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.