | Years,| 1717 | 1732 | 1747 | 1762 | Amount of | from | to | to | to | to |Seventy-five DISEASES | 1701 | 1732.| 1747.| 1762.| 1777.| Years AND | to | | | | | Mortality, CASUALTIES. | 1717. | | | | | from 1701 | | | | | | to 1777. -----------------------+-------+-------+-------+------+------+------------ Ague | 80| 198| 82| 99| 109| 574 | | | | | | Fevers. Malignant, | | | | | | Spotted, Scarlet, | | | | | | and Purple | 50,955| 53,330| 57,995|45,621|48,594| 256,085 | | | | | | Small Pox | 22,219| 34,448| 29,462|29,165|36,276| 151,570 Measles | 1,972| 2,618| 2,858| 3,099| 3,319| 13,866 Quincy, Sore Throat | 226| 169| 287| 306| 309| 1,297 Pleurisy | 384| 602| 811| 407| 321| 3,525 Rheumatism | 368| 447| 310| 175| 128| 1,468 Gout | 313| 645| 769| 803| 1,010| 3,236 | | | | | | Consumption | 42,541| 49,680| 66,009|61,749|68,949| 288,928 Chin Cough, Hooping | | | | | | Cough, Cough | 116| 632| 1,692| 2,755| 4,252| 9,573 Asthma and Tissick | 5,090| 7,938| 9,460| 5,699| 6,154| 34,341 | | | | | | Apoplexy and Suddenly | 2,228| 3,013| 3,287| 3,271| 3,353| 15,152 Palsy | 332| 550| 621| 1,021| 1,020| 3,544 Lethargy | 105| 126| 116| 105| 74| 526 Meagrims | 13| 10| -- | -- | -- | 23 Headach | 21| 32| 6| 18| -- | 77 Lunatick | 412| 513| 777| 1,126| 1,048| 3,876 Spleen and Vapours | 53| 52| 20| -- | -- | 125 Rising of the Lights | 1,219| 1,239| 197| 30| 10| 2,074 | | | | | | Stoppage of the Stomach| 4,139| 2,557| 2,286| 304| 179| 9,465 Vomiting and Looseness | 820| 682| 248| 134| 120| 2,004 Cholic, Gripes, and | | | | | | Twisting of the Guts | 13,668| 11,032| 3,739| 1,475| 796| 29,710 Flux | 178| 200| -- | 252| 341| 971 Bloody Flux | 133| 248| 167| 94| 93| 745 Worms | 697| 662| 161| 115| 56| 1,691 Jaundice | 1,261| 1,798| 2,032| 1,729| 2,089| 8,909 Gravel, Stone, and | | | | | | Strangury | 789| 868| 700| 421| 429| 3,205 Diabetes | 37| 48| 19| 16| 5| 125 | | | | | | Dropsy and Tympany | 11,626| 15,430| 16,036|13,410|14,038| 70,506 Livergrown | 76| 95| 75| 23| -- | 269 | | | | | | French Pox | 917| 1,372| 1,663| 997| 1,016| 5,965 Scurvy | 63| 28| 14| 59| 42| 226 Evil | 1,020| 519| 426| 197| 198| 2,360 Leprosy | 19| 53| 69| 39| 15| 1,915 Rash | 77| 128| 47| 59| 24| 341 Itch | -- | -- | 42| 31| 11| 84 | | | | | | Childbed | 3,560| 3,894| 3,412| 3,005| 3,186| 17,057 Abortion, and Stillborn| 8,746| 10,231| 8,793| 8,820|10,241| 46,831 Chrisoms and Infants | 850| 315| 606| -- | -- | 1,771 Miscarriage | -- | -- | 47| 56| 49| 152 | | | | | | Convulsions | 91,660|114,718|111,966|85,196|89,221| 492,761 Headmold-shot, and | | | | | | Water in the Head | 609| 2,374| 2,013| 1,022| 337| 6,355 Teeth | 18,478| 25,199| 20,274|13,978|11,918| 89,847 Thrush | 839| 1,191| 1,512| 1,391| 1,101| 6,034 Scald Head | 9| 15| 29| 22| -- | 75 Rickets | 3,916| 1,383| 954| 112| 104| 6,569 | | | | | | Inflammation | 8| 67| 698| 894| 1,394| 3,061 Imposthume | 790| 694| 387| 191| 84| 2,130 St. Anthony’s Fire | -- | 73| 36| 63| 69| 241 Gangrene and | | | | | | Mortification | 1,071| 2,857| 3,362| 3,083| 3,023| 13,438 Canker | 138| 181| 123| 77| 61| 580 Cancer | 1,041| 1,059| 774| 682| 719| 2,475 Sores and Ulcers | 695| 485| 402| 253| 236| 2,071 Fistula | 360| 202| 210| 134| 119| 1,025 Bursten and Ruptures | 310| 309| 304| 163| 140| 1,226 Swelling and Wen | 6| -- | 47| 49| 37| 139 | | | | | | Killed by Falls, | | | | | | Bruises, Fractures, | | | | | | and other Accidents | 828| 917| 926| 1,084| 1,065| 4,820 Self-Murder | 445| 667| 693| 555| 509| 2,869 Murdered | 135| 109| 147| 71| 77| 539 Stabbed, Killed, | | | | | | Wounded, Shot, &c. | 15| 32| 13| -- | -- | 60 | | | | | | Executed | -- | -- | 495| 495| 1,020| Drowned | 907| 1,193| 1,444| 1,718| 1,781| 7,043 Burnt | 90| 54| 90| 127| 132| 493 Scalded | 19| 36| 45| 51| 40| 191 Stifled, Suffocated, | | | | | | and Smothered | 13| 34| 62| 90| 68| 276 Overlaid | 817| 1,180| 1,293| 414| 95| 3,799 Found dead | 388| 557| 668| 336| 133| 2,082 Grief | -- | 267| -- | 87| 77| 421 Frightened | 8| 14| 8| 13| 2| 45 Surfeits | 685| 131| 59| 31| 27| 933 Starved | -- | 17| 96| 53| 57| 223 Excessive Drinking | 19| 267| 678| 189| 69| 1,222 Bleeding | 87| 69| 57| 70| 114| 397 Poisoned | 2| 7| 7| 24| 10| 40 Bit by Mad Dogs and | | | | | | Cats | -- | 3| 14| 15| 6| 38 | | | | | | Bedridden | -- | 104| -- | 56| 105| 265 Aged | 27,341| 34,708| 30,058|25,109|22,032| 139,248

_A MEDICAL CATALOGUE of all the principal Diseases and Casualties by
which the Human Species are destroyed or annoyed._

FEVERS. Intermittent, quotidian, tertian, quartan, species and
varieties.

—— Remittent, Continued, and Eruptive; remittent, and the species,
nervous and putrid, miliary, inflammatory, small pox natural and
inoculated, measles, scarlet fever, some cutaneous eruptions, mixed
and anomalous fevers, plague, sweating sickness.

FEVERS with topical inflammation of the brain, of the fauces, including
angina inflammatory and putrid, pleurisy, and peripneumony,
inflammations of the heart, diaphragm, liver, spleen, stomach,
intestines, kidneys and ureters, bladder, peritoneum, erysipelas,
acute and chronic rheumatism, regular and irregular gout. Internal
suppuration and gangrene.

Injured respiration and coughs, catarrh, pulmonary hæmorrhage,
pulmonary consumption, hectick, atrophy and tabes, asthma, hooping
cough, croup.

Natal hemorrhage, headach, nightmare, lethargy, vertigo, apoplexy,
epilepsy, fainting, resemblance of death from drowning, foul air,
&c. palpitation of the heart, internal polypus and aneurism,
tetanus and locked jaw, catalepsy, spasm, cramp, Saint Vitus’s
dance, tremor, palsy, berbiers, insanity furious and melancholy,
hypochondriasm.

Diseases of the sight, hearing, smell, taste, voice, and speech,
sterility of the sexes, morbid irritability of the genitals,
diseases of the teeth, deglutition obstructed.

Diseases of the stomach, and of the complex organization, subservient
to appetite and digestion, gall-stones, jaundice, cholera,
dysentery, diarrhœa, cholick, worms, tenesmus, costiveness,
hemorrhage from the stomach and anus.

Morbid symptoms and diseases from various poisons, canine madness,
venomous bites and stings.

Obstruction and suppression of urine, stone in the bladder, diabetes
and incontinence of urine, ulcers of the kidney and bladder, bloody
urine.

Watery effusions, or dropsies of the head, spine, chest, pericardium,
external cellular membrane, abdomen, ovarium, fallopian tubes,
womb, scrotum, tympany, corpulency, and excess of fat.

Venereal disease, scurvy, scrophula, leprosy, yaws, itch; several
chronic cutaneous defedations, morb. pedicul.

FEMALE DISEASES. Obstruct. mens. chlorosis, excessive menstr. fluor
alb. hystericks, pregnancy, parturition, natural, laborious,
preternatural, and complex, some diseases during pregnancy,
abortion and miscarriage, uterine hemorrhage, fainting,
convulsions, lochial excess and suppression, uterine inflammation,
puerperal fever, after-pains, weed, milk fever, inflammation of
the breast, excess and defect of milk.

INFANT DISEASES. Convulsions internal spasms, dentition, rickets,
thrush.

_N. B._ Vomiting, diarrhœa and watery gripes, hectick and atrophy,
small pox, measles, rash, hooping cough and worms, dropsy
of the head and spine, are before described, under their
respective titles.

Internal schirrus affecting various parts, the lungs, stomach,
intestines, liver, spleen, kidneys, ovaria, womb, testicles; also
internal cancer, external scirrhus and cancer.

External inflammation, suppuration, gangrene, burns, wounds, and
contusions, fractures simple and compound, luxations and sprains,
herniæ, or ruptures, abscess and ulcers, white swelling, spina
ventosa, external aneurism and varix, polypus of the nose, fauces,
vagina, womb, wens, bronchocele, corns, warts, chilblains.

An abstract of the general causes of diseases and mortality, of the
seasons and elements, food and drink, excretions and secretions,
exercise and rest, sleep and waking, passions of mind, venery.

An abstract of mortality in various domestic and military hospitals.

The Poet has, in just and emphatical language, stiled health the vital principle of bliss. In the rude state of science and medicine, and in the ages of superstition and credulity, it was usual to ascribe diseases to the immediate resentment of some invisible demon, or to divine displeasure and chastisement; on which account, in barbarous nations, their physicians have been a set of stupid conjurors. Two centuries have barely elapsed, since the people of England could, with difficulty, be persuaded that the jail distemper, communicated at the Oxford assizes, from the prisoners to the spectators, was not kindled up by witchcraft and necromancy: but learning and philosophy have now discarded such supernatural agents. Others again equally err, in supposing diseases to be unsteady motions of the human machine, excited by something hurtful. This popular error seems to originate from confounding diseases themselves with the versatility of medical remedies and practice. Beyond a doubt, diseases are presented to us, over and over again, in nearly the same form and shape: the diseases delineated two thousand years ago by Hippocrates, at this day retain the same essential marks and prominent features; tho’ in degree and violence, there are many gradations and shades to vary the picture.

A disease, in the pathological language, is when one or more of the various corporeal or mental functions, cannot be performed as in usual health. The symptoms of all diseases are indicated by few or many derangements of the corporeal functions, of the excretions, and of the sensible qualities: such are pain, disagreeable sensation, anxiety, irritation internal or external; the exercise of some of the external or internal senses impeded; of sleep and waking; of the muscular or moving fibres; of the digestive and intestinal functions: of the lacteal, lymphatic, or absorbent system; of the respiration, sanguiferous circulation, and arterial pulsation; of the different excretions and secretions, the feces, urine, perspiration, bile, pancreatic fluid, saliva, milk, menses, semen, mucus, oil, lymph, by extravasated blood: by the countenance, actions, gestures, debility, strength, heat, colour, smell, taste, magnitude, hardness, softness, the nature and appearance of the excretions, &c. I studiously avoid all minute pathological discrimination of symptoms; as symptoms of the disease, of the cause, of symptoms, of reacting nature; of primary, pathognomic, accidental, and accessary symptoms. Nor in briefly enumerating the various causes of diseases, shall I waste time in the explanation of what may be learned from pathological systems and vocabularies: such as the technical distinction of causes into external and internal, predisponent, exciting and occasional, remote and proximate.

There is both fiction and much truth in the warbling melody of the Roman poet: “Post ignem etherea domo subductum macies, et nova febrium cohors incubuit terris.” Consumptions and Fevers we see, by arithmetical demonstration, are amongst the most universal and fatal maladies of our metropolis and Island. I begin this morbid survey with the latter. The principal and most general febrile epidemicks which infested England during two intire centuries, are enumerated in a short abstract, by Dr. Short; and consist of plagues, agues, remittent fevers, summer and autumnal dysenteries, spotted putrid fevers, slow fevers, small pox, measles, putrid and contagious peripneumonies, fatal spring pleurisies, and peripneumonies, and epidemical catarrhs. Throughout all countries, in epidemical diseases, there are years when they are more or less prevalent. Great national calamities, from this source, are rare: none ever inundate a whole kingdom (catarrh in some instances excepted): they sometimes indeed spread from one province to another, but all the community are never attacked at once; nor are large populous kingdoms, or even cities, totally exempt from them. Fevers of various generic forms, as intermittent, remittent, nervous and putrid, scarlet, small-pox, measles, &c. may be local and circumscribed to one city or district, whilst others in the vicinity, continue at the same time healthy; the disease dissipating its virulence within a small boundary. From a comparison of 150 different parish registers, Dr. Short calculates, that within a certain period, some have had 8 to 14 sickly years, and others, in the same interval, only one. He estimates 5, 6, and 8 years interval, as a common rotine of irruption by some epidemical distemper, even in remote country parishes: and a few of them have been so fortunate as to escape any uncommon or remarkable mortality during 11, 12, or even 20 and 30 years. In all the seasons denominated sickly in the country parishes, the burials exceeded the christenings; and according to the nature of the epidemick, the morbid state of the seasons, the medical treatment, and many other circumstances, the gradations of mortality, even by the same disease, were extremely various.

Collating the annual average of deaths in a sickly year of London, and other great cities, with sickly years in the country parishes, Dr. Short found, that cities and towns, in this respect, have the advantage of the country. In spacious open country districts where fatal epidemicks burst out, according to this author, more died in one year than during 6, 10, 12, or sometimes 15 healthy years: whereas, says he, in London, and such other cities, not above one third, fourth, or fifth beyond the ordinary consumption are swept away. Pestilential mortality is a solitary exception to this proportion. In the London bills we may frequently observe, that in different months, the deaths are double or treble above equal periods of the same year: but during the present century, I find no instance of triple, very rarely of double excess in the annual London burials. Dr. Short adds, that mortality is more constant and regular in cities, and not so many destroyed “per saltum” from raging epidemicks, as in the country. In pure open air, he suggests, that contagion and infection, or other adulterated effluvia, are more virulent. Or perhaps he should have said, or at least have added, that in cities where the atmosphere is charged with a load of smoke, and other heterogeneous vapours, epidemical poisons may be blunted, decompounded, or annihilated; that likewise in cities, human bodies are more early seasoned and habituated to such noxious external impressions, and, like doctors and nurses, are in some degree fortified by habit: that besides, in every large metropolis, small-pox, measles, and, some other febrile epidemicks, are almost constant residents; and consequently the devaluation from these diseases is more regular and equal than in the country, where several years intervene between their invasions.

The absolute mortality by fevers in the London bills, without including the small pox and measles, amounts to nearly one seventh of the whole funeral catalogue. In the London dispensaries, the Aldersgate and Westminster, and in the Newcastle hospital, fevers were a fourth and sixth to all other diseases. De Haen computes, that out of two thousand sick, admitted into the hospitals in Vienna, seven hundred of them laboured under acute and febrile diseases. Dr. Cleghorn estimates the summer fevers in that warm Mediterranean island Minorca, as constituting three-fourths of all the diseases in that island. Dr. Lind calculates, that nineteen out of twenty of all the numerous Europeans who visit the sultry climates of Africa, America, and of the East and West Indies, are destroyed by intermittent, remittent fevers, and fluxes; and probably he also should have added, or by chronic diseases and broken constitutions, the consequence of those fevers. In the London bills of mortality, many different genera of fevers are crammed into one indiscriminate heap, from which it is impossible to extricate the specific nature or genus of febrile carnage. I was anxious to determine with some probability, the ratio of desolation in London, by each of the different febrile genera: because it would be an important guide to the prevention and cure. I knew that most of our hospital registers were in this particularly defective; on that account I was favoured by a medical friend, with the perusal of the books of the Aldersgate dispensary. But although no gentlemen are better qualified to discriminate diseases, I perceived, on inspection, that too often the genus of fevers was not marked, only by the general outlines of the class. However, I converted this scrutiny to some other use, as will hereafter appear.

We shall first trace the prominent features of the general febrile Class, descending progressively through the different Orders and Genera. In most fevers, of whatsoever genus, one or more of the following symptoms occur: shivering, chilliness, and heat of the skin alternating: the circulation of the blood, and consequently of the pulse, as felt at the wrist, accelerated more than in the natural state; in adults, to upwards of 96 strokes every minute; and in infants, is considerably more increased in velocity: also general languor, lassitude, and debility of the nerves and muscles; dryness of the mouth and tongue, thirst; little or no sleep, or disturbed and not refreshing, and generally headach: in most of the continued and remittent fevers, there is total suspension of appetite, sickness at the stomach, nausea and vomiting; increased heat of the skin, at least burning sensation; aversion to motion; the sick are mostly confined to bed, unable to walk, or frequently even to sit erect; and this is commonly the case, even in the intermittent genera during the febrile paroxism: the remittent and continued have usually an evening or nocturnal febrile exacerbation: the voice and countenance frequently express condolence: and in the genera of topical inflammations, there is fixed pain in the different parts affected.

_Intermittent Fevers_, or Agues, notwithstanding their febrile type, fall under the Chronic class. They are usually distinguished into different genera, or types; into Quotidian, Tertian, Quartan, with their separate species and varieties. It would seem, by the London registers, that very few die of agues, from which no age is exempted, but to which adults are much more obnoxious. Intermittent havock, if not immediately, yet in its chronic effects, is far more fatal than the London bills represent. Towns in general, it is true, are less harrassed with agues than country places. Pringle remarks, that during the campaigns of the British troops in the marshy countries of Holland and Flanders, where, in all such climates, and in damp soils and situations, agues and remittent fevers are epidemick, that the soldiers quartered in towns were less afflicted than those stationed in country cantonments: that in the former, the fires, sewers, drains, and paved streets, prevented an exuberance of moisture: and that, if the men slept in the upper floors of the house, they were still more secure from damp and intermittent sickness.

The invasion of Intermittent Paroxisms, is during certain periods only, and generally consists of a successive series of shivering and cold, burning heat, and profuse sweats: and exhibits the fundamental outlines of all fevers. Intermittent paroxisms, and consequently the genera and species, vary in duration, in recurrence, and in the symptoms. Quotidians, Tertians, and Quartans, consist of paroxisms, at the respective intervals of 24, 48, and 72 hours. An interval denotes the length of time from the beginning of one paroxism to the next succeeding: an intermission the vacation between paroxisms. Other distinctions, perhaps too refined, are made of intermittents, as Quintanæ, Septiminæ, Decimanæ, Erraticæ, Vagæ. Each of the three primary intermittent genera, are likewise subdivided into duplex and triplex. The double tertian is a very universal form, but may be referred to remittents: it implies that every other or second day the paroxisms are similar, but different in the intermediate days. Again, the type of intermittents is often obscured under a cloud of irregular and adventitious symptoms; and from one predominant symptom, or from similarity to various other diseases, these three fundamental genera are split by Nosologists into other species and varieties; the Quotidiana or intermittens, into simplex, cephalalgia, ophthalmica, nephralgica, stranguriosa, ischiadica, sputatoria, catarrhalis, anginosa, epileptica, hysterica, partialis: the Tertiana into simplex, hemitritæa, duplex, triplex, pleuritica, asthmatica, arthritica, emetica, hysterica, apoplectica, urticata, and other species of double tertian enumerated under the remittent type: the Quartana into cataleptica, epileptica, hysterica, maniaca, comatosa, nephralgica, splenetica, arthritica.

The three stages of intermittent fevers, during their periodical revolution, affect, more or less, the brain and nerves, the inherent muscular power, the heart and arteries, the stomach and intestines, and the sensible qualities of the body; the symptoms usually succeeding in the following progressive order: languor, sluggishness, debility, impaired sensibility, sometimes drowsiness and coma, oscitation, sensation of coldness in the back and spine, overspreading the body and extremities; accelerated and weak pulse; laborious respiration with anxiety; impaired appetite, and often sickness, nausea, and vomiting of bile; thirst; limpid urine; pale face, extremities, and trunk, and cutaneous collapse; rigor and trembling of the extremities and trunk, and gnashing of the teeth, as if cold water was poured on the body. This stage is various in duration in different persons, and in the different intermittent types. Nature at length rallies its powers with success, and with the expulsion of the cold, the second or hot stage is kindled up with undulating flushes of heat, and its preternatural increase over the body; the cutaneous blood vessels are dilated with suffusion of the countenance, redness, and burning heat; the pulse becomes strong, full, and more regular; the respiration continues oppressed, and is accelerated; with headach, throbbing of the temporal arteries, and sometimes delirium. After some continuance of this febrile struggle, and tumultuary rage of the re-acting organs of sensation and motion, the third stage of sweat is introduced by some moisture oozing throughout all the cutaneous pores, and poured out often in profuse streams: with this the heat of the body, the pulse, respiration and appetite become more natural; the urine less transparent deposits a sediment; the febrile tempest abates to a calm; and the body recovers the exercise of all its usual functions. Sometimes indeed there are varieties; such as little or no cold stage, or sweat.

Intermittent paroxisms are always terminated in less than twenty-four hours. Quotidians have the least cold stage, but the longest paroxism: tertians are in the intermediate degree in both respects; quartans have the most violent, or at least the longest cold stage, but the shortest paroxism: their cold stage may be two hours, or longer. The hot and sweating stages therefore constitute the greatest portion of intermittent conflict. Quotidian paroxisms rarely exceed eighteen hours: tertians are from six to twelve: quartans somewhat shorter. Quotidians generally assault in the morning; tertians and quartans in the noon and afternoon. Vernal are said not to be so refractory as autumnal intermittents. But in young sound constitutions, agues, if not inveterate, are frequently cured after a few paroxisms. When death happens in them, it is generally during the cold stage. More frequently their fatality is by transition into some other chronic diseases: such as maladies of the stomach, digestive organs, liver, and intestinal tube; bilious cachexy, jaundice, consumptions, dropsy. Some inveterate corporeal infirmities have been relieved by intermittents. During their revolution the type is frequently changed: quartan and tertian into quotidian: the latter into remittent; and these into continued fever.

_Remittent Fevers:_ fevers with remissions and exacerbations, or which have not a temporary and total cessation, are the most universal febrile form in all parts of the globe. Throughout the equatorial oven, or middle regions of the earth, from Cancer to Capricorn, intermittents, but, above all, remittents and dysenteries are the most universal type of fever. They are the locusts which devour whole crops of mankind. During the periodical rainy seasons of the tropical zones; particularly where they are choaked up with woods and morasses, and in uncultivated new settlements, these fevers often ravage with the desolation of an Egyptian pestilence; and are sometimes so precipitate as to kill in one or two paroxisms, if not sooner repulsed; the doctor, lawyer, and priest quickly succeeding each other in their visits. They destroy not only multitudes immediately, especially of the new European settlers; but when improperly treated, or when convalescents from irregularity, fall back into relapses, they often terminate in fatal chronic diseases, similar to those recently enumerated under the intermittent train.

Not only within the tropicks, but likewise through the northern hemisphere, to the verge nearly of the polar circles, we can descry this remittent febrile host. In the sultry summer and autumnal seasons of Europe, in low marshy countries, soils and situations such as Italy and Hungary, where the summers are long and intense; and in that northern morass, Holland, these are the epidemical tyrants. Armies encamped are often at that season grievously infested with them, and with dysenteric fluxes. In Britain and Ireland also, they are frequent and fatal epidemicks; and are not confined to the summer season only. Even in most dry countries and situations without the tropicks, after an unusual close sultry summer, with long protracted heats, we often see, or read of, such fevers and fluxes. The humours then, says Pringle, are corrupted, the solids relaxed; and in such a disposition of body, irregularities in diet, wet cloaths, and damp air, may give activity to such latent indisposition. In that small southern Mediterranean island, as described by Cleghorn, where the soil is rocky, but the summer heats excessive, such fevers have raged with atrocious severity.

Fevers intermittent and remittent, and those strictly simple inflammatory, are greatly regulated, not only by the climate, latitude, soil, local elevation or depression, but also in the same country by the different seasons of the year. In summer and autumn, fevers tend in various degrees to affect the stomach and intestines with sickness; they are then, more or less remittent, and participate less of the inflammatory. “In Holland,” continues Pringle, “towards June, a healthy month, the inflammatory fevers begin to recede; and the remittent, bilious, and putrid often succeed throughout the summer and autumn, until the return of winter, when the inflammatory again recommence; the seasons and diseases insensibly interchanging and running into each other.” We may also add, that in all warm climates there is a copious and superabundant secretion of bile; and that none of the animal fluids so soon turn putrid. They are more obnoxious to remittent fevers who are constantly exercised in labour and fatigue, and exposed to the external air, than other ranks who are comfortably accommodated, cloathed, and fed. Pringle remarks, that the peasants of Holland were always greater sufferers by the summer, autumnal, and remittent fevers, than those of the more opulent class; and also, that during summer and winter, in the field and in garrison, the private soldiers were more sickly than the officers, and liable to fevers.

Remittent fevers seem to consist of a repetition of protracted diurnal paroxisms, or periodical aggravated exacerbations, nearly similar to the intermittent or primitive type; but without the latter’s complete intermission. Authors have described them under a variety of apellations; but they may be all comprehended as ramifications of one great trunk, or integral genus: they appear in essence the same disease, and are cured by similar remedies. In the medical nomenclature, they are denominated remittent, semitertian, hemitritea, tritophyea, double and triple tertian, putrid remittent, marsh, camp, ardent, bilious fevers, gall sickness: tertian fever obscured under a mist of one or more dangerous and prominent symptoms; hence named tertiana lethargica, vertiginosa, soporosa, apoplectica, paralytica, cataleptica, epileptica, convulsiva, phrenitica, hysterica, syncopalis, asthmatica, arthritica, cardialgica, singultuosa, rheumatica, pleuritica, dysenterica, atrabilaria, cholerica, emetica, diaphoretica, pituitosa, miliaris, scorbutica.

Exclusive of the symptoms common to such fevers, and partly delineated under the intermittent paroxism, remittent fevers are variously diversified by a rotine and medley of nervous, putrid, and inflammatory symptoms; but infinitely more of the two former. The climate, season of the year, remissions, and the notorious epidemick or endemick of that region or place, all contribute to their unerring detection. Sometimes they attack very suddenly and violently with delirium and inflammatory simulation; but soon afterwards, and at the interval of a few days, remissions are evident. Sometimes their approach is in appearance mild, but not less alarming. In general there are great lassitude, debility, anxiety, restlessness, severe headach, frequently delirium, especially at the exacerbations; disturbed sleep, and not refreshing; sickness at the stomach, nausea, bilious vomiting, or efforts to evacuate the ventricular contents; fecal excretion bilious with gripes; inextinguishable thirst; tongue dry and parched; quick hot respiration; skin sometimes dry. When bile is redundant, the intestinal excretion is often putrid and offensive, with bilious diarrhœa or dysentery, in repetition and quantity profuse, exciting tenesmus, and sometimes excoriation of the anus; to these may be added pain in the stomach and intestines, tension and elevation of the belly. According to Lind, the tropical remittents are the most virulent, yet are not contagious, unless accompanied with dysentery, or the sick crowded together; which, if an irrefragable fact, distinguishes this fever from the nervous and putrid: and besides, in those febrile epidemicks and endemicks, from marshy effluvia, the remissions are more perceptible and synchronous than in these from animal contagion. From the air, season, and medical treatment, the remittent may be converted into the intermittent or continued type; in the intermittent there is more security. In warm climates putrescency and death may ensue in a few paroxisms; in others, in all the intervals during three weeks: and usually the crisis is by some of the larger excretories.

_Nervous and Putrid Fevers._ This febrile host are also widely dispersed over the earth; and probably are not so much governed or influenced as the preceding remittents by the climate, season, and sensible qualities of the atmosphere; but may originate in all countries, climates, seasons, and situations; and when extremely virulent, may, like the plague or small pox, be communicated by imperceptible emanation or contagion from one infected person to another; by personal intercourse, by the medium of polluted goods, furniture, apparel, cloaths, and houses; in all which the noxious miasma may be concentrated and lodged. Sometimes they harrass a nation or city in detachment only; and sometimes in formidable phalanx. Such fevers are frequently engendered in jails, crowded with filth and animal steams, and excluded from free ventilation: also in military hospitals, crammed with sick, with dysenteries, putrid sores, and mortifications: also in ships and large fleets, when hastened out in the hurry and spur of approaching hostilities: also in wet and stormy weather at sea, when the hatches are closed.

In cities, contagious fevers may be traced to prisons, perhaps sometimes to hospitals; certainly often to narrow courts and alleys, and small crowded apartments; to the houses of the indigent; to filth, rags, and squalid poverty, co-operating with foul unventilated air: and in the open perflated streets, are much less frequent. Cities, therefore, should be more infested with them than the country; and the poor more than the affluent. Children with adults are subject to them, but more of the latter. In London, perhaps, nine-tenths of the fevers, are of the remittent, nervous, and putrid type, and not of the simple inflammatory. But I exclude from this calculation the exanthematous order, and the topical inflammations. Some, not without argument, alledge, that slow nervous fevers are in general derived from the same origin; and that they differ from the putrid in degree only. Petechial spots are by no means constant symptoms of the putrid type; but when they occur, they point out the disease more unerringly, and its greater malignity. In many instances, their differences may be rationally imputed to climate, season, constitution, miasma, and medical treatment.

I meet with inextricable embarrassment, in endeavouring to draw the exact limits, not only between nervous and putrid fevers, but also between them and what some authors have termed the universal remittent of this island; and which is not limited to any season of the year. I take this opportunity, therefore, to avow, that in what proportion these very general fevers with remissions originate from marshy effluvia, from climate, and constitutional indisposition, from animal contagion, or from other occult causes, I am unable to decide: Their precise relation as to lineage and consanguinity, is beyond my penetration. Nervous and putrid fevers have been described under the following different names: slow nervous fevers, febricula, maligna lenta insidiose mitis, nervous and putrid fevers, putrid remittents, typhus castrensis, jail, hospital, infectious, putrid, malignant, continued, putrid, spotted, purple, petechial fevers; yellow fever of the West Indies, or typhus Icterodes.

Slow nervous fever frequently steals on with treacherous mildness; the sick are rendered unfit for business, but yet not confined to bed, and except to sagacious judges, the fever is not apparently alarming; and too often the sick and their friends are lulled into fatal security. The symptoms slight alternate chills and fugacious heats, especially in the evenings; heaviness, giddiness, and headach, particularly in the posterior and superior part, and the pain often descending down the spine; great debility and prostration of strength; and in both nervous and putrid, the functions of the brain, and of muscular motion, considerably weakened, and interrupted; also depression of spirits, sighing, restlessness, very little sleep and not refreshing; accelerated, weak, and small pulse; nausea, total inappetency; inconsiderable heat of the skin or thirst; dry tongue, a little yellow at the sides; pale urine, and without sediment; irregular sweats; sometimes pains resembling rheumatick. After a few days, the fever, stupor, delirium, and headach increase, with low muttering delirium, chiefly during the nocturnal exacerbation, and with noise in the ears, and universal debility of the corporeal and mental organs. The remissions are generally more distinct in the beginning, and, by degrees, more obscure.

Putrid fever sometimes creeps on with deceitful approach under the nervous cloak; and sometimes, with furious onset, counterfeits the inflammatory. The symptoms when radicated and inveterate are, unremitting headach, pain in the back and loins, and course of the spine; vertigo, throbbing of the temporal and carotid arteries, noise in the ears; delirium, extreme diminution of strength and despondency of mind, trembling of the hands and tongue when thrust out; anxiety, restlessness, or no refreshing sleep; intense burning heat of the skin, especially in the evenings; nausea, bitter taste in the mouth, vomiting of green or black bile: sometimes insatiable thirst; at other times the sick are insensible to thirst and heat, and only complain of universal languor and weariness; the tongue, teeth, and lips covered with a brown or black tenacious crust, with thrush and ulcers; the fecal excretion black, and fetid; the breath and perspiration offensive to the smell; the pulse progressively small, irregular, and quick, often 130 to 140 pulsations, even in adults, every minute; the eyes glazy, the vessels of the tunica albugina turgid with blood, and what is called blood-shot: in stages of still more virulency, petechial eruption sprinkled on the skin, with hemorrhages from the gums and nose, and hemorrhagick subcutaneous extravasations. In the yellow fever of the West Indies, there is a jaundice-colour of the eyes.

In the duration, crisis, and termination of nervous and putrid fevers, there is considerable diversity. Some may be suddenly stifled before they burst into a flame: some of inveterate malignity may prove fatal in a few days; others may terminate in all the intervals within three weeks, or even later. Some terminate auspiciously without any sensible crisis or evacuation: in others, there is more or less sensible defecation by some of the excretories, by perspiration and sweat; diarrhœa and fetid stools; turbid urine; exspuition and salivation; vomiting; tumor of the parotid glands; eruption about the mouth.

Miliary fever, febris purpurata, rubra and alba, is never epidemick, and is denied to be a primary disease; but is spurious, symptomatick, accessary, or fortuitous; it is very rare, and may be complicated with the nervous and putrid, and with small pox and measles. The miliaris alba is more frequent amongst the female sex, especially during the puerperal state, and in other females debilitated by fluor albus, and hemorrhages, of weak constitutions, delicate, prolifick. It sometimes exhibits previous symptoms of angina, pleurisy, catarrh, rheumatism, erysipelas. Its peculiar diagnosticks are extreme languor, anxiety, despondency, terror, sighing, prostration of strength, headach, delirium, restlessness, quick weak pulse, oppression of the breast and stomach, dry cough without expectoration; sometimes profuse sweats towards the third day or later, and the sooner the worse; inextinguishable thirst; urine and stools various. In different stages of the fever, after a few days, a cutaneous efflorescence is perceivable, from which the disease takes its name, preceded by and accompanied with itching and pricking heat of the skin, and eruption of diminutive pustules, the size of millet seed, and, by the fingers, may be felt prominent: they are rarely seen on the face; commonly on the neck, back, breast, and extremities; some of them change into small serous vesications, distinct or clustered, and emitting a peculiar sour odour: of these there is often a retrocession and new eruption, variously protracting the fever to a few days, or even weeks. It is distinguishable from measles by the pruriency and sour smell, and the absence of morbillous sternutation.

_Inflammatory Fevers_, synochus continua non putris of Boerhaave. To this we may add the febris diaria. A different genus of fever, both in its nature and cure, from the remittent, nervous, and putrid, is the simple inflammatory. The frequency and the fatality of this fever, is infinitely inferior to the preceding groups; and in comparison, is as a wasp to a tyger; or a babe to Hercules. The false lights hung out successively by multitudes of authors, and transmitted, in some degree, through the Boerhaavean school, to steer with the antiphlogistick compass and lancet in each hand, in the generality of fevers, have been the cause of numerous shipwrecks. Inflammatory fever is frequently complicated with some local inflammation, and then is distinguished under a different name, and hereafter described. Pringle observes, that in military camps, pleurisies, and peripneumonies are the most frequent form of fever with inflammation; and next to these acute rheumatisms.

The predominancy and reign of inflammatory fever in northern latitudes, is in winter and spring, in cold climates and rigorous seasons, and where cold and moisture are combined. It commonly attacks the robust, strong, athletick, and those in the vigour of life: it is not contagious; and neither its remission nor exacerbation are conspicuous. Its assault is sudden and violent, with severe headach, quick laborious respiration, interrupted sleep and restlessness, or sometimes somnolency; sometimes delirium; but in general the mental functions are not greatly disordered, nor the muscular debility so great as in the nervous and putrid fevers: pulse accelerated, strong, full, and tense; commotion and throbbing of the temporal and carotid arteries; intense heat of the skin, dryness of the mouth, fauces, tongue, and nose; ingurgitation of drink with avidity; the urine somewhat crimson in tincture, and in small quantity; the belly generally costive; the blood drawn, forming a buffy incrustation on the contracted coagulum, complete its portrait. The natural crisis is various by nasal hemorrhage, by sweats, turbid urine, diarrhœa; and the duration of the fever from four to eleven days. The Febris Diaria of a few days continuance, is a sort of minor or infant species, an appendix of the inflammatory: it begins suddenly with nausea, vomiting, shivering, cold, headach, lassitude, heat of the skin, flushed face, restlessness, or disturbed sleep, strong quick pulse: and is rarely dangerous.

With respect to all the preceding confederate genera of fevers, we shall make the following general observation. In the preceding century, during the last thirty years, febrile mortality, by the London bills, is rated at 87,645: and the mortality of the present century is seen in the Chart. Formerly, in this metropolis and island, and probably throughout Europe, fevers seem to have been much more prevalent and fatal than at present: their essential nature and cure is now much better understood by physicians; and we are provided with far more powerful auxiliary remedies, and are more expert in their application. In this particular instance, modern medicine, especially of the century in which we live, is signalized, and may, without arrogance, claim triumphal honours. The supposed innumerable varieties of fevers, and from which perplexity Sydenham could not altogether extricate himself, is now disproved by repeated experience, and by the infallible efficacy of general remedies. It is, however, as yet impossible to fix any definite medium or average of mortality in the above genera of fevers, whether remittent, nervous, putrid, or inflammatory. We have modern authentick records, wherein, under judicious and skilful treatment, of 200 sick in remittent fevers only one died; and even in the nervous and putrid, the blanks were trifling compared to the prizes; whereas, under different and erroneous management, one half, and often the greatest part of the sick perished. The corroboration of these assertions may be seen in those learned authors, Lind, Millar, Robinson, Clarke, Lettsom, Sims, and others.

Throughout the intire morbid host of human foes, there is probably no such flagrant variation in the therapeutick barometer, or scale of mortality, as in that of the fevers hitherto described. Different curatory processes and remedies soon change the natural genus, symptoms, crisis, prognosticks, and event. No dangerous diseases almost whatsoever, are more successfully oppugnable under discreet medical regimen; and when entrusted to nature, from the days of Hippocrates to the present time, they have ever been extremely fatal. Sorry I am to add, that, perhaps in many instances, the errors and fatality of nature, have been less destructive than those of artificial and therapeutick mismanagement. Since the discovery of antimonials and Peruvian bark, few now, under skilful medical pilots, die, compared to the multitudes of sick: but still in the aggregate list of funerals, except perhaps pulmonary Consumptions, it may be doubted whether any other of the belligerent morbid foes commit such ravages amongst mankind.

_Small Pox_, natural and inoculated. We have no vestiges, neither in history nor tradition, of this loathsome disease, nor of the measles, before the irruption of Mahomet and his followers from the Arabian deserts, about 1,300 years ago; and from whom this extraneous contagion was first transplanted into Europe. It is little more than 200 years since the exportation of this exotic poison to the American continent, where it had never before been seen nor heard of. The havock by this scourge of the human race, amounts, in London, to nearly a decimation of the inhabitants; or to about one tenth, or one twelfth. It is equally or oftener much more fatal throughout the torrid and frigid zones; and in the adult age is more violent than in childhood. It attacks the same person but once in life: had this not been the case, the human race must long since have been extinct. On a promiscuous average, one of every seven infected die of the natural disease; but under inoculation only 1 of 500. Besides, to the former deadly catalogue may be superadded a frightful train of mangled constitutions and countenances, of consumptions, abscesses, ulcers, opthalmias, blindness.

In every large metropolis, small pox is an annual epidemick. In country towns and open districts, its invasions are more distant; at uncertain intervals of some years, when numbers contiguous are attacked at the same time. In our climate, it is alledged to be most prevalent in spring and autumn. Very few of the human species escape the small pox, especially in populous cities and towns, wherein there is always lasting variolous fuel, or, lurking embers: a wooden horse with ferocious foes in ambuscade, tolerated within their walls, rioting in human slaughter, and infantile immolation. It might easily be demonstrated, that in London, and probably in all other large cities, variolous ravages are principally amongst children under five years of age. Without entering into any elaborate argumentation, or proofs of this assertion, the reader may, in some degree, be convinced, by only turning his eye to the first Chart, and to a small table of London mortality during ten years; wherein he will observe the trifling annual mortality in the interval between 5 and 20 years; before which last period, a mere handful of the native progeny of the metropolis can be supposed to have escaped an infection with which they are constantly enveloped. It is obvious that the total annual mortality by all diseases, inclusively, in London during this adolescent period of life of 15 years, is not equal to variolous carnage singly. As to inoculation, or artificial engrafting of the contagion, it is throughout the greatest part of Europe a modern practice of the present century, and is yet in its cradle. Even in the London small pox hospital, since its first institution, forty years ago, there have not been inoculated altogether 25,000.

The cruel carnage perpetrated by small pox throughout the earth; the rooted prejudices, and the insinuations urged to shackle the universal benefits of inoculation, and which pervade not only the ignorant mass of the community, but also the generality of the medical profession throughout Europe, would abundantly excuse and urge me to be more diffuse on this interesting and litigated topick. But having, some years ago, published a small Essay on Inoculation, and having now nearly finished a general treatise on the natural and inoculated small pox, I shall postpone the result of much reading and reflection to that republication. An acquiescence in neutrality or indifference, where it can be proved to mathematical demonstration that myriads of lives might be preserved, which are now sacrificed, would, at least in a moral sense, constitute an accessary in criminality.

Small pox, or variolæ, have been properly discriminated into several species: the distinct and confluent, or benign and malign; the crystalline, lymphatick, warty, petechial, and hemorrhagick; the inoculated; the spurious. The principal differences between small pox consist in the period of eruption, the number and form of the pustules, the quantity and state of the fluid contained in them, and the contumacious perseverance of the fever. The progress of variolous fever has been divided into four stages, that preceding the eruption; the eruption; the suppuration; and the exsiccation of the pustules. The first visible effects of the contagion and fever are nausea, vomiting, soreness at the stomach, drowsiness: before the eruption infants are prone to startings, and some even to epileptic fits; adults to sweats. The second stage of eruption is, from three to four days, from the first attack, of small red spots or pimples on the skin, resembling flea-bites, in number and quantity extremely various; from one or more, multiplied to many hundreds. The eruption is commonly first on the face, spreading gradually over the body and extremities, and is compleated about the fifth or sixth day from the febrile commencement: and on this eruption, the fever abates or subsides. In the third stage of maturation the pimples increase daily in size; are elevated into prominences inflamed at the base; and the suppuration is compleated between the eighth and eleventh day from the first attack: the pustules then detached from each other, have risen into small boils, the size of peas or larger, turgid with pus, gradually becoming opake, yellowish, and tenacious. In the fourth stage the pustules shrivel or burst, oozing out part of their contents, and a superficial incrustation is formed, which, after some days, together with the shrivelled pustules, scales off, leaving the subjacent skin of a brown red colour. This is the mild form of the disease; but we are next to describe it under more dangerous and fatal forms.

In the Confluent small pox, the revolutions are the same, but the symptoms more exasperated; the vomiting and the eruptive fever violent, frequently with coma, or delirium. The eruption protrudes earlier; on the second or third day, in congregated clusters, like measles, and more numerous on the face; the fever does not then subside, but increases towards the fifth or sixth day, and continues throughout the disease. The swelling of the face is commonly earlier and more severe: and both in confluent and distinct, when the pustules are numerous on the face and fauces, there is soreness and inflammation of the throat, hoarseness, and difficulty of swallowing; and about the eighth day, the eye-lids are closed up with temporary blindness. On the face, especially, the pustules are small, less elevated, coalescent; and it is often covered with a universal flat vesicle: the fluid is whitish or brownish, not yellow and tenacious, or of due maturation and concocted purulency. The pustular interstices, if any, are pale and flaccid. The facial intumescence subsides about the tenth or eleventh day: and during these stages of fermentation and depuration, a salivation commonly ensues, especially in adults; and in infants a diarrhœa. About the fourth stage the fever, called secondary, is often renewed with considerable vehemence, and with various duration and event. In the latter stages the pustules excite intolerable itching of the skin, and, if not prevented, incessant scratching and cutaneous denudation: the breath, exhalations and excretions are then offensive to the smell. In the mild distinct, the pustules commonly begin to dry on the ninth day, and continue to the fourteenth in a process of exsiccation; but in the confluent, this stage begins about the eleventh day.

The following are all unfavourable omens in small pox: Sudden and premature eruption of pustules. In this first stage, infants, especially before dentition, are sometimes snatched off in epileptick fits. The more small pox appear in the confluent, or in the distinct form, they are more or less perilous. It is only where the distinct are crowded with pustules on the face; or accompanied with fever and putrescency; or with pustules warty and lymphatick, that they are dangerous. Or, a natural mild small pox may be rendered malignant from confined air, heated room, and regimen. In the catalogue of unfavourable symptoms, are the fever continuing pertinaceous; and with putrescency it is still more dangerous: the pustules not sufficiently filled and distended, hard, or warty, or not filled with maturated pus; the top of the pustules depressed; pale interstices at their base; sudden retrocession or subsidence of the pustules during the stage of maturation: severe inflammation of the fauces; difficult deglutition; severe pain at the stomach. The secondary fever arising commonly about the recession and exsiccation of the pustules, or ebb of maturation, is the most dangerous period of small pox. The variolous crisis then is generally by diarrhœa, or turbid urine, or both conjointly, or by salivation. It is evident that, as the cutaneous pores are blocked up, the absorbed, and other floating pus, must be defecated by some grosser excretory. Additional symptoms of alarm, especially in the confluent, are, if the suppurating stage of the fever continues severe, the salivation ceases, and the hands do not then swell. When the putrescency is virulent, the disease sometimes proves fatal in a few days; but in most cases on the eleventh, and sometimes not until the fourteenth or seventeenth. Fatal symptoms of putrescency are petechiæ, and bloody pustules; putrid urine and stools; tumid emphysematous abdomen.

Inoculated Small Pox. Between seven and nine days, some slight fever succeeded by an eruption of pustules; in general not numerous, and the patients are very seldom confined to bed, or indisposed. In ninety-nine cases out of an hundred, inoculation produces a distinct small pox, void of danger. After inoculation from the maturated pustules of real small pox, and the usual symptoms of impregnation, mankind are ever after invulnerable by this contagion.

Chicken Pox. Bastard or spurious; and distinguished under the apellation of petite verole volante, stein pox, and swain pox. They are sometimes epidemick, but inoffensive; and have given rise to the supposition of a person’s undergoing the natural small pox a second time. The eruption forms very quickly into pustules, of which the pus is not concocted, nor tenacious; and after three or four days, incrustations.

_Measles._ Morbilli rubeola. From 100 to 120th part of the community seem to be destroyed by measles. Morbillous mortality is to that of small pox in the ratio of one to ten or twelve; and consequently may be estimated at one of seventy-seven whom it attacks. Sydenham, long ago observed, that measles, if judiciously treated, are attended with very little danger; but he should at least have qualified the expression, by adding immediate and considerable danger; for both immediately, and in their future consequences, they are by no means so innocuous. Few escape this exotick contagion, especially in childhood and in cities. It attacks the same persons but once in life; and, with us, is said to be most epidemick in winter.