Chapter IX: Part 9

_Irregularity of the Lochia_, comprehending excess, obstruction, and suppression. After delivery, there is generally a gush of red blood, from about a half to two pounds. The mother is then weak and infirm, from the fatigue and efforts of parturition; from the great evacuation and diminution of the womb and abdomen; from the loss of blood; from the agitation and anxiety of mind; and from the increased irritability: and, according to certain states of the air and seasons not yet explained, women are then more than at any other time prone to fevers. In most cases the placenta is expelled in ten, twenty, or thirty minutes after the infant. Afterwards, the orifices of the uterine vessels continue to discharge red blood, which gradually becomes thin and serous, and even in some degree purulent. This discharge named _Lochia_, is various in duration and quantity, from two to ten ounces daily, and, gradually decreasing, in about ten or twenty days is dried up; nature having then restored the womb to its natural size: and at this stage all immediate puerperal danger is escaped. Sometimes there are great variations in the lochial duration in different women: in some, they cease after a few days; in most, after two or three weeks; and in a few others, not until after one or two months: the duration and quantity being varied by climate, season, constitution, mode of life, and state of the breasts. Lochial excess is determined more by the morbid effects than the absolute quantity; such as weakness, paleness, dejected countenance, feeble voice and pulse, fainting, convulsions. Or in its consequences it may more slowly sap the pillars of health, and occasion consumption or dropsy. Obstruction and suppression of the lochia is much more frequent and dangerous than excess. Most of the usual complaints after delivery, says Smellie, originate from obstruction of the lochia, or of milk: the former is accompanied with pain of the back and loins, pudenda, and groins; heat, shivering, hard quick pulse, restlessness; sometimes colick and diarrhœa, and difficult oppressed perspiration.

_Inflammation of the Womb_ begins generally between the fourth and ninth day after delivery, and commonly with retention of the lochia: with fever, heat, and pain about the uterine region, elevation and hardness of the abdomen below, with tenderness and acute sensibility on pressure, irritation to urine and stools, colick, intense headach, strong full pulse. The whole, or different parts only, of the womb may be inflamed, whence the contiguous viscera of the pelvis will be differently affected. Where the inflammation is not violent, the crisis is about the fourth or seventh day from the attack; but if severe, may be protracted to the ninth, eleventh, and fourteenth, and be then discussed with some sensible evacuation, by perspiration and sweat, urine, diarrhœa, lochial discharge, or current of milk from the breasts; or may terminate fatally in gangrene, delirium, and convulsions.

The predisposing and occasional _causes_ of irregularity of the lochia, and of uterine inflammation, are, of Excess, grumous clots of blood in the womb; violence done to the womb during parturition; retention of the placenta, or part of it; great weakness; passions of mind; a second child; spasm; repulsion of milk from the breasts; too early and violent motion or walking about; diseased state of the womb; inverted womb; errors in food, drink, passions of mind, excretions, &c. Of Obstruction and Suppression; clots of blood in the vagina; cold admitted to the naked body, either externally or internally; cold rooms, cloaths, and drink; obstructed perspiration; impure air and close heated rooms; passions of mind; hystericks; errors in the non-naturals, diarrhœa. Of inflammation of the womb, suppression of the lochia; external violence; falls; rude extraction of the placenta; morbid adhesion of the placenta; miscarriage; too tight bandages round the belly: its termination is by discussion or gangrene.

_Puerperal Fever_, or Peritonitis, commonly alledged to be peculiar to women after delivery, has been dignified by the moderns, from its danger and fatality, with a generic name: happily for the fair sex, it does not often occur: sometimes it is epidemic, from some unknown quality of the atmosphere; and in such circumstances a considerable number of puerperal women are afflicted at the same time. It generally attacks one or two days, but sometimes a few hours after delivery; and rarely later than the sixth day. The assault is sudden and violent, with shivering, headach, especially in the temples and eyes, giddiness, nausea, sickness of the stomach, and vomiting of bile in large quantity, pains darting through the lower region of the abdomen, and reaching up to the stomach, with extreme sensibility and tenderness, on being pressed with the hand, or by coughing or vomiting: the pain is felt between the stomach and navel, and is higher than in the inflammation of the womb; there is unusual languor and weakness, anxiety, oppression, and load of the spirits, impaired strength, so as not to be able to render themselves any assistance in bed; no refreshing sleep, sometimes delirium; the pulse is always extremely rapid, but various in strength during the revolution of the febrile paroxisms, that is, of the cold and hot fit. When the vomiting abates, it is succeeded by a profuse diarrhœa, accompanied with colick, tormenting gripes, tenesmus. In some, the abdomen begins to swell early. At the beginning the symptoms have an inflammatory appearance; but after a very few days change undisguisedly into the nervous and putrid type, and sometimes with miliary eruption. Often neither the lochial discharge, nor the milk, are interrupted; and it has been observed to ensue even after easy labours.

The puerperal Fever will be affected and diversified by different constitutions and temperaments, whether robust, plethoric, or delicate; by the quantity of the lochial discharge, the putrid atmosphere in the sick room, the medical treatment, the state of the atmosphere and seasons, and morbid quality of the prevailing febrile epidemick. Between five and fifteen days terminates the event in recovery or death. It is always most fatal when most epidemick, and the sooner it attacks after delivery. In some of our London hospitals, one half of the women ill of this fever have died; in others, one of seven. The crisis by discussion is followed by diarrhœa, by a serous or purulent transudation from the omentum or mesentery, into the abdomen; and from this cause sometimes consumption and dropsy. Some, even after a favourable crisis, have recovered slowly. When gangrene is the direful event, it is commonly within four or six days from the attack, and is known by the usual symptoms.

The predisposing and occasional _causes_ are, a peculiar noxious constitution of the atmosphere; errors in the non-naturals; anxiety of mind; hot cordial regimen; heated unventilated rooms after delivery, and impure air; hence miliary eruptions and profuse sweats. The immediate cause is generally ascribed to inflammation of the omentum, mesentery, or peritoneum, and the sudden contraction of the womb after delivery, dragging and tearing down with it these membranes. But it merits the most serious and mature investigation, whether to employ the remedies accommodated to inflammatory, or to nervous and putrid fever. We know that purulency in the abdomen and thorax is likewise found in the putrid fever of the West Indies.

_After-Pains; Weed, Milk-Fever; Inflammation of the Breasts_, are far less formidable foes than the preceding. After parturition, women are sometimes afflicted for some days with pains resembling colick; both in torture and severity extremely harassing. The _causes_ are, the continued and sudden contraction of the womb towards its natural dimensions; fragments of the placenta or membranes, or of clotted blood in the womb; injuries done to the fibres of the womb during parturition; violent extension of the suspensory ligaments; inflammation and irritation of the womb, or its neck: tender state of the intestines; flatulence; flatulent food; suppression of the lochia; errors in the non-naturals; a second child. Weed, or ephemera, sometimes occurs, and is the most simple and innocent species of fever; it is preceded by lassitude, slight wandering pains; a succession of shivering, heat and sweat, resembling an intermittent paroxism; and in the space of a few hours, or at the utmost days, the fever disappears. The causes are some errors in the non-naturals. Milk fever: during pregnancy and parturition the breasts sympathize greatly with the womb. This natural fever begins three or four days after delivery, with shivering and heat, pain, distention and throbbing of the breasts, shooting to the armpits, restlessness; after twenty-four hours, commonly terminating by sweat, diarrhœa, eruption of milk: the usual quantity of this nutritive fluid is from two to three pints daily. In the preceding puerperal stage, inflammation of one, but rarely of both breasts, is a frequent affliction, varying in degree and severity: its symptoms are local redness and swelling, burning heat, extreme tenderness, throbbing; and is terminated by discussion, frequently by suppuration; sometimes by scirrhus. The _causes_ are impetuous rush of milk to the breasts; excess of milk; not suckling; milk obstructed in the breasts or lactiferous tubes; suckling too soon; obstructed lochia; cold and obstructed perspiration.

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_Infant diseases_ every where furnish a vast supply to the gloomy realms of Pluto; and this calamity is infinitely aggravated by the noxious atmosphere of cities and towns. At birth, an infant is not only ushered into a new world, but every function of its frail body undergoes new and sudden changes. From the human oven of 96 degrees of heat, it is launched into a variable climate of heat and cold. A new element of many thousand pounds weight then presses upon the surface of its body. This atmospherick fluid, adulterated in cities with innumerable impurities and feculencies is drawn into its lungs: its diaphragm and muscles of respiration then begin to act, the lungs expand, and the respiration commences. The passage between the auricles of its heart and arterial duct are gradually closed up; the sphere of the circulation is extended; the whole current of blood in its frequent revolution hourly, passes through the lungs; the circulation through the navel-string, and through which it had till then drawn its principal nourishment, instantly ceases: food, for the first time, begins to be taken in by its mouth; the digestive, with all the numerous secretory and excretory organs, then begin to perform their different offices; the tender creature is exposed to sounds, in a few days to light; the bones at the superior part of its head gape, and the brain is there defended by skin only; its head, belly, liver, and lymphatic glands, are large, and its extremities slender; the fetal brain is destitute of ideas; its bones are little more than gristles and cartilages; its muscles are soft, flabby, and without swell or expression; the greatest part of its time is spent in a state of inactive vegetation; it is unable for several months to support its own weight, or to take nourishment, and is then the most feeble and helpless of all the animal creation. With such delicate machinery, it has soon to encounter pain and disease; the assaults of internal and external enemies; when its crazy beams and bolts are easily shook asunder in the first storm.

The acute diseases of early infancy; that is, under two years of age (small pox, measles, and a few others excepted) are in the London registers, principally accumulated into two aggregate heaps, _Convulsions and Teething_: the former of which forms a dreary catalogue of astonishing magnitude in London funerals; amounting to nearly one third of the whole mortality in the metropolis. But convulsions and teething are terms too indefinite. Every infant disease, not immediately obvious to the senses, is thrust into these two articles by the ignorant reporters. If we consider the term scientifically, convulsions, in multitudes of cases, convey no more intelligence of the nature of the disease, than if they had said the child died from want of breath. Let us therefore examine, whether the collected observations of medical authors will not illuminate many dark and defective parts of the publick registers, respecting infant mortality. Infants are exempt from a multitude of the acute and chronic diseases of adults: they rarely suffer so early in life from hereditary diseases, cares, passions of mind, painful impulses of retentive memory, severe study, intemperance, hard labour, the inclemency and vicissitudes of the seasons, and so on. The principal diseases of infancy may be comprehended under the following: convulsions, inward spasms and tetanus, colick, vomiting, acidity, indigestion, flatulence, diarrhœa and gripes, thrush, dentition, hectic fever and atrophy, rickets, scald head, rash, dropsy of the head and spine, inguinal ruptures; together with small pox, measles, hooping cough, worms, and a few others already described.

As infants cannot by speech express their pain, we are too often under the necessity to guess at their complaints by physiognomy, gestures, and dumb signs: these are principally manifested by nausea, indigestion, vomiting, flatulence, refusal of food, or the breast, diarrhœa and its different colour and consistence, restlessness, cries, shrieks, agitation and contraction of the lower extremities, disturbed sleep, injured respiration, cuticular eruptions, pustules, and ulcers. In infancy the pulse and urine are precarious symptoms: their arterial pulsations in fevers are sometimes so rapid, that the most minute divisions of time in horological instruments, cannot keep pace with them.

The general _causes_ of Infant Diseases and mortality may be referred 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.

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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.

Commonly after four or five years, or towards puberty, the cervical ulcers finally close, leaving behind indelible scars. This entailed alloy is often the source of bad health. Sometimes the eyes or eyelids are particularly afflicted with scrofulous ophthalmy. In other cases it excites tumours, deep seated abscess, anchylosis, and caries in various joints of the elbow, fingers, knees, feet; or stubborn ulcers in different parts: and still more deleterious consequences ensue from scrofulous glands of the lungs or mesentery terminating in phthisis, or hectick. Some nations more than others, are afflicted with scrofula. I have read that it is not frequent in tropical climates; and it is not contagious. The predisposing and occasional _causes_ are hereditary: diseases of the lymphatic glands; consequence of small pox: whether it is more prevalent in some countries than others from the air, water, diet, or other causes, is not yet ascertained.

_Leprosy._ A considerable part of the Mosaical code, politically and medicinally, is pointed against this disease. It is now, in a great degree, eradicated and worn out of Europe. After the Crusades, in the twelfth century, Europe was overspread with this hideous judaical scurf, imported from Palestine. Lazarettoes for the confinement of the unclean, were then numerous in many kingdoms: in France alone there were two thousand. At present, in the cold northern island, Iceland, a sort of leprosy is congenial to the natives, from their diet, climate, and mode of life. And in the history of the late discoveries in the Pacific Ocean, we read of a leprous scurf infesting the natives, from their excessive indulgence in a hot spice amongst their food. In our island, at this day, a considerable number are afflicted with a disgusting cutaneous scurf; but greatly inferior in virulence to the Asiatic leprosy. The absolute mortality in the London bills by this disease, is almost undeserving of notice.

TO THE READER.

We must here abruptly, and with regret, but for obvious reasons, the size to which this Publication is already swelled, cut off the remainder of our comments, amounting to nearly one hundred pages more. Those left behind unnoticed of the last group, comprehend most of the chronic cutaneous diseases, the subjects, peculiarly, of the Cosmetic Art. Through the last group of external accidents and diseases, I meant to have persevered in my general plan. For instance, under Gangrene, I should have discriminated the ages, mortality, cures; and at the same time, that originating from external injuries, or surgical operations, and that from spontaneous corruption. Under Fractures, I should have gauged the success and miscarriage of amputation, both after sudden accidents, and in consequence of chronic diseases. This is a most important part of military surgery, and I believe, in a great measure, unexplored. From the trepan and lithotomy, I should also have stated the blanks and prizes. With the surgical group I am obliged to omit the casualties of London: one alone of which I could not entirely postpone, without introducing a few observations in this place, that is the Executed.

_Executed._ Murder, robbery, sedition, and war, are amongst the principal political casualties, chronic distempers, fevers, and frenzies of every nation. In ascertaining the numbers executed, particularly, the London bills of mortality are shamefully erroneous and defective. As I thought it a casualty of infinite importance to be exactly stated and recorded, I made numerous efforts to procure authentic information, by successively and repeatedly waiting upon the Keeper of Newgate, the Clerk of the Arraigns, the Clerk of the Peace for the County, the Town-Clerk of London, the Sheriff’s office of London, and the Secretary of State’s. Throughout this inquiry I was every where treated with liberality and urbanity; and where there was any prospect of information, was permitted access to the records. But, to my astonishment and mortification, I could not find any vestige of records of executions in London before 1754. These were in the Clerk of Arraigns’ office, but were buried in a heap of extraneous law rubbish; and to extract which, the Clerk of the Arraigns told me, it would require three entire days for myself and one of his clerks. I called twice at the Old Bailey, anxious to undertake this task, however laborious; but it so happened, that at both times they were full of business in the office, and could not spare time, nor even room, for my inquiry. By other means, I have come near part of the truth. (_Vid._ CHART.)

The two first columns, from 1732 to 1762, are formed from an average of executions, during twenty-two years of that interval, by Sir Theodore Jansen, Chamberlain of London. The last column, of fifteen years, is formed from an average of the last seven years, with which Mr. Akerman politely furnished me, from his books. In consequence of the riots and conflagration in 1780, his records were all consumed, and do not include that year, wherein there was a notorious glut of executions. During the seven years, beginning with 1781, the executed in Mr. Akerman’s books were 439. But every one knows that there are two theatres, a great and a small one, appropriated for human slaughter in this metropolis; these are Tyburn, now removed to Newgate; and for the large Borough of Southwark, Kennington Common. I took a low average of the executions in the latter, allotting three annually, to the two first columns, and six to the last column, and added the whole together. Amongst the London malefactors there are a few pirates, whose crimes are cognizable in the Admiralty Court.

Two thirds, probably, of all those capitally condemned, are afterwards pardoned. Few, comparatively, of the executed have committed murder, not one in twenty; most of the rest are for robberies of various kinds. Many more are reported as murdered in the bills of mortality: but these are not cases of premeditated and malicious homicide, and are softened into manslaughter on trial. Nineteen out of twenty of the executed are males; and by far the greatest proportion between eighteen and forty years of age. What is the proportion of London executions to the whole nation, is a problem which perhaps our judges cannot unravel. They possibly, like the generality of physicians, drive and strut away, “secundum artem,” in the beaten rotine of their profession, without ever attending to a plain political and mercantile axiom, to state their transactions and accounts in numbers and figures. Vice and executions are universally more prevalent in every metropolis: but there is reason to believe, that at present the executions throughout Britain and Ireland, are double or treble to those of London. The comparative population is as nine million to six hundred and fifty thousand. If they are treble, then 4000 are executed every fifteen years in the two islands; and 26,000 in a century: and both the disease and panacea are rapidly increasing. Five or six times this number are, in the same period, transported to distant regions, and partly also lost to the community, together with their blighted procreation.

We are struck with horror even on reading the history of savage jurisprudence, customs, and butchery of mankind in ancient times; such as the sanguinary codes of Draco and other regal monsters; the sacrifices to idols; the martyrs to gloomy fanaticism; the brutal spectacles of the Romans, wherein gladiators, lions and tygers, were exposed to tear each other to pieces. But I doubt whether, in the most flagitious and facinorous ages of Rome, the Tarpeian rock was besmeared with the blood of such a multitude of human victims; or that in any part of the globe, from London to the Antipodes, out of an equal proportion of mankind, there are so many sacrifices annually made to violated jurisprudence; and to the modern idol, property and money! I meant to have contrasted the executed with those destroyed in wars, by the sword of the enemy (exclusive of diseases) during the present century; but the introduction would be here premature; nor could I launch out in sufficient illustration.

Besides the political patients doomed to the radical cure, or extermination, by the executioner, if we may credit one of our best writers, they are a mere handful compared to those who are consigned to a slow and lingering death. Dr. Johnson, in one of his excellent essays in the Rambler, against perpetual imprisonment for debt, calculates, that half a million of mankind are destroyed in a century in the prisons of Great Britain, by the complicated horror of confinement, sorrow, famine, filth, and disease; and to these I would add suicide. I am inclined, however, to believe, that Dr. Johnson’s computation is exaggerated, by at least four hundred thousand. By far the largest proportion of these are unfortunate sacrifices to poverty and misfortunes, and to the callous vindictiveness of avarice. In the juridical pharmacopœia, this may be compared to the hot iron and cautery of the coarse empiricks of antiquity; with which they outrageously and indiscriminately tortured their patients. It would not disgrace the christianity or humanity of our legislature and lawyers, were they to revise their catechism and breviary of jurisprudence, both as affecting life and liberty: or, throwing religion and humanity to one side, let the question be tried by commercial scales; and, like the Venetian Jew, human flesh estimated in ounces and pounds with brutes, metals, and chattels!

_Of the Institution of the London Bills of Births, Mortality, and Diseases; their Defects, besides those already pointed out; important and easy Improvements recommended._

We shall now, with all possible brevity, enquire into the degrees of credibility and stability of the mathematical and medical data, furnished from the bills of mortality. The births, genealogies, procreation, multiplication, and deaths, of those few miracles of longevity, from Adam to Noah; from Noah’s descendants down to Abraham, Moses, and Christ, are recorded in scripture: some chapters of Genesis are plain registers of births and mortality. The male Israelites, above twenty years of age, were, at distant intervals, mustered and numbered by Moses and his successors; and in a few uncommon pestilences, the devastation is ascertained in the Jewish history. The descent and pedigree of kings, and other great men, have also been kept in most nations, who had made any progress in civilization: but general annual registers of births, diseases, and deaths, are modern establishments, and were unknown to the ancients.

On the continent of Europe, registers were instituted fifty or a hundred years before their introduction into England. In 1538, exact records of weddings, christenings, and burials, were first ordered by the King and council, to be kept in every parish church of England, by either the vicar or curate. But this order was very negligently obeyed in many parishes, until 1559, when, to prevent registers from rotting in damp churches, they were directed to be written on parchment. At first, they seem, both in Germany and England, to have been designed to prove the birth, death, and descent of individuals, and the right of inheritance in property or lands. In 1592, a year of pestilence, bills of mortality for London were instituted; but were discontinued until 1603, another year of pestilential desolation; which was the only distemper then taken notice of in the printed reports. In 1626, the different diseases and casualties of those who died in London, together with the distinction of the sexes, were added and published; and in 1728, the different ages of the dead were ordered to be specified in the London bills. Upon first establishing the distinction of diseases and casualties in the bills of the British metropolis, the primary intention seems to have been, to distinguish the numbers destroyed by the plague, and to detect concealed murders.

Public records of births and mortality are now partly become the rules of political arithmetic: but unfortunately for politicians, calculators of annuities, and medical men, they are yet every where far too incorrect and incomplete. Registers of diseases and deaths in London are entrusted to old women, two of whom are nominated in each parish, and called Parish Searchers, and who consider, the ultimatum of their commission is merely to prevent private funerals and concealed murder. The whole business in London is conducted in the following manner: Upon either being sent for to inspect a corpse, or on hearing the bell toll, and inspecting the books kept in the different churches, the searchers are apprised from whence notice has been sent of a death, in order that a grave may be opened. The two parochial matrons then, whose industry is stimulated by a small fee on each corpse, and whose report is necessary previous to interment, set out to examine that no violence is committed upon the dead, of which they have taken an official oath to make true declaration, and afterwards negligently enquire from the relations the name of the disease, adding the age and sex: or sometimes they are stopped in the hall, and dismissed without any scrutiny. These records, together with the christenings, in the latter of which the searchers have no concern, are deposited with the respective clerks of each parish church, and by the clerks the christenings of the established church, and the burials in their respective parochial church-yards alone, are carried once every week to a general hall in the city: on the following day the weekly bill, comprehending these partial returns, is printed and published; and at the end of the year a general bill, in which all the weekly returns are consolidated.

The law ordains, that every person who dies in the registered parishes of London, Westminster, and Southwark, is to be inspected by two parish searchers, and reported to the parish clerk, who then grants his certificate for the interment: or, if the corpse is carried away to a different parish of the metropolis for interment, the searchers report, and the clerk’s certificate, are equally necessary; otherwise that parish where the corpse is buried is liable to a fine. This process was originally intended to detect the plague, and concealed murders; in both which respects, during the present century, the parish clerks and the searchers have been almost useless. There is now no plague to detect; there are very few murders, and they are always proclaimed by some other means. Even in the preceding century, when the plague raged in London, the searchers report was rarely trusted without a physician or surgeon attending, to prevent mistakes.

Notwithstanding this ceremony of inspection by the searchers, and of making their reports to the parish clerk, it does not hence follow, that the clerk makes the return of the death to the general hall, _unless the corpse is buried in his own ground, or parochial church-yard_. If the corpse is carried to any dissenting ground, and to various other places of sepulture not within the bills, the death and disease is so much waste paper, and is never heard of amongst the burials. But if the corpse is carried to a different parish, together with a certificate, and such burying ground is registered within the bills, then the death and disease is returned to the hall by the clerk of that parish where the corpse is interred.

I made it my business to visit, and to converse with a variety of parish clerks in this metropolis, most of whom agreed with me, that, besides radical defects in the christenings and burials, there were many other gross omissions. One instance I shall mention, and many more might be collected. The parish clerk of Bethnal-green, in which are also three private madhouses, made no return to the general hall, during the year 1780, of either births or burials, and in the preceding year he returned only four burials: whereas in former years, this parish alone annually returned from three to five hundred burials. I was assured, that the company of parish clerks in their corporate capacity, even if willing, have no power of compulsion over any of their refractory and negligent members, to make regular and correct returns: it seems almost optional. It is obvious what flagrant discordance and error this must occasion in various calculations.

Exclusive of gross mismanagement and error from searchers and parish clerks, there are other inherent defects in the London registers, both of burials and births. They comprehend the births alone of those belonging to the established church, and the burials of such only who are interred in the registered parochial church-yards. Jews, Quakers, Papists, Protestant Dissenters of various sects, are not included in the annual christenings; and great numbers of their burials, and of the burying-places not only of the dissenting, but likewise of the established church, are omitted: of the former 32, and of the latter 35, according to Short’s list. Maitland, 1729, (see his History of London) discovered 181 religious congregations, whose christenings were not published, and 63 burying-places in and contiguous to the metropolis, wherein 3038 were annually buried, but excluded from the registers. The large modern and populous parishes of Pancras and Mary-le-bone, in one of which also stands the Foundling Hospital, are omitted in the annual bills. Six hundred abortive and stillborn, who have arrived at an age thought deserving of funeral, are added to the annual deaths, but omitted in the list of births; as are also many young infants who die before baptism.